The picture of celiac disease is changing, and non-celiac gluten sensitivity, which affects considerably more people, is gradually being acknowledged. What is being discovered about these two conditions is shifting so rapidly, it’s difficult to keep up. Here are surprising recent findings about celiac disease:

• People diagnosed with celiac disease are more likely to have either no symptoms or symptoms that are atypical instead of the classic symptoms of diarrhea, weight loss, and malabsorption. In adults, some of the more common presenting symptoms are constipation, acid-reflux-type conditions, anemia, bone disease, or neurologic symptoms.
• Children older than 3 who are diagnosed with celiac disease are more likely to have nongastrointestinal conditions, including type 1 diabetes, thyroid disease, Down syndrome, iron-deficiency anemia, short stature, or mood disorders.
• Most people diagnosed with celiac disease are normal weight or overweight rather than underweight.
• Celiac disease is largely underdiagnosed. For each diagnosed case, there are five to 10 undiagnosed cases.

Getting to Know Gluten Sensitivity
Skepticism in the conventional medical community still exists regarding gluten sensitivity that isn’t celiac disease, but the condition is slowly being recognized. In 2005, the Gluten Intolerance Group developed a medically approved handout on gluten sensitivity. During the past few years, Web sites with a primary or exclusive focus on gluten sensitivity have developed. Last year, Alessio Fasano, MD, medical director of the University of Maryland Center for Celiac Research, published research on gluten sensitivity. He recently said that there is “no question” that gluten sensitivity affects considerably more people than celiac disease does and that 60 to 70 percent of the patients who come to the Center for Celiac Research appear to have gluten sensitivity. He and other researchers are conducting more research to better define the condition and find new ways to test for it.

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In 2008, new revelations were discovered:

• In both gluten sensitivity and celiac disease, the innate immune system, the most ancestral form of defense we have against “invaders,” reacts to gluten. However, in celiac disease, the adaptive immune system, a more recent branch of our immune system, also responds and coordinates with the innate immune system to produce the autoimmune reaction.
• Human beings aren’t alone in having nonceliac gluten sensitivity. Rhesus monkeys, which are genetically similar to human beings, have it too. One study found that many captive rhesus monkeys that were fed a food with gluten had symptoms such as diarrhea, bloating, fatigue, depression, and skin rashes and blistering. Nearly all of those had elevated IgA and/or IgG antigliadin antibodies, which are indicators of gluten sensitivity. Only a few tested positive for celiac disease. When the animals were fed gluten-free food, their antibody levels normalized and symptoms disappeared.

Recommended Tests
How do you know if you have gluten sensitivity? Some nutritionists and doctors recommend the Enterolab gluten sensitivity stool test developed by Kenneth Fine, MD, who developed his test after he became frustrated by so many gluten-reactive people not testing positive on traditional blood tests. Others, such as Fasano, say that the best strategy is to get tested for both celiac disease and wheat allergy. If you test negative for both conditions, try a gluten-free diet and see if any uncomfortable symptoms that you have resolve. If they do, you probably have gluten sensitivity.

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