Gluten allergy, gluten intolerance, gluten sensitivity and wheat sensitivity are terms that are thrown around a lot by the media and people searching for answers to mysterious health symptoms. (For more information on celiac disease, go here.)
You may have heard it called non-celiac gluten sensitivity, gluten intolerance, gluten allergy, wheat allergy, or a host of other combinations. Bottom line: they all mean the same thing. Gluten sensitivity is a real medical condition that affects between 10-16% of the population to some degree; a recent study suggests the numbers are similar to those with celiac disease — approximately 3 million in the United States, alone. It is not an allergy; it is not an autoimmune disease (celiac disease), but it can cause severe, uncomfortable and even debilitating symptoms, including any of the following:
If you have been tested for celiac disease and also for wheat allergy and your test results are normal but you still have unexplained symptoms like those listed below, you may have Non-Celiac Gluten Sensitivity (NCGS) or your symptoms may moderate on a gluten free diet for other reasons. Researchers have determined that symptomatic patients with negative celiac serologies (bloodtests: IgA tTG or IgA/IgG DGP) while on a regular diet, and who show no evidence of malabsorption are unlikely to have celiac disease but are highly likely to have NCGS. Those with equivocal serology should undergo DNA (HLA typing) testing to determine whether there is a need for biopsy.
While there is currently no accepted medical test for gluten sensitivity (one may be in the works), if you have suspicious symptoms, but have tested negative for celiac in bloodwork ordered by your doctor, you may indeed have NCGS. Removing gluten from your diet is a great way to see if your body functions better without gluten, indicating NCGS. It also may help to reduce inflammation in the body, for example (gluten free is part of the “anti-inflammatory diet“).
Gluten sensitivity is not an allergy to gluten, but rather, a condition where the body is unable to properly digest gluten. Recent studies have found that those with non-celiac gluten sensitivity also produce an abnormally high number of proteins that activate inflammation (the immune system’s first defense) and an abnormally low number of suppressor T cells which suppress the inflammation. The inflammatory response, like that brought against the flu virus, can cause fatigue and dizziness. Symptoms can range from quite mild to very serious, but unlike a true “allergy,” anaphylaxis leading to death will not occur.
A gluten free or even a low-gluten diet may help alleviate these symptoms, but the only way to know is to try a completely gluten free diet for a period of several weeks to see if you feel better. If you do, then your body is telling you your answer, whether a doctor gives you a diagnosis or not. Unlike with celiac disease, a person with gluten sensitivity may be able to eat small amounts of gluten without damaging their body — the symptoms suffered will dictate whether and how much gluten is tolerated.
There is also promise with further study of the microbiome; we know that people with celiac disease have different gut flora patterns than others, but more research is ongoing to learn about how to affect the microbiome of those with gluten sensitivity. Probiotics and prebiotics may help alleviate symptoms of gluten sensitivity and make the gut more tolerant.
Many people who avoid gluten due to intolerance or sensitivity are ridiculed and their condition is not taken seriously. I call this unfortunate reaction “Gluten Intolerance Intolerance.” It is important if you feel better after removing gluten from your diet, that you stick with it, despite peer pressure or inconvenience. Your happiness and your health are too important to compromise.
To learn more about the condition of gluten sensitivity, listen to my radio interview with Dr. Alessio Fasano, director of the Mass General Center for Celiac Research: full podcast from my radio show, The Gluten Free Voice.