Irritable Bowels: Could Gluten Be to Blame?

Find out if you are at risk for often misdiagnosed celiac disease

Medically reviewed in February 2021

The most common diagnosis for people who suffer from unexplained and chronic diarrhea and constipation is irritable bowel syndrome (IBS), but many people who are told they have IBS actually may be living with celiac disease, a condition that was once thought to be rare in the United States.

Only relatively recently has it come to light that celiac disease may be a common gastrointestinal problem affecting as many as 1 in 100 people in America. Unfortunately, many of the people suffering from this disease don't know that they have it or that it could be slowly damaging their intestines and robbing their bodies of important nutrients.

What is celiac disease?
Celiac disease is an autoimmune disorder, and its symptoms are triggered by dietary gluten. Gluten is a protein that is found in grains such as wheat, barley, rye and oats, so most breads, cakes, cookies, crackers and cereals contain gluten. But gluten can also be found in other foods, such as some broths, imitation bacon and seafood, processed meats, marinades, pasta, thickeners and self-basting poultry.

In people with celiac disease, gluten damages the intestinal villi that line the upper part of the small intestine. The villi may be blunted or completely flattened when exposed to dietary gluten, interfering with their ability to absorb the nutrients the body needs.

What are the symptoms of celiac disease?
People suffering from celiac disease may experience a cluster of symptoms that are fairly common in the general population and therefore may be easily dismissed or misdiagnosed. Abdominal pain, bloating, loose stools and constipation are classic symptoms of celiac disease. But not all symptoms of celiac disease are gastrointestinal. Other symptoms include joint pain, canker sores, skin lesions or rash, loss of tooth enamel, anemia, delayed puberty, short stature, arthritis, epilepsy, depression, osteoporosis and fertility problems.

It's possible to have celiac disease and experience only nongastrointestinal symptoms. And some people with celiac disease may have no obvious symptoms but still may suffer damage to their intestinal villi due to gluten consumption. Given the range of different symptoms, it's easy to see how celiac disease is often misdiagnosed.

Risk factors
Personal factors that may increase the risk of celiac disease include:

  1. Having a first-degree relative (parent, sibling, child) with celiac disease
  2. Having been diagnosed with another autoimmune disease
  3. Being female
  4. Being Caucasian

Getting the right diagnosis
Celiac disease is largely underdiagnosed in North America. A Canadian health survey revealed that 46 percent of people with celiac disease were first told their symptoms were due to anemia, 32 percent were told symptoms were due to stress and 24 percent were told symptoms were due to irritable bowel syndrome. In the United States, an adult usually doesn't receive a diagnosis of celiac disease until 10 years after the onset of symptoms.

An accurate diagnosis of celiac disease is difficult not only because there are so many other medical conditions associated with the disease but also because a person with celiac disease could easily be treated for related conditions without the root of the problem ever being discovered. Such related conditions are anemia, osteoporosis, depression and lactose intolerance. Also, because celiac disease had until recently been thought of as rare in North America, physicians were less likely to test for it or consider it as a diagnosis.

If you suspect you have celiac disease, consider your risk factors as well as any symptoms you may be experiencing. If you have worrisome symptoms or risk factors for the disease, make an appointment with your healthcare provider.

The longer a person unknowingly suffers from celiac disease and the longer he or she has been exposed to dietary gluten, the greater the risk of developing other autoimmune disorders, such as type 1 diabetes, autoimmune thyroid disease and rheumatoid arthritis.

In the absence of symptoms or a family history, however, screening is not recommended for the general public.

Start with this self-check
If you suffer from constipation or diarrhea, a first step toward understanding your symptoms could be to eliminate gluten from your diet for about a week to see if your symptoms improve. Keep a diary of your symptoms and of the foods you eat both during and after the gluten-restriction phase of your diet. Some gluten-sensitive people may need more than a week for symptoms to subside. Also, some people may need to repeat the experiment.

If your symptoms return within a few days of eating gluten again, let your doctor know. He or she can confirm the presence of celiac disease with a set of blood tests done before and after eliminating gluten from your diet. Other tests, such as endoscopy or biopsy, also may be required to confirm the diagnosis.

There is no cure for celiac disease, but once it is diagnosed, it can be successfully treated with a lifelong gluten-free diet, which should help intestinal villi to fully recover.

To effectively treat celiac disease, absolutely no gluten should be included in your diet. Simply cutting down on gluten won't help. Although this may be difficult, greater diagnosis of celiac disease in North America has brought with it an increase in the availability and awareness of gluten-free alternatives, making a strict gluten-free diet all the more possible and improvements in overall health and quality of life much easier.

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