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What Is Celiac Disease? Why a Gluten Free Diet Isn't for Everyone

Woman with celiac disease eats gluten free pizza

Sick of dealing with uncomfortable bloating after meals? You may be wondering if gluten is to blame.

Celiac is an autoimmune disease where gluten causes the body to react and make antibodies that attack the small intestines. It is extremely rare and only impacts around 1% of adults and kids. Non-celiac gluten insensitivity is even rarer with a diagnosis rate of less than 1%.

Symptoms of celiac disease

Common symptoms can include:

  • Bloating
  • Diarrhea
  • Rashes
  • Headaches
  • Unexplained fatigue
  • Constipation

Patients who present with symptoms will need to undergo blood testing and an endoscopy after eating gluten to receive a diagnosis. Undiagnosed celiac with unchecked inflammation can increase the risk of developing vitamin deficiencies including iron as well as an increased risk of cancer affecting the lining of the small intestine. Therefore, those who have celiac will need to follow a strict gluten free diet and some may need supplements to assist with vitamin deficiencies.

Is gluten bad for you?

If celiac is so rare, why do so many people have digestive issues after eating bread?

“There are probably a lot of patients who are walking around with irritable bowel syndrome or IBS,” said NEMG gastroenterologist Raquel Rozner, MD. “It's probably one of the most common diagnoses we see. I think it also has to do with what we’re eating and unfortunately, a lot of that is out of our control. It’s very processed and there are a lot of additives.”

When people cut out gluten containing products from their diet, they may unintentionally be following what’s known as the low fodmap diet, which is naturally lower in carbohydrates and grains. A low fodmap diet is not supposed to be permanent. The idea is to eliminate certain foods to evaluate whether there is an improvement in symptoms.

“We do sometimes recommend a gluten free diet for patients with severe IBS because they’re cutting out certain foods that make them feel better. But it’s not the gluten that’s the irritant. It’s the other things that are in gluten containing foods,” said Dr. Rozner.

For example, dairy is a common culprit for symptoms related to IBS. Other common conditions that could be causing digestive symptoms include Crohn’s disease, colitis, small intestinal bacterial overgrowth or SIBO. Therefore, Dr. Rozner says anyone who is experiencing discomfort should see a gastroenterologist to get a proper diagnosis.

“Gluten itself is not bad, It's not unhealthy. Gluten free products can be unhealthier than a product containing gluten because it tends to have more fat and has more processed ingredients, more fillers. So, gluten itself is not bad or unhealthy at all, and people who have no issue with it should be able to digest it well,” said Dr. Rozner.

If someone does receive a celiac diagnosis, they can get proper counseling from their clinician to follow a diet that helps to improve symptoms – without having to only rely on gluten free products.