If you suspect that you have celiac disease or one of the
gluten related conditions it is important to see a doctor BEFORE you start on a
gluten free diet. If you are experiencing any of the symptoms of celiac disease
it is essential to get a confirmed diagnosis of the underlying cause so that
your disease can be treated and managed correctly.
The reason for this is that the symptoms of celiac disease can
be quite non-specific and various symptoms mimic other diseases. There are a
range of medical conditions associated with celiac disease and diagnosis can be
quite difficult especially if you have already started on a gluten free diet.
The symptoms of celiac disease include:
•
Gastrointestinal problems
•
Symptoms of malabsorption
•
Bloating, diarrhoea, nausea, vomiting
•
Tiredness, fatigue and headaches
•
Mental problems, depression and anxiety
•
Failure to thrive
•
Skin conditions
•
Arthritis, muscle or joint pain
•
Anaemia
•
Osteoporosis
If not controlled celiac disease may lead to an increased
risk of carcinomas including gastrointestinal cancer. If not controlled symptoms get worse and do
not go away. If you are not diagnosed correctly you may take a blasé attitude
towards your diet and may not stick to it as strictly as you need to. If not
diagnosed correctly you will not get the assistance you need to implement your
gluten free diet. Struggling with a gluten free diet is quite difficult and you
need all the assistance from professionals you can get.
A proper diagnosis ensures that your condition is managed by
a health professional for the rest of your life with regular check-ups to make
sure you have your gluten free diet in good control. Without the initial
diagnosis this care will not follow on.
Also as the symptoms mimic other diseases you may not have
celiac disease at all. Going on a gluten free diet may make you feel better but
celiac disease may not be the root cause of your symptoms and that could be a
problem. If no one knows what is really the cause of your symptoms how can they
recommend the proper treatment.
Celiac disease is also linked to other diseases such as type
I diabetes. If you are correctly diagnosed with celiac disease your doctor will
know to watch out for the symptoms of this associated diseases as well.
So how is celiac disease diagnosed and why is it advisable
not to start on a gluten free diet until after diagnosis has be established?
Blood Tests
Blood tests are taken to look for signs of malabsorption and
other general signs of celiac disease. But most importantly blood tests re done
to look for gluten-antibodies. If you have celiac disease your body produces
antibodies against gluten which also affect your intestine. This is called an
auto-immune response because the antibodies have a detrimental effect on the
body.
If you start on a gluten free diet before you have this
blood test the antibodies may have disappeared from your blood stream or be in
very low levels. If you need a blood test for celiac disease you need to ingest
gluten for at least 3-4 weeks prior to the test to stimulate the antibodies
again.
Biopsy
If antibodies are detected, celiac disease is confirmed with
a biopsy of the small intestine. A normal intestine has small finger like
projections called villi which provide extra surface for your food to be
absorbed. In celiac disease the war between the gluten and the abnormal
antibodies cause the bowel to become inflamed and damaged. The damaged villi flatten and this is what
causes the physical symptoms and the malabsorption.
Enterolab Testing
I recently read about some advanced testing offered by Enterolab, an
accredited laboratory offering tests to detect gluten on fecal samples. These tests may be worthwhile investigating but
I need to do a bit more research before I comment on them. Initial investigation
seems to indicate that they may be oversensitive ( too many false positives)
and no scientific papers have been published. I will write a future blog on the
topic.
Prognosis
If you stop eating gluten the villi repair themselves and become
normal again. If you have started on a gluten free diet before your biopsy, the
villi may have become normal enough for a misdiagnosis.
Therefore if you think you have celiac disease DO NOT start
on a gluten free diet until after you have had your tests because it may result
in a false negative result. If you do have celiac disease It is critical that
you get diagnosed properly so that your brain comprehends the fact you MUST BE
on a gluten free diet and so you can have your condition managed for life with
regular checkups from your doctor.
If you need to start on a strict gluten free diet for your
celiac disease you will find this book “
gluten free cooking guide” extremely helpful.
