Is it Celiac Disease or Non-Celiac Gluten Sensitivity
Gluten-free eating, cooking, and living has been increasing in popularity over the past decade. Some skeptics consider this a fad, while others swear they feel better eating a strictly gluten-free diet. Gluten-free bakeries and restaurants speckle metropolitan areas,and now even body-care and cleaning products are hopping on the bandwagon, labeling their lotions and scrubs as “gluten-free”. So, is it hype, or is there a medical need for eating sans gluten?
It’s definitely not all hype.
Current estimates are that 1% of the US population has celiac disease. That’s a lot. That’s one guest at a wedding of a hundred people. And celiac disease is serious: if a person with celiac continues to be exposed to gluten, they can have chronic diarrhea, malabsorption so severe it can lead to early osteoporosis, chronic rashes, increased risk of developing other autoimmune diseases, and increased risk of many different types of cancer. And yes, that includes even the gluten in their lotions and scrubs.
Celiac disease is an autoimmune reaction to the protein gluten which is found in wheat-derived grains including wheat, rye, and barley. Genetics can predispose you to celiac disease, but you also need the trigger (gluten) and intestinal hyperpermeability aka “leaky gut” to develop celiac. (Circle back to my primer on autoimmunity for a refresher on autoimmune disease). Your doctor can order blood work to determine if you are having an immune response to gluten but you need to be eating one to two pieces of bread (or the equivalent in crackers, whole grains, wheat cereal, etc.) for a good four to eight weeks in order for these blood tests to pick up the immune response. If your blood work shows you are having a certain type of immune response, your provider will send you to get some biopsy samples taken from your small intestine because celiac disease causes characteristic damage to your small intestine.
If you get tested for celiac and there are no signs you have the disease—does that mean you can go back to feasting on glutenous grains? Maybe, but maybe not. You might have non-celiac gluten sensitivity (NCGS), meaning you are having a reaction to gluten, but it is not autoimmune in nature. This condition, unlike other food sensitivities, is recognized conventionally and was first introduced at the International Celiac Disease Symposium in 2011. Similar to celiac, it can cause symptoms and conditions both related to digestion (such as bloating or diarrhea) and unrelated to digestion. Other symptoms associated with NCGS are many and can include fatigue, headache, joint pain, generalized pain such as fibromyalgia, anxiety, depression, and rashes.
Testing for non-celiac gluten sensitivity is more of an art than a science as there are currently no standard tests to make the diagnosis. Beyond an elimination-challenge, there are some specialty labs your naturopathic or functional medicine doctor might order to determine if you might have NCGS.
To take a deeper dive into your history and discuss testing options, please call the clinic and schedule with Dr. Rachel Surprenant, N.D. 503-222-2322.