An Overview of Gluten Sensitivity

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Until recently, people who received negative results on the tests used to diagnose celiac disease were told gluten—a protein in wheat, rye, and barley—was not a problem for them and they could eat whatever they wanted. But this is beginning to change as more doctors are starting to recognize gluten sensitivity—a reaction to gluten that can cause gassiness, abdominal pain, or diarrhea.

Gluten sensitivity often goes by several names, none of which are universally accepted. Most experts in the field tend to use the terms non-celiac gluten sensitivity (NCGS) or non-celiac wheat sensitivity. It is also commonly referred to as a gluten allergy or gluten intolerance, though many people consider the latter a more severe condition.

Symptoms

The symptoms associated with gluten sensitivity sound remarkably like those associated with celiac disease:

There also is one small study that found gluten can cause depression in people who don't have celiac disease.

Many people find that a gluten-free diet alleviates symptoms like fatigue, digestive complaints, and neurological issues, even though they do not have celiac disease. Many doctors and researchers believe that it is not uncommon for people to experience these symptoms after consuming gluten grains.

Overall, scientists have not yet determined whether or not gluten sensitivity symptoms indicate actual damage to your body or simply that you have eaten something that does not agree with you.

Those researchers who do believe that damage occurs say that both organs and systems, particularly the nervous system, can be affected. But again, this theory has not been supported by scientific research.

Causes

Gluten sensitivity has not actually been proven definitively. Researchers do not yet agree on a definition for gluten sensitivity and, as of yet, there is no explanation for why it occurs and how it might be related to celiac disease. It is possible that gluten sensitivity and celiac disease represent different aspects of the same condition. It's also possible that they are completely different.

It also is not clear if it is the protein in wheat, barley, and rye that causes the symptoms of the condition. In fact, some researchers theorize that the problem in those told they have gluten sensitivity may not be gluten at all. Instead, it may be some other compound found in wheat (and possibly in barley and rye, which are closely related to the grain).

Researchers have identified other compounds in wheat, specifically, that they say could be responsible. Some of these compounds, known as FODMAPS, are found in other foods as well.

What's more, the results of one study suggest that gluten sensitivity symptoms occur because microbes and food proteins are crossing the intestinal barrier into the bloodstream, causing widespread inflammation.

"It's All in Your Head"

In the past, too many doctors downplayed and dismissed potential symptoms from gluten, and the "it's all in your head" diagnosis still persists in parts of the medical community, despite advances in awareness. But it is also true that some people who believe they cannot tolerate gluten may be able to tolerate it just fine. In fact, some people who say they're gluten-sensitive can "cheat" on the diet without clear symptoms.

Several studies have found that some people who believe they are gluten-sensitive don't react to pure gluten or to gluten-containing grains when they consume those substances in a blinded study. Others do react, though, which provides evidence that the condition does exist.

Diagnosis

Many people go a long time before ever seeing a doctor about their symptoms, if they ever get evaluated at all. But it's important not to just "deal with" negative consequences of eating gluten-containing foods and to seek a proper diagnosis.

Typically, when you describe your symptoms to your doctor, they will order tests to determine if you have celiac disease, which usually includes blood tests and possibly an endoscopy (a scope to look at your small intestine).

If you are diagnosed with celiac disease, it means you have met strict medical criteria; i.e., you have damage to your intestinal villi (known as villous atrophy) that was caused by an autoimmune reaction to gluten in your diet. Meanwhile, if these tests do not show signs of celiac disease, then you and your doctor can consider alternative diagnoses, including gluten sensitivity.

Most people who show symptoms of celiac disease actually do not have the condition.

There is no proven test to diagnose gluten sensitivity. Your doctor may pursue some further testing after celiac is ruled out, but none of these options have been validated by medical research to date.

For example, some physicians use a positive AGA-IgG blood test result, which indicates the presences of gluten antibodies, to help diagnose gluten sensitivity. Others will diagnose you based on your response to the gluten-free diet—in other words, if you eliminate gluten and feel better, you're gluten-sensitive.

You also have the option of pursuing direct-to-consumer gluten sensitivity testing, which might be done with either a stool sample or a finger-prick blood sample. Be aware that the testing methodology used has not been proven or accepted by most physicians and regulatory authorities. The American Academy of Allergy, Asthma & Immunology and the Canadian Society of Allergy and Clinical Immunology have noted that these tests often give false-positive results, leading to unnecessary dietary restrictions.

Treatment

As with celiac disease, the only current treatment for gluten sensitivity is a gluten-free diet. There is quite a lot of debate over how strict that diet needs to be. Some physicians believe it is fine for people with gluten sensitivity to have foods containing the protein on occasion, while others recommend very strict adherence.

Some foods, like wheat crackers, are obviously off-limits with a gluten-free diet. But there are less obvious gluten-containing foods you should also be aware of—even medications can contain gluten.

It's not clear whether following a gluten-free diet can provide you with health benefits beyond those you get from simply feeling better. It also is unclear whether consuming gluten grains when you're sensitive entails health risks.

A Word From Verywell

There are only a few studies on gluten sensitivity that provide some insight, and some of the medical research to date has been contradictory. Eventually, scientists hope to provide more answers. In the meantime, if you are diagnosed with gluten sensitivity, you need to decide for yourself—in consultation with your doctor—how strictly to follow a gluten-free diet.

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Article Sources

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