¡Being celiac is trendy! Due to the large number of new foods designed in recent years by the food industry, the symptoms associated with the presence of different compounds included in these foods have increased considerably. The discomfort caused by ingesting these new foods has generated curiosity among individuals about what is causing these symptoms, leading them to consult unreliable websites, blogs, and forums where the conclusion is always the same: “gluten makes you feel sick.“

But does this statement make sense?

The symptoms associated with a reaction to gluten are very similar to those of any other type of food intolerance. This fact leads to confusion in many people, causing false beliefs and self-diagnoses regarding their discomfort. There are many types of food intolerances: fructose, sorbitol, glucose, lactose, sugar alcohols… and within the same foods that contain gluten, it is not always gluten that causes the discomfort. We recognize wheat allergy, non-celiac gluten sensitivity (NCGS), or celiac disease itself. Let’s explain each one:

• Wheat allergy: This is a reaction characterized by the production of IgE antibodies (those related to allergies) against wheat proteins and the development of immediate-type symptoms, as seen in food allergies.
• NCGS: This is characterized by the presence of intestinal and/or extraintestinal symptoms after consuming cereal products that may include gluten, provided that a diagnosis of wheat allergy and celiac disease has been ruled out first.
• Celiac disease: Also known as celiac sprue, it is an enteropathy with autoimmune characteristics triggered by foods containing gluten in genetically susceptible individuals who carry risk variants located in the human leukocyte antigen (HLA)-DQ2 gene and/or HLA-DQ8 haplotypes.

As we can see, there are many adverse reactions to nutrients that may or may not be related to gluten; however, since today is World Celiac Day, we are going to focus on correctly explaining the latter.

What are the symptoms of celiac disease?

The symptoms commonly associated with celiac disease include: diarrhea, weight loss, bloating, abdominal pain, nausea, and vomiting, and even constipation. However, there may be non-gastrointestinal symptoms such as: anemia, loss of bone mass, dermatitis herpetiformis, headaches, fatigue, and joint pain, among others… Usually, as it is a pathology that stays with the individual for life, it is detected primarily at early ages through very specific characteristics such as: developmental delay in infants, anemia, short stature, delayed puberty, and even neurological symptoms.

For its diagnosis, according to the updated guidelines from the American College of Gastroenterology for the management and diagnosis of celiac disease, the use of multiple duodenal biopsies (a maximum of 6) is recommended with a grade 1A (very high) recommendation for both adults and children; and with a grade 1B, the use of a combination of high-level IgA TTG (>10 times the upper limit of normal) with a positive endomysial antibody (EMA) in a second blood sample. In symptomatic adults who are unwilling or unable to undergo an upper endoscopy, the same criteria can be considered to identify it as a probable CD diagnosis.

Genetic testing and celiac disease

Furthermore, the use of genetic tests is very useful for ruling out celiac disease itself. It is known that if an individual is negative for the risk variants of the human leukocyte antigen (HLA) complex, celiac disease can be ruled out directly, though not other types of reactions. Within the diagnostic process, there are many branches and variabilities, making assessment by a medical professional more than necessary.

Once the pathology is diagnosed, it is recommended to follow a gluten-free diet since even a minimal amount can trigger symptoms. However, this is not always simple; therefore, healthcare professionals play a crucial role in educating patients to achieve better control of the pathology and reduce the incidence of acute symptomatic episodes. If professional help is not enough, there are various associations, such as the Celiac Association of Catalonia, which are responsible for representing and helping all people affected by the pathology, offering numerous resources that can help in following the treatment correctly, even when eating at restaurants.

What about you? Does gluten really make you feel sick, or are you just following the trend?

Bibliographic references

Posner EB, Haseeb M. Celiac Disease. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441900/

Mayo Clinic. Celiac disease: Symptoms & Causes; Apr. 2023.

Cárdenas-Torres FI, Cabrera-Chávez F, Figueroa-Salcido OG, Ontiveros N. Non-Celiac Gluten Sensitivity: An Update. Medicina (Kaunas). 2021 May 24;57(6):526. doi: 10.3390/medicina57060526. PMID: 34073654; PMCID: PMC8224613.

Rubio-Tapia, A.; Hill, I.D.; Semrad, C.; Kelly, C.P.; Greer, K.B.; Limketkai, B.N.; Lebwohl, B. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. The American Journal of Gastroenterology 118(1):p 59-76, January 2023. | DOI: 10.14309/ajg.0000000000002075