Most Celiacs Lack Digestive Symptoms, Delaying Diagnosis in Spain

More celiacs lack digestive symptoms than have them

What if bread isn't the problem? Celiac disease specialist Isabel Polanco Allué makes it clear in her guide *Vivir bien sin gluten*: "It is much more common for a celiac to have no digestive symptoms than to present them." Headaches, migraines, muscle pain, autoimmune thyroiditis, diabetes. Nothing to do with the toilet. And that's where the problem starts: if the doctor looks for diarrhea, they won't find celiac disease.

The condition affects 1% of the Spanish population according to the working hypothesis cited by Polanco, though the specialist herself admits "the figure could be higher." The reason is that symptoms are a mixed bag: there are asymptomatic people, classic digestive cases, and extra-digestive ones that mask the picture. The consequence is an army of underdiagnosed patients who spend years on medical pilgrimages without a name for what they suffer from.

Tests that confirm celiac disease

The protocol described by the doctor is sequential. First, serological marker analysis upon clinical suspicion. Then, "the definitive test is the intestinal biopsy." The problem arises when the patient has no diarrhea, bloating, or weight loss, because then no one orders the test. And if the patient self-diagnosed and has been gluten-free for months, the test loses reliability.

In practice, the stories accompanying this issue depict trajectories lasting years. Some accumulate four gastroscopies and a thousand diagnoses before someone looks in the right direction. Others discover the disease through rebound: a baby who stops growing, vomits daily, and falls off the percentiles, leading to a diagnosis via the daughter rather than the father who had had a bloated abdomen for a decade. Celiac disease has a genetic component emphasized by the doctor: without predisposition there is no disease, but with it, development depends on factors not yet controlled.

Non-celiac gluten sensitivity, that mixed bag

Here Polanco is particularly harsh. Non-celiac gluten sensitivity "is a mixed bag and great care must be taken when diagnosing," because it lacks an autoimmune basis and is diagnosed by exclusion. She adds the suspicion that "this diagnosis is overused" and acknowledges that we still don't know what causes the symptom cluster.

The nuance matters because it separates two things public conversation mixes indiscriminately. One is celiac disease, permanent and immunological. The other is a trend. And trends have costs: the specialist warns that self-diagnosing as gluten-sensitive can lead to an inadequate diet, loaded with processed gluten-free products containing more sugar and fat than the originals. "Gluten neither fattens nor thins," she states. A well-executed gluten-free diet is based on meat, fish, legumes, vegetables, fruit, and grains. Not on industrial pastries with an 'approved' seal.

The business of gluten-free products and their fine print

The economic side of the matter is complex. Polanco points out that the trend does "a disservice to celiacs": although there are more gluten-free products on the market, they remain equally expensive and don't always come with the rigorous control of those specifically made for celiacs. The industrial logic mentioned fits: achieving certain textures without gluten requires reformulation, and cheap reformulation usually means adding fat or sugar to please the palate.

Hence the recommendation not to base the diet on these products. They can be consumed, but they are not the foundation. Trinc-up should always be done by a specialist, not by personal judgment or label reading.

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The starting question was whether bread disagrees with you. The uncomfortable answer is that often bread has nothing to do with it, and the damage has been installed for years in the form of migraine, thyroiditis, or undiagnosed infertility. Other times the problem is exactly the opposite: healthy people paying a premium for gluten-free products that make them gain more weight than normal ones. Two opposite errors, one same ignorance. And a 1% which, according to the specialist herself, is probably an underestimate.