Gluten Sensitivity

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(also known as non-celiac gluten sensitivity, or non-celiac wheat sensitivity) 

Some individuals who experience distress when eating gluten-containing foods and show improvement when following a gluten-free diet may have what is commonly referred to as gluten sensitivity (GS) instead of celiac disease (CD). It is important to keep in mind that GS is not well understood, and it is still not clear whether other components of gluten-containing grains may be involved in causing symptoms, at least in some individuals. The symptoms seen in gluten sensitivity resemble those that are associated with celiac disease, but often with a prevalence of non-gastrointestinal symptoms.

Diagnosis:
Because gluten sensitivity is not well understood and no bio-markers have been identified, there are no specific medical tests that can be performed to confirm diagnosis. Instead, it is a “rule out” diagnosis. To diagnose gluten sensitivity, both celiac disease and wheat allergy would be ruled out. Antibody testing and small intestine biopsy would rule out celiac disease; immune-allergy tests to wheat would also be negative. Other conditions which may be causing symptoms should also be ruled out Finally an elimination diet and “open challenge” (monitored reintroduction of gluten-containing foods) are most often used to evaluate whether health improves with the elimination or reduction of gluten from the diet.

If you think you may have gluten sensitivity, it is important to consult with your personal physician before giving up gluten. The screening tests for celiac disease will not be valid if gluten has already been removed from the diet.

Treatment:
Scientific studies regarding treatment of non-celiac gluten sensitivity are limited; however the recommended course of action is to follow a gluten-free diet. Consult a physician or dietitian for dietary guidelines.

Frequently Asked Questions

If I have gluten sensitivity now, will I develop celiac disease later?
There is no research showing that gluten sensitivity leads to celiac disease, and this is currently thought not to be the case by experts in the field of gluten-related disorders.

Will gluten damage my intestines?
There may be some intestinal inflammation associated with gluten sensitivity, but gluten does not damage the intestinal villi as is the case in celiac disease.

What are some of the other conditions to consider ruling out when diagnosing gluten sensitivity?
For some individuals who believe they are sensitive to gluten, it can be other components of gluten-containing foods that are problematic, such as “FODMAPs.” FODMAP’s are types of sugars and carbohydrates found in gluten-containing grains, as well as in other foods. Find more information here – FODMAP.

I avoid wheat, but I am still having symptoms. What is wrong?
If your symptoms are due to gluten sensitivity or celiac disease, you need to avoid all gluten-containing foods, not just wheat. This means wheat, rye and barley, as well as any products derived from these grains. (Note: oats should also be avoided unless they are specifically labelled gluten-free, since they are commonly cross-contaminated with wheat.)

Why is a gluten-free diet effective for some people with autism, multiple sclerosis or chronic fatigue?
Some individuals with these conditions may have a form of gluten sensitivity, leading to improvement in some symptoms after eliminating gluten from the diet.

References
Nonceliac Gluten Sensitivity. Kirgel A, Lebwohl B. Advances in Nutrition. 2016 Nov 15;7(6):1105-1110. doi: 10.3945/an.116.012849. Print 2016 Nov.

 

 

This article has been assessed and approved by a Registered Dietitian Nutritionist.