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Ask Dr. Gourmet

Should I keep a food diary if I think I have celiac disease?

This Health and Nutrition Bite, "Testing for Celiac Disease," reported on the validity of physicians testing for celiac disease in those with abdominal symptoms. Recently I received a suggestion that keeping a food diary might also help with diagnosing celiac disease:

"Why not begin with a self-evaluation? Cut out all food containing gluten for 3-7 days. Do you feel any different the gluten-free days (besides frustrated and deprived)? . . . If a person sees a marked difference in how he or she feels with no gluten in the diet then this is something concrete to tell the doctor."

Dr. Gourmet Says...

slices of bread and a bowl of breadcrumbs

I think this is a great idea because we know that celiac disease is under diagnosed. For instance, we have reported on studies that show that those diagnosed with Irritable Bowel Syndrome (IBS) are at higher risk for actually having undiagnosed celiac disease.

At the same time there is evidence that physicians are missing the diagnosis of celiac disease and there are many stories of folks going far too long without confirmation of the disease. Going to your physician with a food diary and evidence of resolution of symptoms while eating a gluten free diet can be a big help.

The one caveat to this is that if you are strictly gluten free for a prolonged period of time it might be difficult to confirm the disease. At this time we use blood tests that check for high levels of antibodies for screening and endoscopy with small intestine biopsy in order to confirm the diagnosis. If you have been gluten free for too long the antibodies will fall and the damage to the villi in the small intestine will heal - and you could receive a false negative result. It's a shame, but right now the common strategies for diagnosis involve being affected by the disease - and you'll have to eat gluten to do that.

Thanks for writing.

Timothy S. Harlan, MD, FACP, CCMS
Dr. Gourmet