by Marcelle Pick, OB/GYN NP
There is tremendous confusion around the term gluten sensitivities vs. actual celiac disease, and generally, conventional medicine continues to ignore the diagnosis of gluten sensitivity. In the standard community the advice given to patients with celiac disease is to be strictly gluten free for life, while those with a sensitivity may just cut back and reintroduce it again later, and having it in smaller amounts is also considered acceptable. From my perspective and that of many of my functional medicine colleagues, the line between the two is not so distinct. Imagine that celiac lies on one end of the spectrum and gluten sensitivity falls at the other end and of course there are many degrees in between. And even a mild sensitivity to gluten, it is now understood may, depending on the circumstances develop into something more significant such as full blown celiac symptoms.
Celiac disease is most often associated with significant anatomical changes within the lining of the gut, specifically the small intestines. A wide range of symptoms can be present before a diagnosis and there is always presence of certain antibodies in the blood, particularly antiendomysial, and anti–tissue transglutaminase antibodies. For many years the gold standard to obtain a positive diagnosis was to obtan an intestinal biopsy. The more damage and irritation to the gut the more likely the antibodies would be elevated. But what has become more apparent is that not everyone with gluten sensitivity had dramatic changes, and of more interest is that modern medicine has still not done a very good job of testing and accurately diagnosing this condition.
Recent studies have reported that about 46% of celiac patients are actually misdiagnosed, and many of them, especially those with “classic” GI symptoms, 59% are told they have some form of IBS. Now the best part of all of this is that more sensitive tests have been and are being developed. In the works is a saliva test which you can do at home to check for antibodies associated with gluten sensitivity. As always, knowing early on that you are reacting to gluten can go a long way to prevent damage to your intestine from constant exposure to repeated gluten, as well as negative effects elsewhere in the body.
Autoimmune disorders are ten times more likely in celiac patients than in the general population.
Here are some common ones.
- Type 1 (autoimmune) diabetes
- Thyroid disease
- Addison’s disease
- Sjögren’s syndrome
- Autoimmune liver disease
- Rheumatoid arthritis
- Hair loss
Although until recently there was no understanding of the term Gluten sensitivity, it is more frequently identified and accepted today because of its prevalence. There is even an insurance code for the diagnosis.
Up to 30 percent of the population carries a genetic predisposition to gluten sensitivity and celiac. This causes an inflammatory/autoimmune response in your gut when you are exposed to gluten.. Gluten is an antigenic protein found in many grains that are part of the wheat family and includes other grains such as rye and barley
Laboratory and Diagnostic Testing for Celiac Disease
- Three-month trial of gluten elimination
- Celiac panel
- Anti-deaminated gliadin IgG and IgA
- Anti-gliadin IgG and IgA
- IgA anti-endomysium antibody
- IgA and IgG anti-transglutaminase ELISA (tTG)
- Total IgA (IgA deficiencies ten times more common in CD)
- HLA DQ2, DQ8 typing
- Intestinal biopsy