Celiac disease diagnosis testing and diet

Celiac disease diagnosis iceberg

Celiac disease diagnosis iceberg

Celiac disease diagnosis is essential for everyone who believes they may be gluten intolerant. Usually, taking a gluten intolerance test is the first step towards diagnosing celiac disease. People who test positive for gluten intolerance are at an increased risk of celiac disease and further diagnostic testing is advised.

Gluten intolerance can be an annoyance, but celiac disease poses far more severe health risks. Gluten intolerance is a relatively mild reaction to gluten. With gluten intolerance, the body mistakes gluten (a protein found in a variety of grains) for a bacteria. The body tries to fight off the nonexistant “bacteria”, which causes a variety of symptoms. This is certainly unpleasant. Celiac disease, however, causes a range of far more serious complications, which we will get into later. Celiac disease diagnosis is the only way to determine which health risks apply. The question is, does eating gluten cause a mere inconvenience or a debilitating condition?

Celiac disease diagnosis is shockingly rare. The metaphor “tip of the iceberg” is applied often and aptly to the lack of Celiac disease diagnosis. Succesfull Celiac disease diagnosis represents the mere tip of the iceberg. The vast majority of Celiac cases remain undiagnosed. For the people affected this is catastrofic. Failure to diagnose Celiac disease spells a lifetime of health problems, even brain damage for them.

The lack of Celiac disease diagnosis can be attributed to two factors: Celiac disease can cause vague symptoms which are not always easy to associate with the eating of gluten. People with Celiac disease may even be entirely asymptomatic. Secondly, establishing a Celiac disease diagnosis is not easy. A variety of tests are needed to complete Celiac disease diagnosis. We will discuss more about testing later.

What causes Celiac Disease?

Celiac disease is an auto-immune condition in which the body reacts to gluten.

Gluten is a protein found in rye, barley, wheat and thousands of products that are made with these grains. Gluten is made up of several components, including gliadine and glutenine. Both gliadine and glutenine can cause health issues. Gluten intolerance and Celiac dissease are both usually caused by gliadin. Gluten allergy is a third, distinct, condition. People can also be allergic to glutenine. This is a seperate issue from Celiac disease. These different conditions, all caused by the same grains, can be confusing and difficult to differentiate. That is why Celiac disease diagnosis is so essential.

The immune system of people with Celiac disease gets triggered by gluten, thereby causing an auto-immune reaction and damage to the intestines. Celiac disease is quite common, probably occuring in 1% or more of the population, but it is difficult to say, with most cases not yet discovered.

Living with Celiac disease

We will try to provide useful information and advice about living with the disease. This includes finding a suitable diet and finding the right medical research to get an accurate Celiac disease diagnosis. Before considering the implications of living with Celiac disease, it is better to first determine if there really is in fact Celiac disease. Celiac disease diagnosis is needed so that Celiac disease doesn’t get confused with gluten intolerance or wheat allergy.

Celiac disease diagnosis: finding the best tests

Celiac disease diagnosis is not easy to obtain. Usually a series of tests are needed.

 Celiac disease diagnosis by testing stool samples

Stool tests are a quick and (cost) effective way to test for gluten intolerance. One cannot get a Celiac disease diagnosis from stool testing alone, but stool testing can help determine if further diagnostic testing for celiac disease is required. In other words, stool testing can help make a preselection of people who have the highest chance of Celiac disease. Both gluten intolerance and Celiac disease causes the human body to make antibodies against gliadin. These antibodies, called antigliadin, can be measured by a laboratory.

For reliable results, Celiac disease diagnosis must be done by a laboratory with validated antibody tests. There are so-called “instant” and “home” tests on the market, but these can not make a distinction between the relative levels of antigliadin. For a reliable gluten intolerance test, the levels of antigliadin must be compared to the total antibodies present in the stool. People with low levels of total antibodies can never have high levels of antibodies against gluten. But this doesn’t mean they don’t have gluten intolerance or Celiac disease!

Celiac disease is an autoimmune disease, with serious risks, while a gluten intolerance is much less severe. This is a point we will keep making, because it is so important. Celiac disease diagnosis is essential for the health. We will get into the dangers and problems encountered by people with Celiac disease who continue to eat gluten.

Simple home tests may indicate a physical reaction to gluten. It is quite something to know if there is a gluten intolerance. It is useful information, and not necessarily a bad place to start. The point is, don’t stop there! If the home test for gluten sensitivity is positive, keep testing and get a proper Celiac disease diagnosis. A true celiac disease patient requires much more stringent measures than a “normal” gluten intolerance does. It is therefore recommended that Celiac disease diagnosis tests be carried out by a legitimate lab.

