Celiac Disease or Gluten Intolerance?

When people are experiencing nutritional deficiencies, anemia, weight changes, and/or other symptoms that seem to be of an unknown origin, it’s fairly common practice for doctors to rule out the presence of celiac disease with a small intestinal biopsy. While this is certainly considered the “gold standard” for identifying the pathological changes associated with celiac disease, many experienced physicians are finding that patients can still have a sensitivity to gluten containing grains, making celiac disease and gluten intolerance separate entities altogether.  This led experts at the recent International Celiac Disease Symposium to define the term gluten insensitivity for patients who don’t meet the criteria for celiac disease or wheat allergy, yet improve dramatically when following a gluten-free diet.

The incidence of Celiac disease has doubled since 1974, and gluten sensitivity alone is estimated to be 6 times the prevalence of celiac disease. Fortunately, for patients and doctors who have recognized this phenomenon for quite some time, there is finally a more established definition of gluten sensitivity. Some of the criteria being used to separate gluten sensitivity from wheat allergy and celiac disease include: Negative testing for the presence of IgE antibodies to wheat; Negative endomysial and ttg antibodies (typically present with celiac disease); Negative small intestinal biopsy; Resolution of symptoms following as gluten-free diet. Researchers have concluded that the genetic makeup and immune response of gluten sensitivity patients is unique, and may be more enzyme mediated (like lactose intolerance), rather than immune based.

Since objective testing is still lacking, people who are symptomatic should consider implementing a gluten-free diet. Some of the most common symptoms associated with gluten sensitivity include abdominal pain, rashes, headaches, “brain fog”, fatigue, depression, anemia, and joint pain. If your doctor tells you that celiac testing is negative, don’t give up hope!

 

Gluten and the Nervous System

This is something my colleagues and I have been familiar with for quite some time, but a new report published in the Lancet Neurology demonstrates further proof that an intolerance to gluten containing foods can cause much more than just digestive symptoms.

Sensitivities beyond celiac

“Celiac disease is only one
aspect of a range of possible manifestations of gluten sensitivity. In
some individuals, gluten sensitivity is shown to manifest solely with
neurological dysfunction,” the authors of the new report explain.

Neurological
disorders that might be tied to a gluten sensitivity include a lack of
muscle coordination leading to instability (ataxia), tingling and
numbness (neuropathies), and migraine-like headaches (encephalopathy).
The authors go on to say that the tests that help to establish a
diagnosis of celiac disease may not reliably show if a person has a
gluten sensitivity that affects only their nervous system. For this
reason, they suggest other tests that may help uncover a hidden gluten
sensitivity in people suffering from certain neurological disorders.

The
report’s authors recommend, “To improve diagnosis rates, the perception
of physicians that gluten sensitivity is solely a disease of the gut
must be changed.”

If you think you have a gluten sensitivity


Get medical support. Identifying and treating a gluten
sensitivity can help you avoid serious complications.

Be
proactive
. Ask your naturopathic doctor if he or she is familiar with the tests
that are useful for identifying different types of gluten sensitivities,
or if he or she can refer you to someone who is.

Pay
attention
. If you think your symptoms might be related to gluten,
consider a six-week gluten-free diet trial. If you’re going in for lab
work, though, eat your normal diet so your test will gauge your regular
reactions.

Living with a gluten sensitivity

Gluten
sensitivity is in the spotlight, so there’s never been an easier time to
go gluten-free. New food packaging requirements mandate that
gluten-free foods be accurately labeled, and gluten-free cookbooks
abound on bookstore shelves. Ask your grocer whether they can recommend
books, recipes, and other resources to help.

(Lancet Neurol
2010;9:318-30)