Sarah Schafer, MD
Celiac disease, gluten, and your health
Updated: May 22
Celiac disease impacts up to 1 out of every 10 Sjogren’s patients.
It is important to know if you have celiac disease because, if you do, eating even tiny amounts of gluten may cause lasting harm.
“Without a timely diagnosis, celiac disease can lead to intestinal cancers, type 1 diabetes, osteoporosis, thyroid disease, multiple sclerosis, anemia, infertility and miscarriage, epilepsy, and more.”
What is celiac disease?
“Celiac disease is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide, but only about 30% are properly diagnosed.” ~ The Celiac Foundation
Learn more about celiac disease here.
When people with celiac disease eat gluten, it damages the gut and causes widespread inflammation in the body.
If you have celiac disease, you must eliminate all gluten from your diet to stop the damage. Accidental ingestion of even tiny amounts of gluten causes intestinal damage, leading to digestive symptoms and widespread inflammation. This can result in nutritional deficiencies, lactose intolerance, peripheral neuropathy and more. It is also important to restrict gluten if you have non-celiac gluten sensitivity, but the consequences of minor gluten exposure are not as severe.
“People with celiac disease who don't maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.” ~ The Mayo Clinic website
What are the symptoms of celiac disease?
Celiac disease is frequently misdiagnosed as irritable bowel syndrome (IBS). Sjogren’s and celiac disease have many overlapping symptoms. Some people with celiac disease have no obvious symptoms. That is why doctors should not rely on symptoms alone when deciding whether to test for celiac disease.
Some of the most common symptoms include:
gastrointestinal (GI) such as abdominal pain, nausea, diarrhea, constipation, and bloating,
neurological, such as migraines, peripheral neuropathy, and “brain fog”.
general, such as joint pain and fatigue.
Learn more about celiac disease symptoms.
Every Sjogren’s patient should be screened for celiac disease, regardless of symptoms, because, if you do have celiac disease, the sooner you stop the damage, the better your health outcome.
Most doctors do not know about the Sjogren’s-celiac disease connection, even though an estimated 5-12% of Sjogren’s patients have celiac disease, versus 1% of the general population. It is the most common immune system comorbidity of Sjogren’s’ that impacts the GI tract. You may need to ask your doctor to screen you for celiac disease.
If you have symptoms, are at high risk, and/or have a positive screening test, ask for a referral to a gastroenterologist for a complete evaluation.
Take this quiz to determine your risk At a minimum, a screening blood test (described below) should be done, even if you don’t have symptoms. Celiac disease tests are not accurate unless you have been eating gluten. Be sure to discuss gluten intake with your doctor before you do blood tests or biopsies. If you have been eating gluten-free, discuss how to do a gluten challenge with your doctor.
Screening tests are intended for asymptomatic people to see if further diagnostic tests are needed.
Diagnostic tests are done to confirm the diagnosis.
Screening blood test
Every Sjogren’s patient should have a blood test for tissue transglutaminase IgA test (tTG-IgA test), regardless of symptoms. This test is almost always positive in celiac disease, but further testing is needed to officially diagnose the disease.
Learn more about screening tests for celiac disease here.
Diagnostic tests should be done if the tTG-IgA screening test is positive or if the patient is high risk. Usually, an intestinal biopsy is performed. Sometimes a skin biopsy or genetic tests are done.
Learn more about how the diagnosis of celiac disease is confirmed.
Can I skip the tests and just stop eating gluten?
NO. It is important to know if you have celiac disease to prevent unnecessary dietary restrictions and long-term damage to your health.
Many people who eat gluten-free for non-celiac reasons periodically “cheat” in small ways and are more likely to inadvertently ingest gluten. People who have been diagnosed with celiac disease cannot afford to do this because the effects of eating gluten can be severe. If you know you have celiac disease, you must be extremely careful to avoid eating even tiny amounts of gluten to avoid gut damage and long-term consequences. Learn why you should be tested before going gluten-free.
How is celiac disease treated?
The current treatment of celiac disease is a strict gluten-free diet. Many patients experience full symptom resolution by 6 months when they adhere to the diet. The gut lining usually heals in about one year. It is common for newly diagnosed patients to accidentally ingest gluten. Going gluten-free requires more than just eliminating wheat from the diet. Gluten is hidden in many foods, including soy sauce, vegan meat substitutes, ice cream, and fermented vinegars. What about non-celiac gluten sensitivity?
Non-celiac gluten sensitivity occurs in Sjogren’s but the number of patients impacted is unknown. Diagnosis of non-celiac gluten sensitivity is done with a food challenge test once celiac disease has been ruled out. Learn more here.
Is gluten bad for you if you don’t have celiac disease?
For most people, including people with Sjogren’s who don’t have celiac disease or non-celiac gluten sensitivity, gluten is perfectly fine to eat. Learn more about gluten and its impact on health.
Learn about the downsides of going gluten-free if it is not medically indicated.
Learn more about intestinal permeability and why “leaky gut” is not a medical diagnosis.