It might just be me, but it seems like everyone I meet these days is gluten intolerant. As a dietician, I have come across many people who follow gluten free diets, most for the right reasons. Among those on a gluten free diet, there is one major problem…not everyone is gluten intolerant. The issue here is the difference between a medical diagnosis and a self-diagnosis. So what is gluten, what does it mean to be gluten intolerant, and how do you know if you really are?

Gluten is a protein found in wheat, rye and barley. It is mainly found in food products, but may also be found in every day products such as medicines, vitamins and lip balms. For a long time it was recommended that those who were intolerant to gluten should also avoid oats, however, new evidence suggests that most people can tolerate oats in small amounts, as long as they have not been contaminated with gluten during processing.

The condition most commonly associated with gluten intolerance is coeliac disease. Coeliac disease is a digestive disease that damages the lining of the small intestine and interferes with the absorption of certain nutrients from food. People with coeliac disease cannot tolerate gluten. When they eat gluten, it damages the lining of the small intestine, and does not allow nutrients to be absorbed, causing vital nutrients to be lost in the stool, rather than absorbed into the bloodstream.

Some people are so gluten intolerant that even a small dusting of gluten on something they eat can cause symptoms. Symptoms of coeliac disease vary from person to person and can range from very mild to severe.

Possible symptoms may include:

• Abdominal bloating and pain
• Chronic diarrhoea
• Nausea and vomiting
• Constipation
• Pale, foul smelling, fatty stool
• Weight loss (in some cases – seen more in children than adults)
• Fatigue
• Bone or joint pain
• Depression or anxiety
• Arthritis
• Bone loss or osteoporosis
• Unexplained iron-deficiency anaemia
• Skin rash (dermatitis herpetiformis)
• Hair loss (alopecia)
• Mouth sores
• Tiredness and/or headaches
• Infertility or recurrent miscarriages
• Poor muscle co-ordination
• Numbness and tingling in the hands and feet

The list of symptoms for coeliac disease is a rather long one.

Because some of the symptoms of coeliac disease are similar to other diseases, it can easily be confused with irritable bowel syndrome, iron-deficiency anaemia, inflammatory bowel disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, coeliac disease has long been under-diagnosed or misdiagnosed.

With more reliable blood tests becoming available, diagnosis rates are increasing. There is still, however, a problem with self-diagnosis. Self-diagnosis can be dangerous. Since coeliac disease covers a range of symptoms, many people who experience any of these symptoms automatically conclude that they are gluten intolerant, and eliminate gluten from their diet. The problem with this is that by unnecessarily eliminating gluten from your diet you may be lacking certain vitamins and nutrients. Many grains are enriched with vitamins, and by avoiding grains on a gluten-free diet, it may mean you’re not getting enough key nutrients such as iron, calcium, fibre, and B vitamins (thiamine, riboflavin, niacin, and folic acid).

If you experience any of the symptoms above after eating gluten, and believe you might have coeliac disease, make sure you go to the doctor to get a proper diagnosis. In order to get a clear diagnosis, it is important to continue eating gluten. A blood test, followed by a biopsy of the small intestine will determine if you have coeliac disease or not. If you have already eliminated gluten from your diet, a biopsy will be unable to show any damage to the lining of the intestine, and may give you a false negative. If you tested negative for coeliac disease, but still experience symptoms, there may be another reason.

Make sure to consult a doctor first to find out the reason behind your symptoms before cutting gluten out of your diet, and possibly missing out on essential vitamins and nutrients. For people with coeliac disease, following a gluten free diet is not just another fad diet, but something they have to follow for the rest of their lives.

Written by BKR