Perhaps the most effective research method is analysis of stool samples. The stools are full of information about the reactions of the body, and these reactions can still be measured. These are the primary three tests used for Celiac disease diagnosis:

  • Anti-Gliadin
  • t-Transglutaminase
  • Secretory IgA

Introductory Information on Celiac Disease

Celiac disease is one of the causes of chronic intestinal disorders such as diarrhea and constipation. Celiac disease can lead to various complications such as anemia, weight loss and chronic fatigue.

The intestines have significant influence on our emotions: hormones such as serotonin are created in the gut. Emotions can become distorted, and symptoms may seem to have psychological nature, when in fact a condition such as Celiac disease may be to blame. With celiac disease seems to cause people to be moody and a feel down. People with Celiac disease are therefore often misdiagnosed as needing psychological help, while they are actually suffering from an illness and need Celiac disease diagnosis! At least 60% of cases of celiac disease has not been discovered, but more likely the tip of the iceberg is even much smaller.

Unfortunately, people with Celiac often live for years with chronic bowel issues without getting a Celiac disease diagnosis. In fact, most people with Celiac disease never get a proper Celiac disease diagnosis, and may never figure it out.

Gluten intolerant people need to mind what they eat. Someone with Celiac disease, however, has to be extremely careful. Just a trace of gluten can harm the body for months. Gluten can be found in many cereals: wheat, oats, rye, barley, spelt and kamut. Especially wheat (flour) is added to many products, sometimes where you would not expect to find it. Therefore, someone with Celiac disease is required to inspect everything they eat for gluten, and will often have to abstain from foods.

It isn’t realistic to live like that unless it is absolutely necessary. That is another reason Celiac disease diagnosis is so important: people who undergo Celiac disease diagnosis and discover they do not have Celiac disease can eat gluten without being overly concerned.

Most people who test positive for a gluten intolerance test don’t have Celiac disease. They have a problem with gluten, but the problem relatively minor in comparison. Getting tested for gluten sensitivity is great, but dont stop there! Seek a Celiac disease diagnosis to find out how bad the problem is.

Misdiagnosis of Celiac disease

Doctors often fail to diagnose Celiac disease. Unsure what it is that causes the symptoms, doctors often call Celiac disease related symptoms “IBS” (irritable bowel syndrome). IBS is a label often attached to misdiagnosed people with chronic intestinal problems. Doctors sometimes simply do not come up with the idea to test the patient for reactions to gluten. This is a shame, because a lot of people have diet related health problems, and wheat is way up there on the list of common allergens.

In general, IBS is attributed to a variety of undiagnosed conditions. This is a shame, because there is no specific treatment for IBS. Often the symptoms are caused by a real condition, such as intestinal parasites, problems with the intestinal flora, Candida albicans or other treatable problems. All of the above mentioned conditions can be solved, or at least moderated, as in the case with Celiac disease. When a doctor fails to diagnose these conditions, and instead calls the symproms “IBS”, the patient is misdiagnosed. Gluten intolerance is an important cause of IBS liek symptoms. Testing can expose gluten as a problem and further testing can lead to Celiac disease diagnosis.

Wheat can cause a number of issues. In many cases there is a starch intolerance, wheat allergy, gluten intolerance – and in the more rare cases – Celiac disease.

When the doctor doesnt come up with the idea to test for celiac disease, its up to the people with symptoms to search for solutions themselves. It can be as simple as communicating the desire to be tested to your GP. Saying something like: “I feel bad when I eat gluten, and I want to know if I have Celiac disease or a wheat allergy” may be all it takes to get your doctor to help you take the right tests. Some people have doctors who simply don’t want to cooperate with the initiatives of their patients. If this is the case, consider getting a second oppinion: it’s your right to do so.

Celiac Disease Symptoms

The symptoms of celiac disease can range from mild (even unnoticed) to severe. Some people don’t even notice any symptoms, yet their intestines may be damaged by the disease. Celiac disease is sometimes misdiagnosed as Crohn’s disease or stomach ulcers in addition to irritable bowel syndrome. Gastrointestinal symptoms caused by Celiac disease may include:

  • abdominal bloating and abdominal pain
  • diarrhea
  • vomitting
  • constipation
  • smelly stool

How exactly does Celiac disease damage the body?

