But, if you’re avoiding gluten as much as possible and are still experiencing gastrointestinal symptoms, such as abdominal pain, gassiness, bloating, or diarrhea, you may want to ask your physician if you can be evaluated for exocrine pancreatic insufficiency (EPI), a condition in which the pancreas is unable to properly produce digestive enzymes, says Kristi King, MPH, a senior dietitian at Texas Children’s Hospital, in Houston. Other possible EPI symptoms are unexplained weight loss and steatorrhea (fatty stools). A review published in October 2018 in Pancreapedia, the American Pancreatic Association’s exocrine pancreas knowledge base, notes that celiac disease is associated with an increased risk of developing acute and chronic pancreatitis and EPI is common in people with celiac disease. If you suspect you may have EPI, talk to your doctor, who can evaluate your pancreatic function with a fecal elastase test or other diagnostic measures. If you are diagnosed with EPI, there are ways to manage both conditions. You might also have to avoid oats, which contain a protein similar to gluten and can cause a negative reaction. “Most people [with celiac disease] can tolerate oats, but some can’t,” Dr. Forsmark notes. Read food labels carefully to check for anything that contains gluten, King advises. Be on the lookout for ones that say, “May contain allergens.” If you want a completely gluten-free household, you’ll also need to monitor products such as toothpaste, shampoo, and makeup, because gluten is present in lots of non-food items, too, King says. You should ask your pharmacist to make sure all the medications you take are gluten free, too. “They can help you find an appropriate substitute if needed,” she says. And don’t forget that over-the-counter items, such as herbal supplements, may contain gluten, she adds. If you have EPI, you may want to start taking pancreatic enzyme replacement therapy (PERT), the digestive replacement enzymes that are typically prescribed for EPI, according to the Pancreapedia review. Another study looked at EPI and celiac disease and found that over time, some people may be able to gradually eliminate enzyme supplements from their treatment plan if their celiac disease is well managed — in other words, sometimes treating the celiac disease can improve the EPI.
Getting Support for Celiac Disease Treatment
There are online resources that do some of the nutritional detective work for you, Forsmark says. “Online support groups are helpful, because tips are shared on what foods and products to avoid,” he says. He also recommends getting nutritional information from reliable sources, such as the American Celiac Society, which regularly tracks and updates lists of gluten-containing foods and products. The good news is that following a gluten-free diet is easier than ever, Forsmark says. “In the past it was very challenging, but now there are so many products available that are gluten free,” he says. And by adhering to a healthy, gluten-free diet, you should be able to successfully avoid uncomfortable symptoms and the risk of EPI.
