Q&A: Gluten Intolerance

What is Gluten Intolerance?

In this disease – also called celiac disease or native thrush – the inner lining of the intestine (the intestinal villi) is damaged by gluten. Gluten is a protein found in several grains, such as oats, rye, barley and wheat. Everyday food such as bread, biscuits and pasta therefore contains gluten. The damaged gut is unable to absorb food.

What are the complaints?

Especially abdominal complaints, a bloated feeling in the abdominal area for example. A patient may have diarrhea, but also constipation. The stool may be oily. Complaints occur after eating foods that contain gluten.

Are there any other complaints?

Yes. Because the absorption of food is so poor, the patient can lose weight. Minerals and vitamins can also be absorbed more poorly in the body. A lack of iron or folic acid leads to fatigue via anemia. A lack of calcium causes bone loss. There are patients who hardly have any abdominal complaints, but do have these other symptoms.

At what age do complaints occur?

In a number of patients it becomes clear at a young age, from the age of two, that they cannot tolerate gluten. Those kids have thin arms and round bellies. But in many people, the disease is not diagnosed until later in life. This may be because their villi did not become sensitive to gluten until later, or because the breakdown of the villi does not go so quickly in them. They don’t have to get sick from it for a long time, because the burden that gluten intolerance causes is not serious enough. It only becomes clear to them later that the stomach complaints are caused by gluten. It used to be thought that almost all cases of gluten intolerance were discovered before the seventh year of life. Today we find out that two-thirds of new patients are adults. Twenty percent of the new patients are even older than 60 years.

Who is gluten intolerance common?

Gluten intolerance is two to three times more common in women than in men. It is more common than average in people whose first- or second-degree relatives is gluten intolerant, as well as in people with diabetes.

How is the diagnosis made?

If a blood test from the GP indicates gluten intolerance, the patient is referred to a specialist. He can do blood tests. But the diagnosis can only be made with certainty by cutting a piece from the intestine (bowel biopsy) and examining it for damage to the intestinal villi.

How many people have gluten intolerance?

In 2004 research showed that 1 in 6000 Dutch adults knew of themselves to be gluten intolerant. However, researchers found that as many as one in 300 adults had a poor tolerance for gluten. The reason that many people do not know this themselves may be that the complaints are not so serious that they go to the doctor. Other researchers even estimate the number of gluten intolerances at one in 100 to 200 Dutch people.

What can be done about it?

Damaged intestinal villi recover as soon as the patient stops eating gluten. The damage is rarely permanent. After intestinal recovery, patients remain healthy as long as they do not ingest gluten. That is not always easy, because the gluten-free diet requires a lot of discipline. Gluten-free varieties of bread, cookies or pasta are expensive. A dietitian can help include alternatives such as rice, potatoes, corn and millet in the diet.

Information: Dutch Celiac Association, www.glutenvrij.nl,
tel. 033-247 10 40. Nutrition Center, tel. 070-306 88 88, has brochures about gluten-free diet and gluten-free branded products; also see www.voedingscentrum.nl.