Q & A

Q:  My Close Relative Has Celiac Disease. Should I Be Tested Too?

A:  Most likely, you'll need to be tested as well, especially if you have symptoms of celiac disease. These can range from digestive issues such as diarrhea and constipation to neurological problems such as migraine headaches, plus skin disorders and joint pain. People with celiac disease may also have infertility, osteoporosis, depression and thyroid dysfunction.

Q: What should people who have to eliminate gluten from their diet watch out for?

A: Be sure to eat healthy! Many gluten-free packed foods on the market are high in fat, sugar and salt, which taste good but aren’t good for you. Make sure there is enough fiber in your diet and that you’re getting enough vitamins, iron, copper and folic acid.  Unlike regular products such as breakfast cereals, gluten-free substitutes aren’t so fortified. Consult a nutritionist if you have questions. Ask your doctor. Join a local celiac support group.

Q: What do you think of doctors who counsel patients to eliminate gluten from their diet even when there is no indication it is a problem?
A:  The physician in me (Celiac expert Dr. Joseph Murray) can relate to the frustration that health practitioners and doctors feel when patients have symptoms that persist, so I can see why they would counsel people to try it. But as a scientist, I search for answers before making a call. I see a lot of patients who go off gluten, feel better for a few months and then their symptoms come back.  So several big issues concern me, including: Have these patients been tested for celiac disease? Maybe the problem isn’t with gluten. Maybe it’s an allergy to wheat or [an issue with] FODMAPs, small sugar-like molecules often found in fruits and some vegetables.  The thing is, if they don’t get tested, then we’ll never know.

Q:  My blood test for celiac disease came back negative, but I am still having symptoms. Is it possible that I still could have it? What should my next steps be?
A:  The symptoms and presentation of celiac disease can vary quite a bit from one person to another. Diagnosing celiac disease is not always a one-step process. It is possible that you could still have celiac disease, even if the results of an initial blood test are normal. Diagnosing celiac disease typically begins with blood tests.   If the blood test is not reliable, other blood tests need to be done or an upper endoscopy may need to be performed.  If it doesn't reveal any damage, then it’s possible your symptoms are being caused by another medical condition. It can be useful to seek care from a physician who specializes in celiac disease to further investigate the cause of symptoms. It may also be helpful to work with a dietitian, whether diagnosed with celiac disease or not. He or she can assess one's diet and identify changes that may help ease symptoms.

References:
Sparks, B. D., Nellis, B. B., & Williams, B. V. (n.d.). Mayo Clinic Q and A: Diagnosing celiac disease not always a one-step process. Retrieved November 23, 2016, from http://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-diagnosing-celiac-disease-not-always-a-one-step-process/

Celiac Disease. (n.d.). Retrieved November 12, 2016, from https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/overview.aspx