Should You Avoid Gluten? A Celiac Disease And Gluten Sensitivity Update


Celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine. When a person who has celiac disease consumes gluten, a protein found in wheat, barley, rye and other grains, the individual’s immune system responds by attacking the intestinal lining and interfering with the absorption of vital nutrients. This response can lead to the classic celiac sign of flattening of the intestinal lining (villous atrophy) observed on an intestinal biopsy performed by a gastroenterologist. Symptoms typically include abdominal bloating or pain, chronic diarrhea, weight loss, and fatigue. The only current treatment for celiac disease is the lifelong adherence to a gluten-free diet. Untreated celiac disease is a contributing factor to many secondary conditions including autoimmune, neurological, digestive and bone diseases, as well as certain cancers.

Celiac disease is the most underdiagnosed disease in North America today, with an incredibly low 3% diagnosis rate. This has led to the metaphor that diagnosed celiacs represent only the visible tip of a much larger undiagnosed “iceberg”. In fact the average length of time it takes for a symptomatic person to be diagnosed with celiac disease in North America is 11 years, compared to only 3 weeks in Italy! Some of the more common diagnoses patients receive before obtaining the correct celiac assessment include irritable bowel syndrome, inflammatory bowel disease, anemia, anxiety, and depression.

In addition, celiac disease is often incorrectly believed to be the only clinical manifestation of a sensitivity to gluten. Actually celiac disease represents only a small fraction of the total gluten sensitive population, as most individuals with the sensitivity do not present with the typical celiac signs and symptoms. Research by gastroenterologist Kenneth Fine MD has shown that up to one-fourth of the North American population may be gluten sensitive. The new stool and saliva testing for gluten sensitivity identifies patients experiencing early stages and variable presentations of the condition, not just those with endstage celiac intestinal damage.

References: Ferguson, A. Celiac Disease, An Eminently Treatable Condition, May Be Underdiagnosed. Am J Gastro 1997;92(8). Fine, K. Early Diagnosis Of Gluten Sensitivity: Before the Villi are Gone (lecture) June 2003. Kaukinen, K. Celiac Disease Without Villous Atrophy: A Revision of Criteria Called For. Dig Dis Sci 3001;46:879. Braly, J and Hoggan R. Dangerous Grains. New York, NY: Penguin Putnam, 2002;4.

Dr. Arjuna Veeravagu is a naturopathic physician, registered acupuncturist and founder of Sage Clinic in Yaletown. He has studied the work of several CD and gluten sensitivity experts, including Kenneth Fine MD and James Braly MD. Dr. Veeravagu offers the new screening tests for gluten sensitivity in his practice at Sage Clinic. More information about Dr. Veeravagu and Sage Clinic can be found at