Dear Dr. Peg,
I have had diarrhea and constipation off and on for a year. My doctor thought it might be irritable bowel syndrome. I also have headaches and joint pain, and I read online that it might be Celiac disease, so I cut gluten from my diet for a while, and I felt much better. But a gluten-free diet is hard to keep up. Could this be Celiac disease, and is there a test to confirm it?
-Gluten Girl
Dear Gluten Girl,
Yes it could, and yes there is.
Lest you fear you are alone, know that one in 100 Americans has Celiac disease, also known as gluten intolerance. That comes out to about 3 million people and qualifies as a common condition. The word “celiac” comes from the Greek word for bellyache, which is the classic symptom of this disease.
People with Celiac disease cannot tolerate gluten. Gluten is a protein that is found in wheat, rye and barley. It is what makes bread doughy and elastic. It is everywhere, not only in the obvious places like bread, but also in some cereals, cheese spreads, chocolate milks, dried fruits, and other foods. It can also be found in surprising places like medicines and cosmetics.
The problem is a genetic autoimmune one.
It is more common in Caucasians, women and relatives of those with Celiac disease. Some people have symptoms starting in childhood. Others don’t have problems until adulthood, when the disease might get triggered by a stressful event like surgery, pregnancy, a
viral infection or emotional stress.
When a Celiac person eats gluten, their
intestines react by creating an inflammatory immune response. This response causes damage to the intestine, and makes it unable to properly absorb nutrients. This results usually in bloating and diarrhea.
Because it causes a general absorption difficulty, gluten intolerance results in many other problems. If your intestine cannot absorb iron, you can become anemic. Calcium malabsorption can lead to osteoporosis. General nutrient malabsorption can lead to poor growth in children, or unexplained weight loss in adults.
There are even some cancers, like lymphoma and intestinal cancers, that are more common in untreated Celiac disease patients.
For reasons that are not yet clear, this condition can also cause symptoms that are seemingly unrelated to the intestine. These include canker sores, headaches, joint pain, discolored teeth, tingling and numbness, infertility and an itchy skin rash.
Most people do have intestinal symptoms, but not all. This puts Celiac in the mystery weird disease category in my book.
The typical intestinal symptoms are what usually bring sufferers to their doctors, where diagnosis, unfortunately, might not happen right away. Gluten intolerance may be common, but not as common as run-of-the-mill viral diarrhea or even irritable bowel syndrome, so sometimes it gets missed for a while.
Feel free to suggest it to your doctor if you think you might have it.
Gluten intolerance diagnosis starts with a blood test for antibodies to gluten followed by a biopsy of the small intestine. If one or both of these tests come back positive, the diagnosis is made, and gluten goes off the menu.
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The treatment for Celiac disease is simple but far from easy.
Avoid gluten. This is harder than you might think. As I mentioned above, that stuff is everywhere, and even a little bit can cause a problem. For example, some products contain oats, which are usually safe for Celiac folks. However, some oats are harvested and processed in a way that causes contamination of the oats with wheat, and even the small amount of gluten that results from this contamination can be a problem.
Nobody knows how much gluten is safe, and Celiac sufferers have to avoid gluten for the rest of their lives.
Once gluten is cleared from the diet, the intestine returns to normal, the antibodies disappear, and all is well in most cases. Usually vitamin and mineral supplements are recommended, as is monitoring for bone density and general health.
As awareness about this condition grows, you can find more gluten-free products marked and marketed on the shelves at stores and even on restaurant menus. Websites offer information about gluten-free medicines and foods, gluten-free recipes and Celiac support groups.
See below.
Finally, I want to commend you, Gluten Girl, for your initiative in researching your own symptoms, and your awareness in paying attention to your body on and off gluten. Taking responsibility for your own health and being mindful of your own body will serve you well all your life. Thanks for writing.
Peggy Spencer, MD, has been a UNM student health physician for 17 years. Drop your questions in her box in the lobby of Student Health and Counseling, or e-mail her directly at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous. This column has general health information only and cannot replace a visit to a health care provider.
