How to diagnose celiac disease, wheat allergy and related problems

March 13, 2020

Providence Nutrition Team

Do You Have Celiac Disease? How can you be sure?

Gluten and wheat cause problems for millions of Americans
Not all gluten- and wheat-related sensitivities are the same
A medical diagnosis is essential for managing these conditions
For an accurate diagnosis, don’t cut gluten from your diet before you are tested

[6 MIN READ]

For a tiny protein, gluten certainly gets a lot of attention. Some people avoid it entirely because they’ve been diagnosed with an autoimmune disorder called celiac disease, which can lead to serious damage in the small intestine.

Other people avoid gluten because they think they have celiac disease, when in fact they may have another condition, such as a wheat allergy, gluten sensitivity or another health issue. Only a medical diagnosis can tell them for sure—and it’s an important step for anyone who is concerned about how gluten and wheat affect their health.

Signs of celiac disease

Gluten is one of hundreds of proteins found in certain grains, such as wheat, barley, rye, semolina, durum and spelt. It helps bind grain-based ingredients together in recipes, and it gives bread its spongy texture.

Gluten is a major problem for people with celiac disease. “When people with celiac consume foods containing gluten, their immune system attacks the small intestine,” says Paige Becker, RD, LD, a registered dietitian nutritionist at Providence Portland Medical Center. “This damages the finger-like projections called villi that are inside the small intestine, which are important for helping the body absorb nutrients from food. Ingesting small amounts of gluten, even crumbs from a cutting board, can trigger intestinal damage. Over time this can lead to serious long-term health problems.”

If you are suspicious that you might have celiac disease, be sure to keep a food diary and track your symptoms. This can help you and your doctor monitor your reactions and see if there are correlations and data to support a full celiac panel and blood test.

How common is celiac disease? About one in 133 people in the United States has this condition. Some don’t have any symptoms, but others do. In fact, there are more than 200 symptoms associated with celiac disease. The most common include gastrointestinal symptoms like abdominal bloating and pain, diarrhea, other bowel movement changes and vomiting. You may also experience chronic fatigue, bone or joint pain, tingling in the hands or feet, and even depression or anxiety. This checklist for celiac disease symptoms can be helpful if you think you may have an issue with gluten.

If you are suspicious that you might have celiac disease, be sure to keep a food diary and track your symptoms. This can help you and your doctor monitor your reactions and see if there are correlations and data to support a full celiac panel and blood test.

How is celiac disease different from a wheat allergy?

A wheat allergy is a different type of immune response to any of the proteins found in wheat (not just gluten). If someone with a wheat allergy consumes wheat, their body has an allergic reaction. Symptoms can include nausea, itching, abdominal pain, swollen lips and difficulty breathing.

Wheat is one of the eight most common food allergies in the United States. For people with a wheat allergy, gluten is not necessarily the problem. They may be able to consume gluten from non-wheat sources, such as barley or rye. Then again, someone with a wheat allergy may also have celiac disease or a gluten sensitivity. Only medical tests can tell for sure.

Is gluten sensitivity an allergic reaction?

Gluten sensitivity, also known as non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS), is not a well-defined condition. It isn’t an autoimmune disorder like celiac disease, and it doesn’t cause an allergic reaction. But it may be related to many symptoms that are similar to those of celiac disease—abdominal pain, gas, bloating, bowel movement changes and depression. And it can affect the intestines.

At this time, there isn’t a cure for celiac disease. Treatment for celiac disease involves eliminating gluten from your diet. This is essential in order to protect your small intestine from damage.

There is no definitive test to diagnose these sensitivities. But a diagnosis may come when tests for celiac disease and wheat allergy are negative, and when symptoms go away after removing gluten from the person’s diet.

Why get tested?

If you’re experiencing symptoms and think gluten is to blame, it might be tempting to simply cut gluten-containing grains from your diet. But it’s important to get a diagnosis from a licensed medical professional before you take that step. A diagnosis can guide decisions you make about what you eat for the rest of your life. In addition, if you cut gluten-containing foods out of your diet prematurely, you may not get enough of the key nutrients (like B vitamins) that your body needs.

When you’re ready to get tested, your doctor may recommend a blood test to detect antibodies that are fighting against the gluten. “These antibodies will only be present if your immune system is currently fighting against gluten,” Becker says. “If you have already stopped consuming gluten, the test may not provide helpful information.”

If the first test is positive, the doctor may recommend a biopsy to check the small intestine for damage. This test is performed by a gastroenterologist on an outpatient basis. Damage to the villi would confirm a diagnosis of celiac disease. If there isn’t damage, that suggests a wheat allergy, NCWS or NCGS. To confirm a wheat allergy, the doctor may want to perform a blood test or skin prick test.

After a diagnosis, what’s next?

It can be a relief to finally know what’s been causing your symptoms. But living with a diagnosis of any wheat- or gluten-related condition can also be a big adjustment.

At this time, there isn’t a cure for celiac disease. Treatment for celiac disease involves eliminating gluten from your diet. This is essential in order to protect your small intestine from damage.
If you have a wheat allergy, you have to avoid wheat—but rye, barley and other gluten-containing grains are okay.
People with a gluten or wheat sensitivity (NCGS or NCWS) can still safely consume gluten-containing foods, but they may cause uncomfortable GI symptoms.

The good news is that the world is becoming a friendlier place for people who must avoid gluten and/or wheat. You may not even have to give up your favorite foods – as long as your diet is well-balanced, you can switch to gluten-free alternatives and still get the nutrients you need. A --registered dietitian nutritionist can help assure your gluten-free diet is balanced and healthy.

Find a doctor

If you’re wondering whether you have celiac disease, a non-celiac wheat or gluten sensitivity, or a wheat allergy, talk to your doctor. You can find one in our provider directory. Or, you can search for a primary care doctor in your area.

How do you support a loved one with celiac disease? Share it with #celiacsupport @psjh

Regional resources

Alaska: Pediatric Gastoenterology

California: Nutritional Counseling

Oregon: Going Gluten-Free

Texas: Covenant Health LifeStyle Centre

Washington: Nutrition Consultations | Providers