If you suffer from stomach pain, bloating or other forms of abdominal discomfort, you’ve probably wondered if you have Celiac disease.
Celiac disease is a hypersensitivity to gluten which leads to difficulty in digesting food. We frequently see people in our practice who avoid eating gluten-containing grains because they feel better without them but who do not have Celiac disease. Others are diagnosed Celiacs, meaning they cannot eat gluten without suffering serious side effects.
So, if you have take gluten out of your diet and you feel better, does that mean you are a celiac?
Not necessarily, and that’s good news. But you may have a gluten sensitivity which is being triggered by a number of things including fructose malabsorption or a wheat allergy.
Here’s the not-so good news. Untreated celiac disease can make life very hard. Formal diagnosis means you can be screened for related conditions like osteoporosis or autoimmune disorders. It also means you can rule out other causes of the symptoms you experience when eating a gluten-containing diet.
Here’s what you can do to find out of you have Celiac disease.
There are some common things to look out for, including:
- Digestive problems including abdominal pains and bloating
- Skin rashes
- Low iron or anemia
- Muscle cramps and joint pain
Don’t stop eating gluten!
Ideally you will not have taken yourself off gluten before you have investigated your signs and symptoms. You need to eat gluten for six weeks in a row before you test for it, eating the equivalent of four pieces of gluten containing bread a day (children need to eat two slices) to ensure you get an accurate result. It is the inflammation and immune activation that is being measured.
Get a blood test
First and foremost, get tested for the Celiac gene. Gene testing can be ordered through your GP and is done via a blood test or a cheek scraping.
What the test reveals
Let’s get technical for a moment.
Over 99 per cent of people affected by Coeliac disease possess either HLA DQ2 or HLA DQ8 genes. Having the DQ2 mutation causes the most severe damage to the small intestine. You see slower healing and recovery from damage caused by eating gluten.
Patients that have the DQ8 mutation may also develop Coeliac disease at some point if they continue to eat gluten but the damage caused is not as severe.
The good news is if the gene test is negative for HLA DQ2 and HLA DQ8 then Coeliac disease can be ruled out.
Other important tests
If you find out that you are positive for the Celiac disease gene speak to your GP about having a blood test called Celiac serology. This is a measure of the following antibody levels in the blood:
- Anti-tissue transglutaminase antibodies (tTG-IgA)
- Deamidated gliadin peptide (DGP) IgA and IgG
- Anti-endomysial antibodies (EMA)
If Celiac serology comes back positive, consider having a small bowel biopsy
This involves seeing a gastroenterologist and undergoing an endoscopy. Bowel damage can be detected and biopsy can determine if there is any villous atrophy, i.e. damage to the microvilli that line the small intestine.
If a person has tested positive for the gene, has avoided gluten and there is a family history of autoimmune conditions, recommending a gluten-free diet is a good idea.
Gluten has been found to act as an autoimmune antigen trigger and can create inflammation in susceptible individuals. You can have the gene and may never have the disease but knowing that you have the gene gives you the opportunity to prevent the disease from developing.