Could Celiac Disease Be the Cause of Your Lower Abdominal Bloating?

Dish of Cookies   by Maren Sederquist, MES, CSCS, CPT

Celiac Disease is an intolerance for ingesting gluten, the proteins found in wheat and some other grains. A bloated abdomen is just one of the common symptoms. People can have a variety of gastrointestinal symptoms, seemingly unrelated complaints, or no symptoms at all. It’s been estimated up to 1% of the U.S. population could have Celiac Disease.

Celiac Disease may appear at any time in a person's life. Some people seem to be genetically susceptible. The disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy or childbirth. It causes damage to the mucosal surface of the small intestine caused from an immunologically toxic reaction to the ingestion of gluten, and interferes with the absorption of nutrients, and can lead to other complications.

Classic symptoms include:

    • Abdominal pain
    • Anemia
    • Cramping
    • Intestinal gas
    • Distention
    • Bloating
    • Constipation
    • Diarrhea (chronic)
    • Irritable bowel syndrome
    • Steatorrhea (fatty stools)
    • Weight gain
    • Weight loss with large appetite

Other symptoms: 

    • Aphthous ulcers
    • Bone or joint pain
    • Dental enamel defects
    • Depression
    • Fatigue, weakness and lack of energy
    • Infertility (male and female)
    • Migraines
    • Muscle cramps
    • Osteopenia or Osteoporosis
    • Rheumatoid conditions

 

Diagnosis

The first step for diagnosis is a panel of blood tests. Sometimes called a Celiac Panel, it should include the following tests: anti-endomysial antibody (lgA EMA) and anti-gliadin antibody (lgA & IgG), and tissue transglutaminase (tTG IgA). You MUST have gluten in your system to test positivie, so make sure you're not staying away from gluten before being tested!

Since tests can produce both false positives and false negatives, a small bowel biopsy is usually done to confirm the diagnosis. Even then, patients are frequently misdiagnosed as having Irritable Bowel Syndrome, Spastic Colon, or Crohn's disease.   

When blood tests and biopsy are inconclusive, testing for specific HLA (human leukocyte antigen) genes associated with Celiac Disease may be done.

Because osteoporosis is common for Celiacs, bone density should be measured upon diagnosis. 

 

Treatment

Unfortunately, there is little incentive for research, since Celiac Disease is perceived to be rare, and money-making surgery and drugs are not the answer. So, for now, the only treatment for Celiac Disease is a lifelong adherence to a gluten-free diet. When gluten is removed from the diet, your small intestine will start to heal and you should start feeling better almost immediately. However, it may take months to years for your overall health to improve. 

Adapting to a gluten-free diet requires a tremendous lifestyle change.  It is essential to read labels, which are often imprecise, and to learn how to identify ingredients that may contain hidden gluten. Wheat-free is not necessarily gluten free.

 

The following grains and derivatives should NOT be consumed:

  • Wheat (Durum, Graham, Semolina, Kamut, Spelt, Einkorn, and Faro)
  • Barley (Malt, malt flavoring, malt vinegar)
  • Rye
  • Triticale (A cross between wheat & rye)

 Common products containing or possibly containing gluten:

(Contact with these ingredients during processing can be enough to contaminate a product!)

