A Gluten Guide: What to know about celiac disease

by Cotton Shallcross, MD

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Grocers are finding “gluten-free” foods to be profitable products in 2015. Some shoppers assume non-gluten options are guaranteed-good-for-you,equating them with fat-free and sugar-free benefits.

However, medical professionals urge families to make careful, informedchoices about gluten foods, based on their physicians’ advice.

“There are a lot of people who self-diagnose themselves with celiac disease,” says Cotton Shallcross, MD of Birmingham Gastroenterology Associates at St. Vincent’s One Nineteen. “They treat themselves with a gluten-free diet. We have people who alter their diets, and then come in to tell us they think they have celiac disease. But if you’re on a gluten-free diet and we test you, you’ll test as normal.

“So, don’t alter your diet until after you see a doctor.”

Celiac disease symptoms — diarrhea, anemia, constipation, fatigue, skin rashes, abdominal pain and related concerns — can be “exactly the same,” says Shallcross, as other diagnoses, including irritable bowel syndrome. Celiac disease, an allergy to the gluten protein in wheat and other grains, affects about one percent of the population. Sufferers can be of any age.

“It’s an immune reaction to eating gluten. It is increasingly becoming more common than we once thought, and we don’t know why.”

A blood test ordered by a primary care physician or gastroenterologist can screen for the disease. Definitive diagnosis is made through a gastroenterologist’s biopsy of the small intestine. If the results are positive, the only treatment is a gluten-free diet.

A gluten-free diet is not synonymous with a healthy diet, says One Nineteen Wellness Dietitian Donna Sibley, R.D.

“I really don’t advocate a gluten-free diet unless a doctor has stated you have gluten sensitivity. Any diet where you cut out a whole food group raises concerns of missing key nutrients. And in this case, you’re losing fiber, too. Some people are swapping traditional foods for gluten-free substitutes that actually contain more salt, fat and calories.”

Most adults would benefit from cutting back on their consumption of breads and starches and adding more fruits and vegetables to their diets, Sibley says. However, she urges those going “gluten-free” for weight control to explore alternatives.

“Talk to a registered dietitian about what you need. Whole grains are a huge source of energy. Unless you’ve been diagnosed with celiac disease, entirely eliminating those whole grains means you’re losing valuable components of a healthy diet.”

Although Shallcross has a special interest in celiac disease, he says primary care physicians are well-versed on screenings. Meanwhile, gastroenterologists can make definite diagnoses. Patients seeking those consults may find their symptoms are due to other conditions that can be treated effectively.

“If you’re concerned you have celiac disease, you really should see a doctor and be tested, to see if you have it,” he says. “A nutrition plan should be addressed
after the diagnosis has been made.”