For most people, there is no reason to give up gluten forever.
But that’s not so easy for people with two gluten-related medical conditions: celiac disease and gluten intolerance, according to Dr. Sarmed Sami, a gastroenterologist at Mayo Clinic Healthcare in London.
It offers some details about this protein and the two health conditions. Gluten is a protein found in grains such as wheat, barley and rye.
In people with celiac disease , eating it triggers an autoimmune reaction that causes cell damage in the small intestine. That reaction can cause diarrhea, fatigue, weight loss, bloating, anemia and lead to serious complications, Sami said.
Gluten intolerance is more common, he added.
"In gluten intolerance, there is no cellular damage or inflammation . It is more of a sensitivity : ’Gluten doesn’t agree with me,’" Sami said in a clinic news release. "If you eat gluten and have an immediate reaction, like diarrhea, you are more likely to have gluten intolerance than celiac disease, which is a slow process that you don’t tend to feel right away."
A sign of gluten intolerance or celiac disease is having one or more gastrointestinal symptoms such as diarrhea, bloating, or heartburn that decrease or disappear if gluten is eliminated from the diet. These symptoms then return if the person starts eating gluten again.
It’s important to get tested in case you have more severe celiac disease, Sami said.
Those who have a gluten intolerance can reduce their consumption of gluten-containing foods rather than having to eliminate them completely, Sami said.
"It depends on the level of intolerance. Some people may do well to halve their gluten consumption, while others may need to reduce it further," he said. "It’s different from celiac disease, where you have to be strictly and completely gluten-free."
To diagnose celiac disease , doctors begin with a blood test to determine if the body sees gluten as an invader and reacts by generating high levels of antibodies. After a positive blood test, an endoscopy can take biopsies to check for damage to the small intestine.
"We typically recommend that people not follow a gluten-free diet if they are tested for celiac disease, because that can cause false-negative blood test results," Sami said.
For most patients who have celiac disease, eliminating gluten keeps it under control, he said. Without a diagnosis of celiac disease, there is no reason to eliminate gluten, she said.
"There is no evidence that a gluten-free diet alone is healthier," Sami said. "It’s not about gluten. Take a cookie, for example: it’s more about the fat and sugar in the cookie than it is about gluten."
What does this mean
Get tested for celiac disease if you have gastrointestinal symptoms after eating foods containing gluten, and then follow your doctor’s advice.