We need to start by dispelling a common misconception. It is thought by some people the gluten protein itself actually causes the damage. Some people mistakenly think (and write online!) that gluten damages the mucosa of the small intestine, so that the intestine cannot absorb nutrients any more. This is a complete misconception! Gluten proteins themselves are innocent. Hence, not everyone is bothered by gluten. Gluten is not “bad”. But gluten is eaten by many way people too often, making it likely that they eventually develop symptoms of intolerance. With Celiac disease, genetics play an important role in addition to overstimulation caused by eating too much gluten. Genetic testing is very valuable for Celiac disease diagnosis. Read more about Celiac disease diagnosis and genetic testing.

Celiac disease Auto-immune response

With Celiac disease, it is the human body which is in the wrong: the body is mistaken, and thinks that the gluten are dangerous. Then the immune system tries defending the body. This causes all kinds of symptoms that also occur when we are sick and our immune system is defending us against real dangers. Symptoms such as diarrhea, constipation and abdominal pain are common.

Celiac disease and malnutrition

Celiac disease can also lead to shortages of all kinds of nutrients, causing weight loss and even malnutrition. The intake of vitamins (especially vitamin D) and minerals like iron and calcium are effected. The small intestine can no longer absorb these nutrients efficiently. Deficiencies of calcium and vitamin D can cause osteoporosis (bone loss) and eventually spontaneous bone fractures may occur.

Iron shortages can in some cases leads to anemia, which is reflected in fatigue and lethargy (this is also consistent with the common misdiagnosis, that people with Celiac disease supposedly have emotional or mental problems would.

A shortage in essential dietary intake by kids with Celiac disease in children can lead to growth disorders. Celiac disease diagnosis is recommended for kids with growth disorders.

Celiac disease diagnosis and a gluten free diet

Fot those considering Celiac disease diagnosis, please note this important consideration: Celiac disease diagnosis is only possible for people who actively eat gluten. Celiac disease diagnosis is based on finding reactions of teh body to gluten. If there is no gluten in the body, there won’t be a visible reaction either. Often people start a gluten free diet before receiving a Celiac disease diagnosis through medical testing. Going on a gluten free diet is a nice idea on teh one hand, but somewhat impulsive on the other, because a gluten free diet effectively prevents a Celiac disease diagnosis. People who are on a diet but want to get a Celiac disease diagnosis, need to eat gluten for at least 6 weeks (3 months is better) before taking the tests.

Complications of Celiac disease in men and women

Women who have Celiac disease experience more symptoms than men. Gluten allergy is also more common in women: the female / male ratio is 2:1. Possibly, this ratio is not correct, and Celiac disease is simply overlooked in men more often. Since women have more stomache complaint symptoms than men and more often have anemia, they are more likely to be tested and to receive a Celiac disease diagnosis if applicable.

Celiac disease and the skin

Celiac disease is often associated with skin disorders. Skin conditions and other skin complaint symptoms caused by gluten are found more frequently with men than with women. Celiac disease diagnosis is of value to people with skin conditions, as the correlations are very strong.

Dermatitis herpetiformis

Dermatitis herpetiformis is an itchy skin rash. It mainly occurs on the elbows and knees. The skin condition is also common without any IBS or other bowel symptoms. Atopic dermatitis can be caused by wheat allergy.

Dermatitis herpetiformis was first described in 1884. Even as recent as 2004 there was still no consensus that Dermatitis herpetiformis is caused by gluten. It is now generally accepted that these skin problems are indeed caused by gluten. Epidermal transglutaminase occurs in normal skin. Serum IgA anti-epidermal transglutaminase is found in dermatitis herpetiformis patients. The transglutaminases which are found in Celiac disease and dermatitis are not identical, but are very similar.

Since the symptoms of Dermatitis herpetiformis disappear or decrease thanks to a gluten-free diet, it is fairly certain that Dermatitis herpetiformis is a form of gluten allergy.


A determination of IgA antibodies against gliadin in psoriasis patients showed that the levels were much higher than in the control.

Celiac disease diagnosis in the case of vitamin defficiency

Celiac disease is a serious condition. Therefore it is important that Celiac disease diagnosis be sought out as intensively as possible. The main root causes of complications caused by Celiac disease are protein deficiency, iron deficiency and depletion of vitamins and minerals.

People who suffer from vitamin, protein and / or iron dificiency should seek Celiac disease diagnosis. Celiac disease diagnosis should be done in the case of vitamin defficiency, as these deficiencies are reponsible for causing numerous health problems.

Vitamin B6 deficiency can have serious consequences, such as decreased thyroid function and depression. Also rheumatism is associated with a B6 deficiency. Folate and B12 deficiencies can cause elevated homocysteine ​​and thus an increase in heart disease. Gluten allergy also increases the chance of developing osteoporosis and thrombosis.

