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Expert, columnist discuss celiac disease and gluten sensitivity.
Learn more about gluten-related health problems from a leading medical authority.

Date published: 4/25/2011

Editor's note: Below is a lightly edited transcript of a conversation between Healthy Living columnist Delise Dickard and Dr. Alessio Fasano of the University of Maryland's Center for Celiac Research.

Q: What symptoms should a person or their physician be looking for that may be a sign of celiac disease or gluten sensitivity?

A: This question is the first challenge in the entire situation because the symptoms are vague and nonspecific. Thatís the reason why it is sometimes very difficult to make a diagnosis based on the clinical presentation.

Typical symptoms are gastrointestinal symptomsópain, bloating. Diarrhea is frequent ... IBS type symptoms can be there.

As concerns celiac disease, there is no organ that is spared, so you can have symptoms that involve bones, like osteoporosis or joint pain. Symptoms can be related to anemia, or you can have symptoms related to [behavior], like chronic fatigue. You can have mood swings, short[term]-memory loss, all the way to depression and schizophrenia.

You can have reproductive issues like infertility or miscarriages, and the list can go on and on.

Q: So what if a person thinks they do have some of these symptoms, what should they, with their doctor, do?

A: The first thing to do is to go through the list of possible alternatives reasons or causes that brought them to have those symptoms. And depending on what we are talking about, celiac disease is on the list: on the top, in the middle or the bottom.

Definitely a wise approach would be to take into consideration all the possible causes of that particular system including, of course, celiac disease.

Q: OK, so the wisest approach is to take everything under consideration, but you want to be sure celiac disease is on the list?

A: Absolutely ... Once all the proper tests have been done and all causes have been ruled out including celiac disease, gluten sensitivity can be considered.

Gluten sensitivity is [diagnosed] by exclusion criteria because we donít have the specific markers, like for celiac disease, to make the diagnosis. So only when every other cause has been ruled out, gluten sensitivity can be considered.

Q: So I understand that you had a role in the development of the blood test used to diagnose celiac disease?

A: Thatís right.

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