Hidden Intolerance to Wheat
A disease known for causing chronic diarrhea and weight loss often doesn’t. As a result, many people may not know they have it — and this is particularly worrisome for women, because a missed diagnosis could mean years of silent damage to their bodies.
The condition is called celiac disease (CD), an intolerance to a protein called gluten found in wheat, rye, barley, and oats. Just one in 15,000 people is diagnosed with it. But according to new research, CD may affect as many as one in 133 people, or about 2 million Americans, most of them women.
Left unchecked, CD can cause a laundry list of serious problems, including osteoporosis, anemia, infertility, an increased risk of intestinal cancers, and behavioral changes such as memory loss and mood swings, says Alessio Fasano, M.D., director of the Center for Celiac Disease Research at the University of Maryland. Research is finding that CD is often hard to detect.
In a recent Indian study of 33 women with painful early-onset osteoporosis, 13 were found to have the disease but none had any recent diarrhea, a signature symptom of CD. Typical treatment — removing gluten from the diet — relieved their pain within three months and improved their bone density within a year.
In another trial, about 5 percent of people with migraines were found to have CD; treatment for it cured or reduced the headaches.
Doctors might have trouble diagnosing CD because the symptoms are often no different from everyday complaints. A team led by Robert D. Zipser, M.D., a gastroenterologist and clinical professor of medicine at Harbor-UCLA Medical Center in Torrance, California, recently surveyed more than 1,000 people from a CD support group. Only half had frequent diarrhea, and only 32 percent were underweight. A follow-up survey found that fatigue, abdominal pain, and gas were their most common symptoms. On average, a year elapsed before the patients received a correct diagnosis; for one in five, the wait was more than 10 years. They were most often told they had irritable bowel syndrome, anxiety or depression, or fibromyalgia.
The disease is hereditary. The most serious cases occur in children, but adults can develop it at any time, particularly after surgery or pregnancy, or as a result of stress. CD is an autoimmune disorder, meaning your own immune cells attack your body. In this case, they destroy the lining of your intestines. Conditions such as osteoporosis and anemia develop in people with CD because the intestinal damage interferes with nutrient absorption. That’s true no matter how much you eat and even if you’re lucky enough to avoid diarrhea, a major cause of nutrient loss.
A blood test can confirm that you have CD. But Fasano doesn’t think asymptomatic people should be screened for the disease since the remedy can be Draconian: avoiding all foods containing gluten — including most breads, pasta, and cookies — and exercising extreme caution when eating processed foods, many of which contain gluten as an unlisted additive. Still, Zipser advises people who have irritable bowel syndrome, chronic fatigue, or fibromyalgia that doesn’t get better after treatment to ask their doctors for a celiac-antibody test.