Celiac disease complications include atopy, autoimmune hepatitis and immuunthyroiditits, rheumatism, sacroidosis, pericarditis and neurological disorders. Celiac disease diagnosis may be useful for people suffering from all of these conditions.

Hidden Celiac disease

Most gluten allergies remain hidden forever. The question is whether this will always the case.  If we want to change that statistic, Celiac disease diagnosis will also be needed for the vast majority of Celiac patients – those with hidden Celiac disease. Diagnosis is needed to see hidden Celiac disease without obvious clinical symptoms.

Even without clinical symptoms, Celiac disease patients form antibodies to gluten. These are patients often have no gastrointestinal symptoms. That is what makes Celiac disease diagnosis so difficult in their case. These patients do suffer neurological disorders, joint pain, headaches, lung diseases and many other diseases. Only a Gluten intolerance test and possibly Celiac disease diagnosis can determine if gluten is the cause.

Should everybody with antibodies against gluten be screened for Celiac disease?

Obviously a lot of people are suffering from Celiac disease, and something should be done about it. But what? Is it necessary to screen the whole population for sensitivity to gluten?

That is a question that scientists have not yet fully answered. People sometimes make antibodies against gluten, but experience no symptoms. One may wonder whether a person has no symptoms but does make antibodies against gluten should receive Celiac disease diagnosis.

On the one hand, unattended Celiac disease may cause an increased risk of cancer and neurological diseases.

On teh other hand, an intestinal biopsy is also not without risk (though the risk is small). The real question is whether people who test positive for antibodies but have and no symptoms want to follow a lifelong gluten-free diet. Trying to get Celiac disease diagnosis for large populations may have more disadvantages than advantages. The responsibility for getting Celiac disease diagnosis comes down to the patient.

Celiac disease and Neurological symptoms

Celiac disease manifests not only in the intestines, the disease is also associated with neurological problems. Researcher Luostarinen found Celiac disease in 23% of patients with neuropathy and in 8% of patients with muscle weakness.

51.4% of Celiac patients develope neurological problems: muscle weakness (1%), dyslexia, learning disabilities or ADHD (31%), migraine or headaches (27%), memory loss and dementia (20%).

Especially in cases where Celiac disease diagnosis is made late, more complications occur.

Peripheral nerve disease (neuropathy) is the second most common complication of Celiac disease. Screening of patients with neurological disorders manifesting in the arms or legs – when no cause was found – revealed that 40% had a gluten allergy.

A study done on 143 people who had balance issues, including Ataxia, 41% had antigliadin circulating in their blood.

In another study of patients with neurological diseases of unknown cause, it was found in 57% of teh cases that there were gluten antibodies in the blood. People with known neurological disorders had only 5% anti-gluten substances circulating in their systems.

Behavioral issues and Celiac disease diagnosis

Celiac disease is associated with a variety of behavioral and emotional problems. Symptoms of depression occur with 31% of celiac patients (7% for others) and behavioral disorders with 28% (versus 3%).

Some of the complaints may stem from hormonal imbalances caused by Celiac disease or from the stress and heavy burden that the disease causes. For young people in particular, the gluten free diet can cause social problems and many young people find it difficult to maintain the diet. Of the 47 children who participated in a study in Sweden, 87% managed to stick to the diet and were as healthy as the control children.

While social pressures may be greater for young people, they experience less discomfort. Perhaps due to their youth, Celiac patients feel better when they are younger. A research showed that women who have been diagnosed with after their 20th birthday had more symptoms; 83% of celiac patients who were diagnosed before this age, claimed to feel good to very good.

Thyroid problems and Celiac disease diagnosis

Celiac disease causes low thyroid function relatively commonly. This is known as autoimmune hypothyroidism.

A vitamin B6 deficiency may play a role with a low thyroid function, and vitamin B6 deficiency may be caused by gluten allergy or Celiac disease.

Celiac disease is an auto-immune disease that is associated with another auto-immune disease called Graves hyperthyroidism. In one study, 14 % of the 111 patients with Graves had antibodies against gluten in their blood.

4.5% of Celiac patients have Graves and 0.9% in controls. patients with thyroid problems may want to consider tests for Celiac disease diagnosis.

Type I diabetes and Celiac disease diagnosis

Diabetes type I and cirrhosis of the liver are also autoimmune diseases and frequently occur with individuals with a gluten allergy or Celiac disease.

Celiac disease patients have diabetes in 3.2% of the cases. Diabetes is more common in families with a gluten allergy and Celiac disease.

