Gluten Free?

Celiac disease is one of the most common genetic conditions in the world, yet 97 percent of people with this disease go undiagnosed. The disorder is activated by eating gluten, the proteins found in wheat, rye and barley.

"Celiac disease has varying symptoms and problems, including gastrointestinal issues, bone or joint pain, behavioral changes, fatigue or weakness, and infertility, to name a few," says David Ruiz, MD, with Family Medicine of Southwest Washington.

PeaceHealth Southwest's Diabetes, Endocrine and Nutrition Center is partnering with Dr. Ruiz to increase awareness and treatment.

Q1. What is celiac disease?

A1. Celiac disease is an autoimmune disorder in which the absorptive surface of the small intestine is damaged in genetically susceptible individuals when they ingest gluten. The immune system sees gluten as a toxin.

Q2. What causes celiac disease?

A2. For some people, celiac disease runs in families. You may have a genetic disposition to inherit the disorder (HLA gene with DQ2 or DQ8 allele). In addition, type 1 diabetes and celiac disease are found on the same region on a specific HLA gene. For other people, celiac disease may be activated by illness, surgery, viral infection, stress or pregnancy.

Q3. I've heard that celiac disease can affect the skin too?

A3. Dermatitis Herpetiformis (DH) is another autoimmune disease caused by gluten intolerance. It results in itchy, blistering skin with a rash usually on the elbows, knees, buttocks or back. DH can be diagnosed with skin biopsy. The skin irritation can be relieved with medication (dapsone). However, this does not prevent damage to the small intestine.

Q4. Why is celiac disease under-diagnosed?

A4. Diagnostic criteria is changing. Previously an intestinal biopsy was required. Now, a TTG (tissue transglutaminase) blood test has been provided 90-95% accuracy.

Q5. What are some symptoms of celiac disease?

A5. Digestive problems include diarrhea, constipation, gas, cramps, bloating, vomiting, or reflux. Other problems may include:

  • Behavioral changes: mood swings, depression, sleeping problems
  • Respiratory problems: wheezing, shortness of breath, sinus problems, throat clearing, dry cough
  • Skin problems: eczema, dry skin, hives or rashes, itchiness, flushed color, welts
  • Pain: aches in joints or muscle, loss of strength, migraines
Q6. Who should be treated for celiac disease?

A6. Individuals with gastrointestinal symptoms, short stature, delayed puberty, iron-deficiency anemia, infertility or early osteoporosis should discuss testing with their doctor. Also, individuals with Type 1 diabetes, other autoimmune diseases or who have relatives with celiac disease should be tested.

Q7. If I have celiac disease, where do I start to become gluten-free?

A7. Simple but important steps include:
  • Consult with a registered dietitian.
  • Thoroughly clean the kitchen (including a separate toaster, hand towel, refrigerator shelf).
  • Plan on simply prepared meals with the right ingredients.
  • Always check labels (food, medications, cosmetics, toiletries).
  • Keep separate toothpaste and dental floss.
  • Avoid contact surfaces at work.
  • Pack your own food when traveling.
PeaceHealth Southwest's Diabetes, Endocrine & Nutrition Center also can help.

Q8. Where can I find out more about celiac disease?

A8. Click on or contact any of these resources: Q&As excerpted from Celiac Disease and the Gluten-Free Diet, presented by Dee Sandquist, MS, RD, CD