Celiac Disease, A Still Under-diagnosed Disorder

With the rise of gluten-free products and the number of people following a gluten-free diet in the last decade, it is a bit of a surprise that celiac disease is still an under-diagnosed disease.  It is estimated that 1% of people in the US have celiac disease, but only 15% of them are properly diagnosed.

What is celiac disease?

Think of celiac disease as an extreme form of gluten sensitivity, to the point that there is damage to the cells that line the small intestine.   People who have celiac disease commonly suffer from chronic non-bloody diarrhea, abdominal pain, excessive fat in the stools, fatigue, gas/bloating, rash, malabsorption, nutrient deficiency and weight loss.  However, some people can experience no symptoms or less common symptoms, such as patchy hair loss, elevated glucose, elevated liver enzymes, acid reflux, restless legs and anxiety.

Conditions that are commonly associated with celiac disease include:

  • Iron-deficiency anemia
  • Hashimoto or other types of autoimmune thyroiditis
  • Type 1 diabetes
  • Osteoporosis
  • Schizophrenia or other mental disorders
  • Infertility
  • Neurological disorders

How to spot it?

To properly test for celiac disease, the initial step is to check for a number of antibodies.  This is done through a blood test. In order to do the test, one must consume gluten, which is found in wheat, barley and rye.  You need to eat about 2-3 grams of gluten, which is equivalent to 1-2 pieces of bread a day for 4-8 weeks prior testing. If your test was done when you were on a gluten-free diet, you might get a false-negative result.  

A common problem I often see when patients bring in their test results is that an insufficient number of tests are ordered.  There are currently six possible antibodies blood tests that can be ordered through common labs, such as Quest. Most doctors only order two tests, which can unfortunately result in celiac disease going undetected  I recommend taking a minimum of four tests. Once I see that any one of the antibodies is elevated, I send the patient to get an EGD (Esophagogastroduodenoscopy) through their gastroenterologist for biopsy. Sufficient amounts of samples at various locations are also key for an accurate diagnosis.

If you ever wonder whether gluten can be a cause to your symptoms, don’t jump into gluten-free diet right away.  Find a well-trained doctor for proper diagnosis first.


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