Healthy Living

A Conversation on Gluten Intolerance

Jul 4 2019

In this episode of the Mercy Health Medical Minute on 700WLW, Mike McConnell interviews Dr. Mark Manegold about celiac disease. Check out these gluten intolerance facts.  

Mike McConnell: Let’s get some definitions out of the way. First of all, are only people who have celiac disease gluten intolerant, or are there other people who are gluten intolerant?

Dr. Mark Manegold: There are two groups. People who suffer from true celiac disease and then people who do not have celiac disease but don’t tolerate gluten in their diet.

The difference would be celiac disease is a true allergy to gluten or wheat protein. It’s an immune-mediated disease where the body directs an immunologic response against the lining of the bowel and interferes with intestinal absorption.

With gluten sensitivity, there actually is a term for this now called non-celiac gluten sensitivity. This is when people subjectively feel better if they restrict the gluten in their diet. Again, it is not true celiac disease and these individuals don’t typically have the complications of untreated celiac disease. So while they may not lose weight or suffer from malnutrition and vitamin deficiencies, their gastrointestinal tract feels more settled if they avoid gluten.

“What percentage of people suffer from celiac disease?”

Mike McConnell: And for some could it be all in their head?

Dr. Mark Manegold: It can be to some degree.

Mike McConnell: I’ve known one or two people who just decided at some point in their life they were gluten intolerant and it never seemed to bother them the rest of their life.

Dr. Mark Manegold: My suspicion is there is a certain percentage of those people that do get a placebo response.

Mike McConnell: What percentage of people suffer from celiac disease?

Dr. Mark Manegold: Celiac disease is actually more common than we once thought. The reported cases are between 1 and 300 nationally and 1 in 1000 people worldwide. It is also more common in people of northern European descent, for example, people of either Scandinavian or Celtic ancestry. Many people who have been misdiagnosed with IBS actually have celiac disease.

Mike McConnell: So, is it something that you are born with?

Dr. Mark Manegold: You have the genetic susceptibility to develop celiac disease and then, at some point in your life, you develop this immune response to the ingestion of gluten or wheat protein.

Mike McConnell: So, you have a baby that’s fine with eating bread and at some point it changes. Is it onset late childhood or adulthood or when?

Dr. Mark Manegold: It can occur at any age.

“This is a very life-altering diet.”

Mike McConnell: Other than avoidance, how can it be treated, if it can be?

Dr. Mark Manegold: Avoidance is really all you can do. The only documented effective treatment is to follow a gluten-free diet. This is a very restrictive and life-altering diet, so we always want to make sure we have the correct diagnosis for the patient.

With this diet you have to avoid all wheat, rye and barley. You can eat soybeans, rice, corn and potatoes but, you cannot drink beer. They apparently do make some gluten-free beers. I have not tried them, but my suspicion is that they are not very tasty. You can still drink distilled spirits like liquor and wine though.

Since wheat protein gluten is in so many food substances, we always have the patient go through formal dietary consultation with a registered dietician. The dietician can outline the dos and don’ts of what the patient can and cannot eat.

The other important aspect is that patients have to be able to read labels when they grocery shop. So many foods have gluten as an additive that they may not suspect.

Mike McConnell: I’m just thinking through restaurants that I go to and if I’m looking at a menu, do most restaurants make it a point to have gluten-free choices?

Dr. Mark Manegold: They do now, and that is a big benefit to patients that suffer from celiac disease. It has become so common now that restaurants have found out they can cater to these people who suffer from this disease, allowing them to go and enjoy a dinner out.

“We make a better diagnosis now.”

Mike McConnell: So, what changed? Ten years ago we started hearing about this all the time as opposed to rarely. What brought it to the floor?

Dr. Mark Manegold: We make a better diagnosis now. We can tentatively confirm a celiac disease diagnosis with a simple blood test.

Once they have that elevated blood test, you then confirm the diagnosis by doing an endoscopy. This is when you pass a scope down through the mouth, into the stomach, and the upper part of the intestine obtaining small bowel biopsies. There is a very characteristic appearance of the small bowel under a microscope that then makes the diagnosis definitive.

Mike McConnell: If it’s onset at any time, what would be the initial symptoms?

Dr. Mark Manegold: In its full-blown form, people with celiac disease have diarrhea. They lose weight, they suffer from malnutrition and they may develop vitamin deficiencies.

But, we now see people who have less severe presentations. They may simply have some abdominal pain, gas, bloating and sometimes they present with nutritional deficiencies like a vitamin D deficiency or anemia due to an iron deficiency. Females sometimes suffer from infertility and you can also have neurologic complications like neuropathy.

Again, these are very vague symptoms sometimes. We have seen an increase in the incidence of celiac because a number of people who were previously diagnosed with IBS have been correctly diagnosed with celiac disease.

Visit the Mercy Health website to learn more about gluten intolerance and how to get tested for celiac disease.

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