Tests and Treatment
Many people go years without knowing they have celiac disease, while others believe they have it when they actually don’t. Identifying celiac disease can be tricky (if you’re not looking for it), because symptoms may be general, vague or entirely absent. Tests and treatment for celiac disease is a bit of a journey, but it is manageable with practice and open communication with your doctor.
If you think you may have celiac disease and your doctor doesn’t raise the possibility, don’t be afraid to bring it up yourself. In Canada, the average time from the start of symptoms to diagnosis is 12 years for adults and 1 year for children. This should not be the case. Fortunately, new blood screening tests are improving the speed and accuracy of diagnosis. The most effective of these tests are:
- IgA anti-transglutaminase antibody test (tTG)
- IgA anti-endomysial antibody test (EMA)
If you have a positive blood test for celiac disease, you’ll need an upper endoscopy and intestinal biopsies (tissue samples) to know for sure whether you have the disease. This safe outpatient or day procedure is performed under sedation.
If you want, you can reduce the gluten in your diet to the equivalent of 1-2 slices of bread per day without affecting the biopsy results but do not cut out gluten altogether as a gluten free diet before the biopsy may reduce damage which makes it very difficult to confirm the diagnosis.
How is celiac disease treated?
Treatment for celiac disease is both simple and challenging. Those with the disease must maintain a strict gluten-free diet for life. By avoiding gluten, you allow your intestine to heal. Your other symptoms should gradually subside and your risk of developing serious complications of untreated celiac disease will be reduced
Going gluten-free can be challenging because it requires you to educate yourself about foods that contain gluten, to watch for “hidden” gluten in food products and medications, and to give up a number of common foods you may enjoy. Here’s a partial list of where gluten can be found:
• Most breads and baked goods (e.g., muffins, donuts, cakes)
• Many other grains, including spelt and kamut
• Most breakfast cereals
• Most pasta
• Some soups, sauces and salad dressings
• Some processed meats and fish (e.g., wieners, imitation seafood)
• Most beer (which contains barley)
• Some cosmetic products
• Some condiments.
Fortunately, the world has become a much friendlier place for people who can’t eat gluten. In fact, in 2009 the gluten-free diet became the # 1 “speciality diet” in North America. Grocery stores stock an increasing number and variety of gluten-free products, including gluten-free versions of pasta, bagels, crackers, pretzels, and other baked goods. Be sure that these products are nutritionally sound before using them. Gluten-free options are also gaining ground in restaurants, cookbooks and cooking websites. You should also check out our 7 day gluten free diet plan!
Once you’ve been diagnosed with celiac disease, ask your doctor to refer you to a registered dietitian with expertise in celiac disease for nutritional counselling. Your local chapter or the national office of the Canadian Celiac Association can also provide excellent resources about diagnosis and management. You will most likely need to start Vitamin D and may also require extra iron and multivitamins until your intestine heals.
You should get follow-up blood testing to verify that your intestines are healing. This will be done ideally 3-6 months after you’ve started a gluten-free diet and every 1-2 years after that. Some, but not all people, require a repeat intestinal biopsy.
Adults living with celiac disease who have symptoms of malabsorption (such as diarrhea, weight loss, or anemia) or bone pain need a bone mineral density (BMD) test at diagnosis and annually afterwards until the problem is resolved. You should also request BMD testing if you are a woman at menopause or a man over age 50. Children’s bones heal rapidly and most do not require a BMD.