Gluten is a protein found in products made from wheat, rye and some forms of oats. In some people, gluten can trigger an immune response, which damages the fingerlike projections of the small intestine known as villi causing them to become flattened which limits their ability to absorb nutrients properly.

People that suffer from gluten-sensitivity may become diagnosed with an autoimmune condition known as gluten-sensitive enteropathy, non-tropical sprue, or celiac sprue, which are three different names for the same condition. Since the exact cause of celiac disease is unknown, prevention is difficult. For those that can recognize risk factors or identify multiple suggestive symptoms, early diagnosis and treatment can limit long-term complications and ensure a long and healthy life. Celiac disease diagnosis is typically based on results of a series of blood tests and perhaps small intestine tissue evaluation to look at specific antigens and antibodies.

A New York Times article last week reported that celiac disease is frequently overlooked and under diagnosed.

Here are some facts from the article that I found interesting.

• One out of every 133 people in America has diagnosed celiac disease compared to 10 years ago when it was only about one out of every 10,000 people across the United States.
  
  
• There are approximately three million Americans with celiac disease.
  
  
• It takes about ten years for a person with symptoms to receive a diagnosis of celiac disease.
  
  
• In 2003 there were approximately 135 gluten-free products on the market compared to today where there are over 830.
  
  

Back in the 1990's when I was working as a Registered Dietitian in a teaching hospital, it was very rare that I would have a client in need of gluten-restricted diet education or restriction. When someone did have that need, we used a resource list for specialty products that could be mail ordered and eating away from home was strongly discouraged. Today, you can walk into many large supermarkets and find a complete gluten-free section and there are resources such as the Gluten-Free Restaurant Awareness Program to help people find gluten-free dining opportunities. However, the increased awareness and availability of gluten-free foods for those that need them also opens a door for food marketers and fad diet promoters as well.

While symptoms of celiac disease vary significantly from person to person, here are some of the more typical gastrointestinal symptoms that are experienced.

• Abdominal pain, distention, bloating, gas, indigestion
  
  
• Constipation or diarrhea but typically there is consistency once a symptom is exhibited
  
  
• Appetite changes and weight issues
  
  
• Lactose tolerance issues which many times go away once gluten treatment begins
  
  
• Nausea and vomiting
  
  
• "Fatty" stools that float and are foul smelling and blood tinged

The intestinal symptoms many times accompany several non-intestinal symptoms as well.

• Low blood counts and anemia
  
  
• Bone and joint pain as well as bone diseases such as osteoporosis, kyphoscoliosis or fractures.
  
  
• Ease in bruising
  
  
• Depression
  
  
• Fatigue
  
  
• Hypoglycemia
  
  
• Skin disorders such as dermatitis herpetiformis
  
  
• Defects and discoloration in dental enamel

Sometimes celiac disease also accompanies other diseases and conditions such as:

• Autoimmune disorders such as rheumatoid arthritis or systemic lupus erythematosus
  
  
• Frequent miscarriage or unexplained infertility
  
  
• Neurological conditions
  
  
• Thyroid disease
  
  
• Type 1 diabetes

A family with someone diagnosed with celiac disease is at an increased risk of having others that will suffer with it as well. Celiac disease is most commonly found in Caucasian individuals and those from European descent as well as in woman more often than men. Typically, once someone has been diagnosed through medical examination and diagnostic testing, a gluten-free diet is recommended which includes the elimination of foods, beverages, and medications that contain wheat, barley, rye and sometimes oats. Education from a Registered Dietitian who specializes in celiac disease and the gluten-free diet is recommended and beneficial as well since diet modification needs are not always obvious. Many times the goal of diet therapy focuses on three goals: 1) to halt all disease symptoms, 2) to heal existing villi damage, and 3) to prevent any further or lasting damage to the small intestine.

There are many foods that create the staples of a gluten-free diet that allow it to be a fairly healthy and well balanced way to eat.

• Cereals made without wheat or barley malt
  
  
• Fruits and vegetables.
  
  
• Lean meats
  
  
• Low fat diary
  
  
• Potatoes, rice, corn and beans
  
  
• Specialty foods like pastas and breads made with alternative grains such as rice, potato, corn flours and starches

The Bottom Line

According to the National Institutes of Health, 95% of people suffering from celiac disease have not officially been diagnosed. At the same time, others are following a gluten-free diet unnecessarily because the marketing and diet industry has promoted it as the next great thing. Chronic symptoms like many that are listed above are potentially a sign of a food intolerance. Four different food intolerances (different from food allergies) are typically experienced.

• Dairy (lactose) Intolerance
  
  
• Fructose intolerance
  
  
• Yeast sensitivity
  
  
• Gluten and wheat intolerance
  
  

If you or someone in your family has several of the symptoms or conditions listed above and you are not getting a clear direction on what might help turn things around, perhaps a trial elimination diet would be helpful to see if gluten-intolerance could be a contributing factor. The Celiac Sprue Association has outlined a wonderful three step process for gluten-free diet self-management that can help as well. There is also a basic list of what to include in your basic gluten-free diet for several weeks to help you see if gluten intolerance is a possibility. At the end of your three to four week elimination trial, you can go back to eating normally as you were before for several weeks. This will help you tell if there is a need to follow up with your medical provider for additional testing or if making the dietary changes made no difference. However, if you have minimal symptoms or medical conditions associated with gluten-intolerance and are using gluten-free products as a way to lose weight or believe it to be a healthier way to eat, you might be wasting your money.

Did you know about celiac disease as the reason for the gluten-free products or did you think they were simply a new diet fad. Is this an area you think might be beneficial to check into further for you or someone in your family?