  • Binders
  • Blue cheese
  • Bread
  • Breading
  • Broths
  • Brown rice syrup
  • Candy (hard candies, licorice, jelly beans, some chocolates, others)
  • Caramel coloring (made from barley malt enzymes)
  • Cereals
  • Coatings and coating mixes
  • Cold cuts
  • Colorings
  • Communion wafers
  • Condiments
  • Crackers
  • Croutons
  • Dextrins
  • Dispersing agents
  • Emulsifiers
  • Excipients (added to prescription medications)
  • Extenders
  • Extracts
  • Fillers
  • Flavorings
  • Flours made with above grains or derivatives
  • Grain alcohol (ale, beer, bourbon, gin, grain vodka, lager, rice beers (use malt), rye, scotch, whiskey)
  • Gravies
  • Herbal supplements
  • Homeopathic remedies
  • Hydrolyzed protein
  • Hydrolyzed plant protein (HPP)
  • Hydrolyzed vegetable protein (HVP)
  • Imitation bacon
  • Imitation seafood
  • Lipsticks
  • Low or non-fat products
  • Marinades
  • Modified starch, modified food starch (when derived from wheat)
  • Mono- and di-glycerides (made using a wheat starch carrier)
  • Nutritional supplements
  • Oils (wheat germ oil & any oil with gluten additives)
  • Packaged foods
  • Panko
  • Pastas
  • Pharmaceutical Drugs & Over-the-Counter Medications (Request clarification from food and drug manufacturers when necessary.)
  • Playdough
  • Preservatives
  • Processed luncheon meats
  • Sauces
  • Self-basting poultry
  • Soups and soup bases
  • Soy sauce or soy sauce solids (when fermented using wheat)
  • Spices (if containing anti-caking agents)
  • Starch (made from grains listed above, unidentified starch, modified food starch)
  • Stuffing, Dressing
  • Texturized vegetable protein (TVP)
  • Thickeners (Roux)
  • Toothpaste
  • Vegetable gum (when made from oats)
  • Vegetable protein
  • Vinegars (distilled clear and white or with a mash starter)
  • Vitamin E oil
  • Vitamins & Mineral Supplements

***When in doubt, contact the manufacturer!

 

As hard as it is, if you've been diagnosed with Celiac Disease it's really important to avoid ingesting gluten. Many specialists think untreated Celiac Disease, even without obvious symptoms, can lead to many other complications.

Illnesses associated with untreated Celiac Disease:

    • Anemia
    • Central and peripheral nervous system disorders
    • Intestinal Lymphomas and other GI malignancies
    • Lactose intolerance
    • Osteoporosis
    • Pancreatic insufficiency
    • Vitamin K deficiency associated with risk for hemorrhaging
    • Vitamin and mineral deficiencies

Other associated autoimmune disorders:

    • Dermatitis Herpetiformis (DH)
    • Insulin-dependent Type I Diabetes Mellitus
    • Liver Diseases
    • Systemic Lupus Erythematosus
    • Thyroid Disease

Less commonly linked to Celiac Disease:

    • Addison’s Disease
    • Alopecia Areata
    • Chronic Active Hepatitis
    • Down Syndrome
    • Graves' disease
    • Infertility
    • Myasthenia Gravis
    • Rheumatoid Arthritis
    • Scleroderma
    • Sjogren’s Syndrome
    • Turner Syndrome
    • Williams Syndrome

 

Ok, What Can I Eat?!

The list of foods to avoid is so long you may feel like there's nothing left you can eat. There is however, a wide variety of foods left over. All fresh fruits and vegetables; nuts and seeds; meats, poultry & seafood, dairy, and the following grains & starches are allowed:

  • Amaranth
  • Arrowroot
  • Beans
  • Buckwheat
  • Corn
  • Garfava
  • Millet
  • Montina®
  • Nut Flours
  • Soy
  • Potato
  • Quinoa
  • Rice
  • Sorghum
  • Tapioca
  • Tef

Research suggests that pure, uncontaminated oats in moderation (1 cup cooked) daily are safe for most persons with celiac disease, but many oat products are contaminated with gluten during processing, so be cautious.

Alcohol that is safe: wine, rum, tequila and sake.

If Celiac Disease has been ruled out as the cause of your lower abdominal bloating, look for sensitivities or allergies to other foods. Dairy products are another common cause of bloat.

 

References / Resources:

Celiac Disease Foundation

Gluten Intolerance Group of North America

Great publications for more info

A Celiac Disease and Gluten-Free Resource Since 1995

Gluten Free Mall

Whole Foods has a gluten-free shopping list and a gluten-free bakehouse.

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