Step away from the gluten

luten free has become a marketing "buzzword" for a variety of grain-based foods.

But who should be eating it?

Dr. Ahmed Hasan, a gastroenterologist with Blue Mountain Health System in Lehighton, said many people don't know they are sensitive to gluten and are going undiagnosed or misdiagnosed with something else.

"Celiac disease has been one of the most commonly missed conditions in the United States," he said.

In order to find out just how many people have symptoms of celiac disease, he created an anonymous online survey.

Since it was unveiled in 2014, about 20,000 people in the region have taken the survey and said they experience symptoms of the disease.

Diagnosis

The disease is common in western and Eastern Europe. Hasan said one in 300 people in Northern Ireland, and one in 100 people in Finland are affected by celiac disease, but only one in 3,000 are diagnosed with it in the United States.

Instead, people are being diagnosed with irritable bowel syndrome, lactose intolerance, GERD, diabetes and thyroid disease.

"They've been given prescriptions and treated for the wrong thing instead of getting to the crux of the situation," he said.

If left untreated and undiagnosed, celiac disease can cause:

• Malnutrition

• Cancer in the small intestine (Enteropathy-associated T cell lymphoma)

• Refractory celiac disease (severe complications of celiac disease)

• Severe osteoporosis

• Ulcerative jejunitis

Hasan and his research associate Vivian Q. Tao are doing research to find out the pervasiveness of celiac disease.

"Celiac disease remains underdiagnosed due to the fact that it affects people very differently," Hasan said. "Some people may have symptoms that are similar to other digestive disorders; others may have no symptoms at all. However, celiac patients are all at risk for long-term complications, regardless of any visible symptoms."

Symptoms

There are numerous symptoms related to celiac disease.

Some of the more common ones include: abdominal pain, cramping or discomfort that feels like a pit in the stomach; bloating; constipation; chronic diarrhea; flatulence; heartburn or acid reflux; loose or hard stools, an urgent need for a bowel movement or a sensation that the bowels have not been completely emptied; iron-deficiency anemia; nausea; weight loss and vomiting.

But what causes celiac disease?

In some people, gluten causes destruction to villi. This destruction is also known as villous atrophy, Hasan said.

Villi are tiny fingerlike appendages along the lining of the small intestine that absorb nutrients.

The tips of the villi have an enzyme that breaks down lactose. Many people who are diagnosed as being lactose intolerant actually began with celiac disease, he said. The villi have been destroyed and the enzymes that should be there are eliminated.

Similarly, malnutrition and anemia can result when the villi are destroyed, because they become shorter and shorter and absorb fewer and fewer nutrients. In children, this can stunt their growth.

"In Italy, all children are tested for celiac disease before the age of 6," Hasan said.

Testing

In order to diagnose celiac disease, a physician begins with a blood test. The blood test looks for elevated levels of antibodies. Antibodies are proteins that target the body's own cells and tissues, this is what is called an autoimmune disease. The test looks for the anti-tissue transglutaminase antibody, IgA (tTg-IgA), or anti-endomysial antibodies, IgA (EMA-IgA).

Hasan said it is possible to test negative for the antibodies, but still have celiac disease. A false negative can occur if the person has been avoiding gluten before the blood test, then the antibody level may be too low to detect.

If a blood test suggests a problem, then the doctor will take a biopsy of the small bowel using a endoscopy.

Hasan said it is very difficult to get into the small intestine because it is too narrow for the endoscopic probe. There is a new advanced procedure that uses a camera in the form of a pill to move into the small spaces. It is called a capsule endoscopy.

The patient simply swallows the camera like a pill, and it moves down into the stomach and bowel system. Visualization is the best way to diagnose the health of the villi.

Treatment

Although not curable, once the disease is diagnosed, the solution is to maintain a gluten-free diet.

"Get away from the gluten," Hasan said.

Be aware though, gluten can be hiding in products unexpected by consumers, such as soups, ketchup, lipstick and vitamins, to name a few. Gluten is found in the wheat germ, which can be used as a binding element.

Once free from gluten, most people notice improvements within a few days. The intolerance is still there, but the villi will repair themselves. It could take up to two years for older adults before the villi in the small intestine are completely healed.