An Overview of Gluten Sensitivity

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Gluten sensitivity is a medical condition characterized by a number of different symptoms such as stomach upset, rashes, and even mood problems. It occurs if you develop an immune reaction when you eat foods that contain gluten—which is present in wheat, barley, and rye.

Several diagnostic tests can help identify gluten sensitivity. There are two main types of gluten sensitivity— celiac disease and non-celiac gluten sensitivity. Treatment is generally focused on adjusting your diet.

Symptoms

Gluten sensitivity causes a variety of symptoms and you are likely to experience more than one (but probably not all) of these different effects if you have the condition. However, don't worry or think that no one else has your exact experience with gluten sensitivity—if you have the condition, you will recognize many of the typical effects.

surprising gluten allergy symptoms
​Illustration by Emily Roberts, Verywell

Digestive Problems

This is the most common symptom of gluten sensitivity. Issues can include heartburn, bloating, diarrhea, or constipation. Abdominal pain can range from merely annoying to completely debilitating.

Due to these digestive problems, you can experience the effects of malnutrition, such as fatigue, weight loss, and anemia (low red blood cell function).

Rashes

Gluten sensitivity is associated with a skin condition called dermatitis herpetiformis (DH). Is causes skin changes such as redness, bumps, itching, and burning.

Several other skin conditions are also associated with gluten sensitivity, including psoriasis, chronic urticaria (hives), and atopic dermatitis (eczema).

Foggy Brain

With gluten sensitivity, you may have difficulty concentrating, experience short-term memory lapses, or lose your train of thought. This type of brain fog can be associated with low energy, physical discomfort, or it can occur as a direct result of the gluten sensitivity.

Headaches

Headaches, including migraines, may be triggered by gluten. These episodes may be more frequent when you have a high intake of gluten-containing foods.

Neurological Issues

You may have a sensation of tingling in your arms and legs when you have gluten sensitivity. This stems from gluten-induced peripheral neuropathy.

Gluten ataxia (impaired coordination) may cause slurred speech, difficulty swallowing, impaired coordination, and trouble walking.

Issues such as seizures and encephalitis (inflammation of the brain), can occur as a result of gluten sensitivity—although they are rare. Brain fog and mood problems may also be related to encephalitis.

Mood Changes

People who have gluten sensitivity may experience a higher risk of depression and anxiety than the general population. This can be the result of the toll of living with chronic effects of gluten sensitivity, or it could be caused by the inflammatory process that occurs with this condition.

Fertility Issues

There is a strong connection between infertility and celiac disease. Women and men who have been diagnosed with celiac disease have a higher risk of infertility.

It is possible that celiac-associated malnutrition may play a role, but there may be other factors related to gluten sensitivity that contribute to infertility as well.

Attention-Deficit Hyperactivity Disorder (ADHD)

There appears to be an association between ADHD symptoms and gluten sensitivity. This may be associated with brain fog, but while the link is not completely clear, dietary adjustments may have an impact on the symptoms of ADHD.

Causes

Gluten sensitivity is caused by an inflammatory reaction to gluten, which is a form of plant protein found in foods containing wheat, barley, and rye. Even small amounts of gluten can trigger the reaction if you have gluten sensitivity.

Some of the foods that contain gluten include:

  • Pasta and noodles
  • Bread
  • Breaded meats and fish
  • Cookies, cake
  • Cereals
  • Crackers
  • Tortillas
  • Beer

Inflammatory Response to Gluten

Gluten sensitivity is often described as gluten intolerance. The inflammatory reaction that occurs in gluten sensitivity is different than a standard allergic reaction. Typically, the effect does not occur immediately, as it would with an allergy.

For people who have gluten sensitivity, eating foods that contain gluten can elicit an inflammatory immune response that damages the body.

There are two separate types of gluten sensitivity.

  • You may mount an inflammatory process that damages the lining of your intestines—triggering celiac disease.
  • An inflammatory process triggered by gluten can directly affect the skin, joints, and/or nervous system, resulting in non-celiac gluten sensitivity.

Interestingly, celiac disease and non-celiac gluten sensitivity can produce similar symptoms.

Risk Factors

Experts have not reached a conclusion about why some people have gluten sensitivity. There may be a genetic component because you are at a higher risk of you have a family member with the condition. Genetic changes in the HLA-DQ2 and HLA-DQ8 genes have been associated with gluten sensitivity.

