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more articles by Lemberg, Brent D. , MD  |  author's bio

When Gluten is a Problem

When Gluten is a Problem

By Brent Lemberg, MD


Celiac disease has become an increasingly common diagnosis lately. In the United States nearly two million people have it and we suspect many more remain undiagnosed. Celiac disease is an inflammatory condition of the small intestine caused when the body’s immune system reacts to gluten, which is a protein found in the grains wheat, rye, barley, and oats.


This immune reaction injures the tiny villi on the interior walls of the small intestine. The villi are shaped like fingers and their job during the digestive process is to extract vitamins, minerals, calories, and fat from the food we eat. However, in people with celiac disease the tops of the villi are damaged and eventually die off, leaving the villi short and flat. As a result they are not able to do their job very well, which can cause difficult symptoms.


Who gets celiac disease?


Celiac disease is a genetic condition: if your mother, father, sister, or brother has celiac disease, there is a 7-10 percent chance you have it, too. It affects both children and adults and is most common in people of northern European ancestry. The symptoms are often most severe in the teenage years.


What are the symptoms of celiac disease?


Some people experience very mild symptoms while others suffer from symptoms that are quite severe. Symptoms include bloating and gas, chronic diarrhea, weight loss, and fatigue. In children, celiac disease can result in growth retardation issues and small stature due to the inability of the small intestine to absorb nutrients. Unfortunately the symptoms of celiac disease are so common to other disorders that finding the proper diagnosis can take a while. Some mild cases of celiac disease go on for many years and are not diagnosed until the symptoms grow much worse.


How is celiac disease diagnosed?


The first step in diagnosis is a blood test to check for antibodies that are produced during the body’s immune system reaction to the presence of gluten. If the blood test results are positive, the second step is a small bowel biopsy. This is recommended because blood tests have a 5 percent rate of false positive. A gastroenterologist performs the biopsy using an endoscope, which is a narrow, flexible tube that can be used to collect tiny pieces of tissue from the inside of the small intestine.


How is celiac disease treated?


Treatment involves adapting your diet to avoid wheat, barley, rye, and oats, which can be tricky for teenagers who consume lots of pasta, pizza, bread, and bagels. Thankfully it is much easier nowadays to adhere to a gluten-free diet because since 2006 manufacturers have been required to label food that contains gluten. However, products such as lipstick, multivitamins, and candies also contain gluten so there are many ways to ingest it without realizing it.


Getting involved with a good dietitian is very helpful. We refer many celiac disease patients to the dietitians at the Cayuga Center for Healthy Living (6o7-252-3590). They can tell you what to eat, what to avoid, and which restaurants serve gluten-free food. Many celiac disease patients have been struggling with their symptoms for so long they have forgotten what it is like to feel good. Within a week or two of eating a gluten-free diet they experience significant improvement.


Dr. Lemberg is board certified in gastroenterology and serves on the medical staff of Cayuga Medical Center. He practices with Gastroenterology Associates of Ithaca and can be reached at (607) 272-5011.

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