The gluten-free craze is unlikely to go away anytime soon. Many people say they feel better after adopting a diet free of gluten, a protein found in wheat, barley and rye, even though relatively few gluten avoiders have been given diagnoses of celiac disease, an autoimmune condition that can attack the intestines and other tissues when gluten is consumed. Approximately one person in 140 is known to have celiac disease, which can remain silent for decades and become apparent at any age. Celiac disease is an autoimmune condition that can attack the intestines and other tissues when gluten is consumed. Despite the current focus on gluten, there are probably many people walking around with celiac disease who don’t know they have it. The disorder can induce a host of vague and often confusing symptoms, the true cause of which may not be determined for a decade or longer. Among possible symptoms: abdominal pain, bloating, gas, chronic diarrhea, or constipation; chronic fatigue, anemia, unexplained weight loss, and more. When undiagnosed celiac results in persistent fatigue or infertility, “you can lose years of quality of life that you can’t get back,” Dr. Murray said. If symptoms are subtle, he added, “if the whole population were screened and people with celiac were found and treated, it could result in no health consequences.
The fact is, however, that celiac disease can remain silent for many years, during which time hidden damage can occur with lifelong, sometimes irreversible, health effects. And as a report for the United States Preventive Services Task Force that reviewed the evidence recently stated, many of these “adverse health consequences” are “potentially avoidable.” These factors suggest that a screening program to detect hidden disease might be health-saving for millions of people. However, after a thorough review of published reports, the task force did not endorse a screening program — not because it considers the condition not serious or because there is no screening test. Rather, the task force said, there is still not enough evidence to answer “key questions related to benefits and harms of screening for celiac disease in asymptomatic individuals.” The team concluded that a lot more well-designed research was needed before a screening recommendation could be justified as medically sound. “There’s a simple blood test for celiac, but it must be done before you change your diet,” Dr. Murray said in an interview. Until evidence is developed that could justify screening the entire population for celiac, Dr. Murray advocates screening “everyone in the at-risk group,” which would include family members of celiac patients and everyone with Type 1 diabetes, premature osteoporosis and anemia, which may be signs of celiac disease. He also advised that people with chronic bloating, mouth ulcers, chronic headaches or fatigue should be tested. Others who may be at risk for celiac include people with tingling or numbness in the arms and legs, thyroid disease, rheumatoid arthritis and Sjogren’s syndrome.