Yet, there is not an explanation for why some people develop symptoms during childhood, while others develop symptoms during adulthood. Similarly, the reason for the wide-ranging variability in symptoms is unclear.

It is believed that celiac disease and non-celiac gluten sensitivity are two different conditions that happen to have the same triggers and many similar effects.

Diagnosis

There are a number of diagnostic approaches that can be used to help identify whether gluten sensitivity is the cause of your symptoms. Some doctors recommend that you go on a gluten-free diet or take a gluten challenge to see how your symptoms change. This process takes weeks, and you have to follow a strict diet while the evaluation is going on.

Dietary Modification

You can work with your doctor and a dietitian to evaluate your symptoms in response to a gluten-free diet. You may be given a questionnaire to record your symptoms when you have a regular diet for several weeks, followed by a gluten-free diet for several weeks.

A gluten challenge is a test in which you would follow a gluten-free diet and take a pill given to you by your doctor. The pill may contain gluten, or it may not—the point of the test is that you would not know whether it has gluten or not as you record your symptoms.

Diagnostic Tests

Several diagnostic tests can be used to identify markers or effects of gluten sensitivity.

Blood tests: Blood tests can identify immunological markers of celiac disease and gluten sensitivity. Antibodies, including AGA-IgA, AGA-IgG, and tTG-IgA, may be elevated when you have gluten sensitivity. However, these antibodies can be normal in gluten sensitivity, and they can be elevated even if you don't have the condition—so the results are helpful, but not definitively diagnostic of the condition.

Genetic testing: Because a few genes have been associated with gluten sensitivity, genetic testing can help identify whether you carry the genes associated with gluten sensitivity. If your genetic tests are positive (meaning that you carry the genetic alterations), this suggests that gluten sensitivity could be the cause of your symptoms. However, you can have gluten sensitivity even if you do not carry the genes for the condition.

Endoscopy: This is an invasive test in which a tube with a camera is inserted into your mouth. Your doctor can see the intestinal changes of celiac disease with the test. These changes are described as villous atrophy. The villi are tiny structures in your small intestine. They help you absorb food. In celiac disease, the villi are damaged by the body's inflammatory response.

Treatment

The best treatment for gluten sensitivity is a gluten-free diet. This diet eliminates gluten-containing foods. You may also need treatment for the symptomatic effects of gluten sensitivity, such as the rash, headaches, and other aches and pains.

Gluten-Free Diet

There are many foods that you need to eliminate from your diet if you have gluten sensitivity. But there are also a number of foods that you can eat.

Foods you can eat when you have a gluten-free diet include:

  • Fresh, canned, or cooked fruits and vegetables
  • Beef, chicken, pork, and seafood—as long as it isn't breaded
  • Unflavored milk, cheese, and yogurt
  • Gluten-free pasta and cereal

Other foods that may be gluten-free include condiments, snacks, and prepared foods that are labeled as gluten-free.

One of the challenges of following a gluten-free diet is that gluten-free foods can become contaminated when the same utensils are used to prepare food that is not gluten-free. This can be tricky, especially when you are eating out.

Symptomatic Treatment

Issues such as neuropathy and rash may need medical treatment. When you adopt a gluten-free diet, it can take some time for a rash to resolve. You can talk to your doctor about creams, lotions, or oral medications that may help your rash, especially if it is itchy, painful or unsightly.

Depression and anxiety associated with gluten sensitivity can be treated with prescription medication until your dietary changes take effect.

Neuropathy can have lasting effects, including pain and tingling. You may need to use prescription medication to reduce these symptoms. Ataxia and neuropathy can both interfere with your ability to walk. Physical therapy can help you optimize your balance and physical abilities.

A Word From Verywell

Gluten sensitivity is a controversial condition. Many people feel that their symptoms improve with a gluten-free diet. But there have been misunderstandings about the condition. Many mistakenly believe that it can be used as a weight loss strategy, or that gluten is bad for everyone.

Gluten is not harmful unless you have gluten sensitivity. Foods that contain grains contain many nutrients and are often low in fat and cholesterol. So it may not be beneficial for you to adopt this diet unless you have a gluten intolerance. Be sure to work with a dietitian when planning your diet so that you can be sure to maintain a low fat, high nutrient diet even while gluten-free.

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