Should I get tested for celiac disease?
While about 1% of the population has actually been diagnosed with celiac disease there are many others that assume that they are gluten intolerant. Let’s explore three reasons that people may have problems with their digestion after eating products made with wheat such as bread.
Celiac disease is an autoimmune disease that causes damage to the small intestine when gluten, a protein found in certain grains, is eaten. Most nutrients are absorbed in the small intestine so when someone with celiac disease does not follow a gluten free diet they can have problems with growth, digestion and nutrient deficiency. The only treatment for Celiac disease is to follow a strict gluten-free diet. Non-celiac gluten sensitivity is sometimes used as a diagnosis when someone tests negative for Celiac disease, but still reports symptoms after eating gluten containing foods, such as wheat. There is research that shows some of these people might not be reacting to the gluten protein. They may be reacting to a carbohydrate called fructan.
Fructans are present in many foods such as wheat, onions, garlic and grapefruit. These carbohydrates are not well absorbed and this can cause extra water to be pulled into the small intestine. The fructans and extra water then travel to the large intestine and can contribute to the production of helpful gut bacteria and short chain fatty acids which are widely regarded to be beneficial to gut health. This process also produces gas. Most healthy people can tolerate moderate amounts of fructans, but some people with irritable bowel syndrome may have unpleasant symptoms such as bloating or pain after eating fructan-containing foods. The main way to avoid or limit these symptoms is to reduce your intake of fructans. This doesn't mean avoiding them completely. Talk to a dietitian to find out if you might benefit from limiting these foods in your diet.
A wheat allergy can produce many symptoms including hives, vomiting or the life-threatening reaction of anaphylaxis. This happens when the body is exposed to certain proteins in wheat and typically occurs within minutes to 2 hours after consuming wheat. Since allergies have the potential to lead to life threatening anaphylaxis, wheat should be avoided by those with a wheat allergy. If you suspect you have a wheat allergy, you should talk to your doctor about testing. Popular at home commercial tests that check for IgG antibodies cannot be used to diagnose an allergy.
Is it worth getting tested for celiac disease?
I think it is. As a dietitian it is my goal to help people follow the least restrictive diet to manage their symptoms and make progress on their health goals. If someone tests negative for celiac disease and they do not have a wheat allergy, they have more flexibility with their intake of wheat and other gluten-containing grains. Also, determining that someone is reacting to fructans instead of gluten can help us modify intake of other fructan-containing foods to better manage symptoms.