Should you avoid gluten if you haven’t been diagnosed with celiac disease, an autoimmune condition that can attack the intestines and other tissues when gluten is consumed? The issue is more complex than you might think.

While few gluten avoiders have been diagnosed with celiac, the disease may be far more common than is reported, experts say. Undiagnosed celiac can lead to medical issues from organ damage to fatigue and infertility.  However, a report for the United States Preventive Services Task Force did not recommend routine screening until we have more evidence to justify it, in part because a gluten-free diet can cause its own health problems.

For now, experts recommend testing only those considered at risk: family members of celiac patients and anyone with Type 1 diabetes, premature osteoporosis or anemia. Those with rheumatoid arthritis and Sjogren’s syndrome may also be at risk for celiac.

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