A study of a large group of type I diabetes patients showed that 8.4% had celiac disease.

Pregnancy and the need for Celiac disease diagnosis

Research from Italy in 2002 indicated that 1 in 70 pregnant women there had celiac disease. In Ireland 1.6% of pregnant women had Celiac disease.

Women with Celiac disease reach puberty later and entered menopause earlier. Essentialy, their fertility is shortend. 38.8% of women with Celiac disease do not appear to have menstruation. A study of infertile women, where no disease was found, showed that with 1 in 13 cases the cause was a gluten allergy or Celiac disease.

Complications during pregnancy

Half of the women with undiagnosed and untreated Celiac disease will experience a miscarriage or complications during pregnancy. In almost all cases, these problems can be avoided in 6 to 12 months time on the right diet.

Folic acid deficiency increases the risk of neurological abnormalities in the baby.

Infants of mothers with Celiac disease have a lower birth weight. A Danish study of a group of 127 mothers with Celiac disease that their children had an average birth weight that was 238 grams lower than the weight of the children of healthy mothers.

The connection between Crohn’s diease and Celiac disease

Recent literature indicates that there may well be a relationship between Celiac disease and Crohn’s disease. In 27 patients with Crohn’s disease was antigliadine, anti-endomysium and anti-transglutaminase antibodies were tested. 9 individuals tested positive. A third had a gluten allergy! (Of course this is a small sample size, but the result is interesting.) Celiac disease diagnosis for Crohn’s patients is advized.

Headaches and Celiac disease:

There are different types of chronic headaches. The most well known are migraines, cluster headaches and tension headaches. Now chronic headaches are also becoming fairly common. 15% of the Dutch population has headaches at least 1 time a week.

Celiac patients with headaches and migraines improve significantly on a gluten-free diet.

Osteoporosis and Celiac disease

Serological tests of 89 women with osteoporosis, showed 17 of them had a gluten allergy.

Bone specific alkaline phosphatase is a useful measure for the mineral content of the bone. When the bone growth of children with Celiac disease is studied, bone specific alkaline phosphatase proves to be significantly lower than in healthy children.

The risk of bone fractures in celiac patients was 13% greater compared to controls, there was only a small difference between men and women.

Homocysteine and Celiac disease

Celiac disease patients suffer from a folic acid deficiency in 37% of the cases and in 20% of the cases from a B12 deficiency. This causes an increase in serum homocysteine ​​levels. Increases serum homocysteine raise the risk of heart disease and vascular disease. It can also lead to thrombosis and damage to the arteries. Another factor is a mutation of the methylenetetrahydrofolate reductase gene wihich may be caused by inflammation of the intestines.

Cancer and Celiac disease

No relationship has been found between cancer and Celiac disease. Celiac disease diagnosis does not appear to be of particular added value for people with cancer.

13% of adenocarcinomas occur in the small intestine, the same organ where Celiac disease causes so much damage. But there does not appear to be a correlation.

Breast cancer is not found more frequently in patients with a gluten allergy.

Gastrointestinal complications from Celiac disease


Of all aneurysms around the abdominal area,  4% are caused by celiac disease. Most aneurysms will go unnoticed, most are only detected when there’s a burst aneurysm.


Patients with acid reflux and inflammation of the esophagus have no more gluten allergies than other people. However, people who do have a gluten allergy in addition to reflux, are relieved of their symptoms when they do a gluten free diet.

Celiac disease symptoms

Gastrointestinal complaints

  • Hepatology
  • Canker sores or mouth ulcers
  • Spastic colon
  • Gastritis
  • Ulcerative jejunitis


  • Peripheral neuropathy
    Myalgia (ME)


  • Type I diabetes 1-2%
  • Infertility
  • Recurrent spontaneous abortion
  • Thyroid Diseases
  • Addison’s disease
  • Kidney Abnormalities

Blood Disorders

  • Anemia (iron, folate and vitamin B deficiency)
  • Platelets, by a vitamin K deficiency
  • IgA deficiency
  • Mild too small
  • T-cell lymphoma
  • Musculoskeletal

Bone abnormalities

  • Osteoporosis
  • Arthritis


  • Dermatitis herpetiformis
  • Psoriasis
  • Pigmanet Brown spots in mouth


  • Deviations enamel


  • Down syndrome (4-5% (poland)
  • Heart and vessels, increased homocysteine
  • Baldness: Alopecia areata
  • Sjögren’s syndrome


  • Cancer of the throat or esophagus
  • Small bowel adenocarcinoma