Not knowing the source of a health problem can sometimes be more frustrating than the problem itself. For those with digestive issues, it's often a guessing game. Maybe it was the dairy. Maybe I'm not getting enough fiber. Maybe I just ate too much.

Frequent abdominal pain, cramping, bloating and bowel irregularities are a few symptoms of gluten intolerance. Gluten is a protein found in wheat, barley and rye-main ingredients of many baked goods, pastas and other popular foods.

For some individuals, gluten causes more than digestive discomfort. It triggers an inflammatory response that damages the lining of the small intestine and prevents proper absorption of nutrients (including crucial fat-soluble vitamins A, D, E and K), which can contribute to potentially serious health complications such as anemia, itchy skin rash, numbness, mouth sores, joint pain, weight loss, missed menstrual periods, infertility, headaches and more. These people suffer from a condition known as celiac disease.

Although it can affect anyone, celiac disease tends to run in the family-if one of your parents or siblings has it, you're 5 to 15 percent more likely to have it, too. It can appear at any time in life, as early as infancy all the way into senior adulthood, and is sometimes set off by pregnancy, physical trauma, infection or severe stress.

According to the Mayo Clinic, celiac disease is four times more common today than it was 50 years ago. In 2003, a study in the Archives of Internal Medicine found that approximately 1.5 million Americans suffer from celiac disease, making it twice as common as Crohn's disease, ulcerative colitis and cystic fibrosis combined¹. Study authors point out that symptoms vary among individuals, making the disease difficult to diagnose – researchers have approximated that upwards of 90% of people with celiac disease may be unaware that they have it.

So, how do you know if you're dealing with just a sensitivity to gluten, or actual celiac disease? You should see your physician, who can perform a blood test to officially diagnose the condition. Although it may seem counterproductive, it is important to consume gluten before having the test. People with celiac disease have higher levels of certain antibodies (IgA antitissue transglutaminase and IgA antiendomysial antibodies), created by the body in response to the presence of gluten². If you eliminate gluten before testing, these antibodies will not show up in test results.

While there is no cure for celiac disease, it is possible to halt symptoms, heal existing damage and prevent future harm to the small intestines. Following a gluten-free diet is necessary to manage the disease. Luckily, doing so has become less challenging as the condition has become more widely recognized. Gluten-free foods and ingredients, including pastas, breads, flours, snacks and more, can be found easily online and in many stores, and some restaurants now offer gluten-free menu items.

Fruits, vegetables, legumes, nuts, seeds, meats, fish, poultry, eggs, pure milk and aged, hard cheese are staples of the gluten-free diet. Certain grains are gluten-free such as corn, rice, quinoa, amaranth, millet and buckwheat. Because cross-contamination can occur (especially in oat products), be sure to thoroughly check a product's ingredients and whether or not the company is strictly dedicated to the manufacture of gluten-free items.

As always, to your good health,
David N. Ilfeld, M.D.


1. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003 Feb 10;163(3):286-92.

2. van der Windt DA, Jellema P, Mulder CJ, Kneepkens CM, van der Horst HE. Diagnostic testing for celiac disease among patients with abdominal symptoms: a systematic review. JAMA 2010 May 5;303(17): 1738-46.