Coeliac's disease is a severe, chronic, autoimmune condition in which there is destruction of the lining of the small intestine following exposure to gluten.
Patients with Coeliac's disease have a higher predisposition to many major complications and disorders including other autoimmune conditions (Rheumatoid Arthritis, Hashimotos Thyroiditis, Diabetes etc), Osteoporosis, easy bone fractures (particularly risky in later life), Iron Deficiency Anemia, Lymphoma and Chronic Fatigue Syndrome.
Coeliac's disease is a genetic condition and the treatment requires life long strict adherence to a gluten free diet with no exception. Even the slightest exposure could lead to severe symptoms such as heart arrhythmias, severe pain or extreme fatigue.
Symptoms of Coeliac's disease typically appear within 2hours of consuming gluten and may continue for up to 1 week. Sufferer's call this "being glutened" or the "gluten flu" - with many suffering severe fatigue, pain, joint and muscle aches, severe digestive issues, fever, headache and many other cold and flu type symptoms.
Given the severity of this condition, it should be no surprise that accurate diagnosis is important. In our previous post we discussed the difference between food allergy, food intolerance, food sensitivity and Coeliac's disease. In this post we also discussed the unique testing procedures of each condition - and identified that in order to have an appropriate diagnostic assessment of Coeliac's disease you must be consuming gluten.
But what if you're already gluten free?
The truth is that, while to get a confirmed diagnosis that you are coeliac, you must be eating gluten (and a lot of it), you can in fact get a confirmation that you are not coeliac - while still eating your gluten free diet.
Testing Option 1 is that you return to a gluten-filled diet for 4-6 weeks. For some this is a great opportunity to indulge in breads, cakes, croissants etc and without feeling guilty. If your symptoms are not particularly debilitating or severe then this may simply feel like a guilt-free indulgence.
With this option the first step is to have a blood test called Coeliac Serology after the 4 weeks of your gluten challenge. A gluten challenge is where you eat 4 slices of wheat bread (or equivalent wheat products) every day for 4-6 weeks. You shouldn't be taking any digestive support during this time as this may dampen your reaction - so no probiotics, no gut healing formulas, no immune balancing herbs or amino acids.
After your gluten challenge, the blood sample may confirm that you are definitely not coeliac, or that you possibly are.
The next step, which is the only way to get an accurate diagnosis of coeliac's disease, is to have an endoscopy - again you must be consuming gluten until this time. Bear in mind it can take some time to book in with a gastroenterologist to get this done - so you may be on the gluten for another month or more.
Testing Option two is to begin with a genetic assessment. This again is a blood test, however rather than looking for markers that change in a Coeliac on a gluten-rich diet, we are now looking for the genes which cause Coeliac's disease.
Similarly to the blood test in option 1, this option cannot confirm diagnosis, however it can rule it out. If your genetic test determines that it is not possible for you to have Coeliac's disease then congratulations! If however it confirms that Coeliac's disease is possible, then it's time to follow a gluten challenge and go through the steps of testing option 1.
What do we recommend?
At Food Intolerance Australia we see numerous patients with gluten intolerance, wheat intolerance, and gluten & grain sensitivity. Many of our patients come to us having been gluten free for some time, after being advised by a practitioner, or after doing their own research.
It is of the utmost importance to us that our patients get accurate diagnosis of their conditions and if there is any indication that the patient might be Coeliac, we recommend further investigation.
However we are also human and understand how much suffering can be caused by non-gluten Coeliac sensitivity. Therefore, as both genetic testing and coeliac serology provide the same outcome (ie: they can deny but not confirm diagnosis), we typically suggest option 2 as the best starting point. This allows the patient to determine how necessary it is for them to go through the suffering of the gluten challenge, and prevents unnecessary illness.
What if I've already been through a gut healing protocol?
If you have already completed a gut healing protocol and have found you are reacting now that gluten has been returned to your diet, we always recommend further investigation for coeliac's disease. The good news is that if you are coeliac, while you will experience intestinal damage during your gluten challenge (a necessary factor for you to be diagnosed) you are less likely to experience the more serious additional complications during this time. However it is important to note that all Coeliac's must adhere to a life-long strict avoidance of gluten, with no exceptions. No gut healing protocol can take the place of this treatment.
What a gut healing protocol combined with a gluten free diet can do however is improve your healing response, decrease the complications associated with this disease, and improve your general health and well-being in a much shorter time frame than a gluten free diet alone.
We hope that this article has been helpful. If you are concerned you may be coeliac and would like to book a Coeliac Gene Test click here.