Gluten-sensitivity is mostly self-diagnosed, not medically proven | SummitDaily.com

Gluten-sensitivity is mostly self-diagnosed, not medically proven

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Those who think they're intolerant to gluten should first get tested for celiac disease

Written By Lauren Glendenning
Brought to you by Kaiser Permanente

Just about every restaurant you dine in these days has a "GF" symbol next to the dishes that are gluten-free, but how many Americans actually suffer from celiac disease, wheat allergy or gluten insensitivity?

Celiac disease, a chronic digestive disorder, is the most severe of the body's reactions to gluten. It affects about 1 in 141 Americans, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Gluten, a protein found in wheat, barley, rye, also pops up in various processed foods, medicines, vitamins and supplements. An intolerance or sensitivity to gluten is estimated to affect about 0.5 to 13 percent of the population.

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The range is so wide due to the fact that there aren't verifiable diagnostic tests, meaning the diagnosis is made primarily through self-reported symptoms, said Dr. Shannon Garton, Family Medicine physician with Kaiser Permanente's Edwards Medical Offices.

"There is no clear definition of non-celiac gluten sensitivity or gluten intolerance, but the diagnosis is made when a patient reacts negatively to gluten, but testing has ruled out celiac disease and allergies," Garton said. "However, some experts believe this isn’t a real condition. They think the adverse effects are imaginary or caused by substances other than gluten."

Symptoms and causes

The bodies of people with celiac disease treat gluten as a foreign invader. The immune system attacks the gluten, as well as the lining of the gut.

"Celiac causes a number of symptoms including bloating, diarrhea, fatigue, abdominal discomfort, malabsorption of nutrients, weight loss, skin problems, anemia, and osteoporosis," said Dr. Patricia Dietzgen, Family Medicine physician with Kaiser Permanente's Frisco Medical Offices. "Treatment of celiac is following a lifelong gluten-free diet. This allows the lining of the small intestine to heal, and improves symptoms and absorption of nutrients from food."

Some people with celiac do not have digestive symptoms, though, and instead exhibit tiredness or anemia, making celiac a hard disease to diagnose. About 1.4 million people — out of the estimated 1.8 million who have the disease — don't know they have it, according to a 2012 study published in the American Journal of Gastroenterology.

Since celiac disease is often common in families, Dietzgen said anyone with a first-degree relative who has the disease should get tested.

People who do not test positive for celiac disease but still react negatively to gluten are said to have non-celiac gluten sensitivity or gluten intolerance, with similar symptoms to celiac that can include diarrhea, stomach pain, tiredness, bloating and depression. However Dietzgen said there are no definitive tests for gluten intolerance but that many people report feeling better after eliminating gluten-containing foods from their diets.

Garton said some experts believe the adverse effects to gluten are imaginary or caused by substances other than gluten. She pointed to one study in which researchers looked at 400 people with self-diagnosed gluten intolerance and investigated whether they improved on a gluten-free diet. Only 55 people of the 400 actually had issues with gluten — 26 of them had celiac disease, 2 had a wheat allergy and 27 were diagnosed as gluten insensitive.

"Therefore, many people who think they're gluten intolerant actually have other causes for their symptoms," Garton said.

Inflammatory foods

Simple carbohydrates, such as pasta and bread, can cause increased levels of inflammation in the body. Garton said reducing simple carbohydrates in the diet may result in feeling better or healthier.

"Many times people with gluten sensitivity or gluten intolerance may be noting improvement of their symptoms because adhering to a gluten free diet may decrease overall levels of inflammation caused by diet," she said.

Sugar is also a major cause of inflammation in the body, but saturated fats and omega-6 fatty acids can also cause it. People who report feeling better on a low-gluten diet may feel that way due to the fact that the diet is low in inflammatory foods, Garton said.

"It is not a good idea to strictly avoid all gluten if there is not a known severe sensitivity or celiac, as there are nutrients in foods which contain gluten," she said. "But maintaining a diet with lower amounts of inflammatory foods is a good plan."

Celiac disease vs. gluten intolerance

Celiac disease is a chronic digestive disorder in which gluten damages the small intestine. The list of symptoms is long and varies from person to person, but some common symptoms include stomach pain, tiredness, joint pain and digestive issues.

Gluten intolerance can have similar symptoms to celiac disease, but it’s much harder to diagnose because there are no verifiable diagnostic tests. Most people who report having the intolerance have self-diagnosed the condition and may actually have other causes for their symptoms. Anyone who thinks they’re gluten intolerant should first get tested for celiac disease or wheat allergy.