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Goodbye Gluten? How to Know if a Gluten-Free Diet is For You.

From pizza to beer to entire dedicated sections in grocery stores, the options for gluten-free foods have skyrocketed in recent years. 

Rather than being stuck in the salad section of every menu, those who observe gluten-free diets are more likely to find a muffin at their favorite bakery or a bun option for their burger. 

“Now my gluten-free patients don’t have to feel as restrained when eating out or enjoying group settings,” says Dr. Eric Hilgenfeldt, a gastroenterologist at Tryon Medical Partners. “They still have to plan ahead but there are so many more options than even just 10 years ago.”

This influx of choice comes as conversation about a gluten-free diet in popular culture has increased. Previously only observed as a treatment for celiac disease, gluten-free diets are now being tried by those looking to rid undiagnosed gastrointestinal discomforts, skin conditions and a range of other issues. But if you don’t have celiac disease, can going gluten-free really help?

“I’m always in favor of giving patients information so they can guide their own decisions,” Hilgenfeldt said. “If patients don’t have celiac disease but feel better off gluten, it’s hard to argue with them. That’s a decision that is an individual choice.” 

However, Hilgenfeldt explains that many other diseases and conditions can mimic celiac, so it’s best to be well informed and work with a doctor, like a gastroenterologist who specializes in the complexities of the gastrointestinal system.

What are the symptoms of celiac disease?

Celiac disease is an immune-related inflammation of the small intestine, inhibiting the body’s ability to break gluten. Celiac disease can be completely asymptomatic or cause gastrointestinal issues so severe they send patients to the emergency room.

Common symptoms are chronic diarrhea, unexplained weight loss, abdominal pain, distention, bloating and constipation. Less commonly, patients may have iron or vitamin deficiencies, abnormal liver tests, rashes, fatigue and headaches. 

What goes into a formal diagnosis?

A combination of tests come together to form a celiac diagnosis, Hilgenfeldt says. A routine blood test can identify certain enzymes in the body that can be celiac-indicative. Further testing can be done during an upper endoscopy via a biopsy of the intestine to look for the inflammation and damage you’d see in celiac patients. For those whose tests result in a celiac diagnosis, management often includes a lifetime gluten-free diet. 

“Seeking the help of a dietician is an important part of the process for patients who have been newly diagnosed because going gluten-free isn’t easy,” Hilgenfeldt said. “A dietician can also help address the vitamin deficiencies common in celiac patients, replacing them to normal levels. Once the illness is controlled and nutrient levels are resolved, annual follow-ups can monitor to assure progress is going as planned.”

What happens when you have celiac symptoms but not a diagnosis?

Before patients decide they are gluten-sensitive despite previous testing that is negative for celiac disease, they should be seeing a gastroenterology doctor to make sure there’s not another condition leading to their symptoms, Hilgenfelt says. 

Lactose intolerance and irritable bowel syndrome (IBS) can often present with celiac-like symptoms. Another possibility is a bacterial overgrowth in the small intestine that can be treated with antibiotics. 

The bottom line, Hilgenfelt says, is that a doctor can help make sense of your symptoms, provide resources, and even those with celiac disease can have corrected nutrient deficiencies and live asymptomatic lives. 

“With a physician to help you,” Hilgenfeldt says, “this disease does not need to impact your quality of life in any way, shape or form.”