The gluten-free industry has soared while the disease that largely propelled that growth has remained out of the forefront.

May is Celiac Disease Awareness Month. Dr. Thomas Flass, a pediatric gastroenterologist with Kalispell Gastroenterology, said while it seems information on the disease would spread with people’s hesitance about gluten, many remain oblivious about whether or not they have celiac disease.

“People know enough of their friends and family members affected by it to know gluten-free is not just a fluke or a Hollywood trend,” Flass said. “But, 80 to 90 percent of people with celiac disease go undiagnosed.”

On Tuesday, more than 70 people sat in an audience at Kalispell Regional Medical Center and listened to Flass define terms such as “non-celiac gluten sensitive.”

According to a study released by Gallup in 2015, roughly one in 100 Americans has celiac disease and must avoid gluten, a protein found in wheat, barley, and rye. However, as many as one in five Americans try to have a gluten-free diet, according to the study.

Flass said many people enter the gluten-free world like a guessing game.

In a global survey by the Hartman Group, 49 percent of respondents said it was important to buy food labeled gluten-free. But in the same survey, 35 percent of respondents could give “no reason at all” for why it was important.

“The growth in people moving into a gluten-free lifestyle, for whatever reason, isn’t bad. It’s when they do it without knowing why but they have other symptoms that it’s not good,” Flass said.

For people with celiac disease, avoiding gluten is a medical necessity. The disease is autoimmune in nature, which in this case means white blood cells attack gluten, tearing away the lining of a small intestine. The absence of gluten can take a person from incapacitated to symptom-free as the lining of their small intestine returns to normal.

“But those people who never get diagnosed operate within the unknowns. They don’t have the answers about how to truly feel better and have an improved standard of living,” he said.

Flass said it’s important for people with gluten intolerances to get checked for celiac disease. He said people who remain undiagnosed can leave medical issues often tied to the disease invisible.

A body with celiac disease struggles to absorb nutrients, which means someone with it can suffer from malnutrition and miss key vitamins and minerals.

The autoimmune nature of the disease means it could lead to a variety of other autoimmune problems, although Flass said those possible connections are debated among doctors today.

Flass said in rare cases, untreated celiac disease can also make a person more susceptible to certain cancers.

He said under a best-case scenario, someone who goes undiagnosed will have side effects such as an upset stomach, migraines or constant fatigue.

Celiac disease can also form later in life. Many people who have the disease carry genes that wait in their bodies like triggers, Flass said. Large events on someone’s body, such as having a baby or getting sick, can flip the switch to where that person suddenly can’t handle gluten.

People are more susceptible to the disease if someone in their family has it, if they have Type 1 diabetes or if they have another autoimmune diseases.

There also are unique cases where signs of the disease are hidden in forms of anemia, unexplained arthritis, depression or vitamin deficiencies.

“People kind of get the eye roll and think, ‘Sure, blame the world’s woes on gluten,’” Flass said. “But the reason I show all this is because it’s not a clear picture in a lot of cases ... which is why it gets missed in 80 percent of the people who have it.”

He said the current gluten-free phenomenon is a chance to observe the westernized diet. America has hit a sharp increase in cases of obesity, Type 2 diabetes and autoimmune diseases because of the county’s food culture, Flass said.

“Whether you’re looking at gluten-free, other dietary things, understand why you’re doing it. Take a good look at what you’re feeding yourself and your family and be an advocate for yourself by questioning the status quo of the food industry,” he said.

Reporter Katheryn Houghton may be reached at 758-4436 or by email at khoughton@dailyinterlake.com.