Elimination Diets and Food Challenges: Can They Help Diagnose Celiac Disease?
Celiac disease is diagnosed by blood tests and biopsy, not through tests that determine food allergies.
By Connie Brichford
Medically Reviewed by Pat F. Bass III, MD, MPH
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Celiac disease is often confused with food allergy, specifically wheat allergy. It’s easy to understand why this misconception is so common. If you have either of these conditions, wheat and wheat products are off limits, and the treatment for both conditions is to avoid eating wheat entirely.
But it’s more complicated than that, and the critical differences between celiac disease and food allergies make the methods of diagnosing them vastly different. “Elimination diets are used for allergies, and not used to diagnose celiac disease,” says Carol Shilson, executive director of the University of Chicago Celiac Disease Center. In fact, cutting out gluten before you have a definite diagnosis of celiac disease can actually make it harder to diagnose.
Differences Between Celiac Disease and Food Allergies
Arthur DeCross, MD, an assistant professor of medicine and the director of the gastroenterology fellowship program at the University of Rochester Medical Center in New York, explains the differences between celiac disease and wheat allergy.
- Intestinal disorder.“Celiac disease is a disorder of the intestinal immune system, which is triggered by exposure to wheat (as well as rye and barley),” Dr. Decross says. Celiac disease is an autoimmune disease that damages your small intestine, which hampers the way your body absorbs nutrients.
- Wheat allergy.“A wheat allergy involves the allergy cells of the immune system, and is not different from an allergy to anything else, like pollen or peanuts. Allergic reactions can be severe or mild, but they do not have the same consequence as having celiac disease,” says Decross.
- Lifetime commitment.While people with a wheat allergy may someday be able to eat wheat again, this is not possible for people with celiac disease, because celiac disease does not go away. Shilson emphasizes that with celiac disease, treatment is a lifetime commitment. “Treatment is strict adherence to a gluten-free diet for life,” she says.
Elimination Diets and Food Challenges
The idea behind an elimination diet is fairly straightforward. If you suspect that a certain food might be causing your problems, you remove that food from your diet for a short time, and then reintroduce it into your diet, keeping track of how you feel before, during, and after the trial period.
Food challenges are also pretty much what they sound like. If you suspect that you are allergic to a certain food, you are “challenged” with the food in question by eating increasing quantities of the food, while your reaction is closely observed by your doctor. Because severe allergic reactions can lead to anaphylactic shock and death in extreme cases, this type of test should be done under a doctor’s direct supervision.
Food challenges and elimination diets are not useful for celiac disease because they rely on observing the body’s reaction to foods. While some celiac disease symptoms such as diarrhea, abdominal bloating, or abdominal pain can be observed, some people experience no symptoms at all. The real action of celiac disease happens inside the small intestine and can only be detected through blood work and biopsy.
Celiac Disease vs. Allergy: Why the Right Diagnosis Is Important
Although you could do an elimination diet at home, it’s not enough to discover that your body doesn’t react well to wheat. You need to know whether you have an allergy or celiac disease.
“The biggest issue if you don’t get diagnosed is genetics,” says Shilson. “It’s not good health information for the rest of your family.” Celiac disease runs in families, so getting a firm diagnosis can alert the rest of your family that they are at risk as well.
Another big issue is the risk of serious complications for untreated celiac disease.
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