Is celiac disease a sign we should all be living gluten-free?

Gluten-free products exploded onto the marketplace a few years ago and they’ve become big business. While this has deepened awareness of celiac disease for some people, others roll their eyes at what they see as just another dietary fad. But the symptoms of celiac disease have real consequences for those who suffer from it. And some have taken it as a sign that we should all be avoiding gluten. Let’s dispel some of the myths surrounding this.

What is celiac disease?

Myth: Celiac disease is just part of a new fad diet.

Truth: Celiac disease (or CD) is an autoimmune condition that affects the intestines. For those of us with CD, ingesting gluten damages small, finger-like structures that line the intestines called “villi.” Villi are crucial to our digestion, and when they’re damaged, we can’t properly absorb nutrients from our food. This can lead to malnutrition, osteoporosis and all sorts of other bad things. By some estimates, about 1 percent of us have celiac disease worldwide.

What is gluten?

Myth: Gluten is a made up substance to scare us off from eating bread.

Truth: Gluten is a substance found in grains such as wheat, barley and rye. It’s a combination of two proteins and is the reason that dough is elastic and sticky (which is why gluten-free baked goods are usually crumbly).

Causes of celiac disease

Myth: You can get celiac disease from eating too much gluten.

Truth: Celiac disease has a hereditary component in some cases, and you have a one in 10 chance of developing it if you have a sibling or parent with the disease. In other cases, external factors bring it on. Some evidence suggests that introducing gluten into a child’s diet before three months of age, or not breastfeeding them when gluten is introduced, can increase their risk. In yet other cases, certain intestinal infections at a young age can cause the onset of CD.

For certain individuals, celiac disease develops much later in life. In these cases, it can be brought on by major life events such as pregnancy, childbirth, or surgery. In other instances, viral infections in the gut can cause it.

Celiac disease symptoms in adults

Myth: It’s easy to identify the symptoms of celiac disease.

Truth: There are basically three categories when it comes to symptoms of celiac disease. The first includes those you would suspect from a disease that targets the digestive system: gas, bloating, diarrhea, abdominal pain and weight loss.

The second category is more diffuse and can be downright mysterious: skin irritations, anemia, joint pain, infertility and depression. 

The third category includes people who may have no external symptoms at all. Falling into this group is perhaps the most dangerous, since untreated celiac disease can increase the risk for certain types of cancer. In some instances it can even be fatal.

Celiac disease symptoms in children

Myth: Celiac disease isn’t that severe in children.

Truth: Diagnosis of CD in children rarely happens before the age of six months, as most don’t begin to consume solid food (and therefore gluten) before then. Classic symptoms present as they do in adults, with diarrhea, abdominal discomfort and lack of appetite. But because CD disables the body’s ability to absorb nutrients from food, impaired growth is often a symptom in children. Celiac disease affects behaviour as well, with children expressing irritability, depression and anxiety. Sleep and behavioural issues were also reported by mothers of children with untreated celiac disease. 

What is celiac disease screening?

Myth: There’s no test to conclusively diagnose celiac disease.

Truth: Diagnosing celiac disease used to involve taking a history of patient symptoms. Thankfully, a simple blood test provides celiac disease screening today. Although this procedure usually suffices, in some cases doctors may follow up with a biopsy of the small intestine. The catch is that in both of these cases, your diet must still include gluten for them to work. So there’s usually no benefit to removing it until you’ve been to the doctor. The blood test measures “Tissue Transglutaminase IgA,” which is the antibody your body produces in response to gluten if you have CD. If you’ve gone off gluten already, there will be no response to measure.

Are celiac disease and gluten intolerance the same thing?

Myth: Being sensitive to gluten means you have celiac disease.

Truth: Some individuals without CD report celiac-like symptoms that disappear when they eliminate gluten from their diets. This is called non-celiac gluten sensitivity (NCGS) and includes symptoms like diarrhea, bloating, skin rashes, brain fog, acid reflux and even joint pain. The tricky part is that gluten doesn’t damage the small intestines for those with NCGS like it does for those with CD. This means the regular CD screening tools don’t work if you have NCGS. On top of that, several recent studies have called into question whether NCGS is a true “state of illness.” 

While the jury is still out on NCGS, it’s crucial, for anyone showing these symptoms to be screened for celiac disease before eliminating gluten from their diet, in order to rule it out.

Treatment

Myth: If you have celiac disease you can indulge in “cheat days” on special occasions.

Truth: There are no special exceptions for birthday parties or your friend’s home-brewed beer. For those with CD, even a small amount of gluten can damage the intestines. And each time you ingest gluten, the body has to start the healing process over again. The body can be so sensitive, that even cross-contamination of foods can cause problems — when buying unpackaged bulk food, for example. The only way to treat celiac disease is by completely eliminating gluten from your diet, and doing so for your entire life.

While there’s no doubt that many have recently jumped on the gluten-free bandwagon, those with celiac disease are suffering from a real illness. For the rest of us, a gluten-free diet may seem healthier in some ways because it usually avoids processed and carb-heavy foods. But gluten isn’t bad for humans, as long as you’re eating a balanced diet. So unless you’ve been diagnosed with CD, there’s no need to avoid that avocado toast or your nonna’s pasta.