What do osteoporosis, anemia, hypothyroidism, irritability, diarrhea, and constipation have in common? They are all signs and symptoms of gluten sensitivity. A recent article in the Wall Street Journal called Clues to Gluten Sensitivity has helped me get in gear to cover this enormous topic.
What is gluten sensitivity?
As mentioned in the article linked above, it is important to understand the difference between celiac disease and gluten sensitivity. “Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats.(1)” “Gluten sensitivity (GS) encompasses a collection of medical conditions in which gluten has an adverse effect.(2)” These medical conditions can be related to damage to the small intestine or may present in other ways.
Which foods contain gluten?
- Wheat (all forms, including durum, semolina, spelt, kamut, couscous, bulgar, etc)
A quick way to remember gluten-containing foods is the acronym BROWSK, which stands for Barley, Rye, Oats (more on that in a second), Wheat, Spelt, Kamut.
Oats should technically be safe to eat on a gluten-free diet but most commercial oats are contaminated with gluten as they are farmed, transported, and packaged. You can buy gluten-free oats, such as Bob’s Red Mill Gluten-Free Oats. A small number of gluten sensitive people may also be sensitive to oats, so it is important to assess this for each patient individually.
This information is specific to celiac disease (see definition above), but still gives a good idea of the prevalence and importance of diagnosis.
Prevalence of celiac disease (3):
- In average healthy people: 1 in 133
- In people with related symptoms: 1 in 56
- In people with first-degree relatives (parent, child, sibling) who are celiac: 1 in 22
- In people with second-degree relatives (aunt, uncle, cousin) who are celiac: 1 in 39
- 60% of children and 41% of adults diagnosed during the study were asymptomatic (without any symptoms).
The average length of time it takes for a symptomatic person to be diagnosed with celiac disease in the US is four years; this type of delay dramatically increases an individual’s risk of developing autoimmune disorders, neurological problems, osteoporosis and even cancer.(4)
Those diagnosed with celiac disease between 2-4 years of age had a 10.5% chance of developing an autoimmune disorder. Additional findings show that the later one is diagnosed, the more likely her or she is to develop and autoimmune condition (5):
Age at diagnosis and chance of developing an autoimmune condition:
- 4-12 yrs: 16.7%
- 12-20 yrs: 27%
- Over 20 yrs: 34%
As is now becoming clear, patients may have “silent” or atypical form that presents with no gastrointestinal symptoms. (6)(7)
Signs and symptoms
Signs and symptoms of celiac disease (1):
- Abdominal pain, bloating, gas, or indigestion
- Decreased appetite (may also be increased or unchanged)
- Diarrhea, either constant or off and on
- Lactose intolerance (common when the person is diagnosed, usually goes away after treatment)
- Nausea and vomiting
- Stools that float, are foul smelling, bloody, or “fatty”
- Unexplained weight loss (although people can be overweight or of normal weight)
Signs and symptoms of “silent” celiac disease (8):
- Short stature
- Neurologic symptoms
- Dermatitis herpetiformis
- Reduced bone density (osteopenia/osteoporosis)
- Apthous stomatitis, dental enamel defects
- Infertility, recurrent miscarriage
- Irritable bowel syndrome (IBS)
- Esophageal reflux
- Neurologic symptoms
- Autoimmune diseases
- Celiac Disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1435993/
- Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.
- Green PHR, Stavropoulos SN, Panagi SG, Goldstein SL, Mcmahon DJ, Absan H, Neugut AI. Characteristics of adult celiac disease in the USA: results of a national survey. Am J Gastroenterol. 2001 Jan;96(1):126-31.
- Ventura A, Magazzù G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease. Gastroenterology. 1999 Aug;117(2):297-303.
- Sanders DS, Hurlstone DP, McAlindon ME, Hadjivassiliou M, Cross SS, Wild G, Atkins CJ. Antibody negative coeliac disease presenting in elderly people–an easily missed diagnosis. BMJ. 2005 Apr 2;330(7494):775-6.
- Feighery C. Fortnightly review: coeliac disease. BMJ. 1999 Jul 24;319(7204):236-9.
- Green PH, Alaedini A, Sander HW, Brannagan TH 3rd, Latov N, Chin RL. Mechanisms underlying celiac disease and its neurologic manifestations. Cell Mol Life Sci. 2005 Apr;62(7-8):791-9.