Celiac disease is a condition in which the small intestinal lining becomes damaged as a result of a reaction against a common dietary ingredient, gliadin, a protein in gluten found in wheat, barley and rye. About one percent of the U.S. population is affected by celiac disease, yet most have not been diagnosed. Celiac disease diagnosis is confirmed by biopsy of the small intestine.

Scientists are trying to determine why so many cases of celiac go undiagnosed. A recent study by Colombia University Medical Center has found one reason—improper intestinal biopsy. Celiac disease affects patches of the small intestine, not the entire intestine. Medical recommendations for intestinal biopsy suggest that at least four specimens be taken to ensure that enough areas of the intestine are sampled to detect damage. Researchers used a nationally representative database of over 100,000 individuals who had undergone intestinal biopsy for symptoms like diarrhea, abdominal pain, esophageal reflux, and anemia and found that only 35 percent had the recommended four specimens taken. Most had only two.

In those individuals in whom four specimens were taken, the diagnosis rate for celiac disease more than doubled. “The process of increasing the number of specimens from two to four takes approximately one extra minute during endoscopy,” said Dr. Lebwohl, lead author of the study.

Celiac disease is the most severe form of gluten intolerance, another condition that doesn’t involve intestinal damage—yet! If you are undergoing a biopsy to detect celiac disease, be sure to ask the doctor if they’re taking at least four specimens. If the biopsy comes back negative, however, don’t think you can jump right back into eating gluten. You may have the milder form of gluten sensitivity. A stool test from enterolab.com could help you determine if this is what ails you.

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I know it seems that I am obsessed with poop—but trust me, all the answers to life’s problems lie in the poop. Well, OK, not all of them, but certainly all digestive ones. A stool test can be the single most important test you can take, for instance when determining celiac disease.

If you are sensitive to gluten this may in fact be the beginning stages of celiac, as they really are one and the same—just different degrees of reaction within the body. Gluten sensitivity implies that a person’s immune system is intolerant of gluten in the diet and as a result forms antibodies or displays some other evidence of an inflammatory reaction. When these reactions cause small intestinal damage (visible on a biopsy), the syndrome is then called celiac sprue, celiac disease, or gluten sensitive enteropathy. Research shows that as many as 30% of Americans are gluten sensitive, and 1 in 225 of those has progressed to the stage of celiac disease. A simple stool test will determine if you are truly gluten sensitive or if you have celiac. You can get the scoop by visiting enterolab.com.

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