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If you suffer from digestive problems and you were unable to pinpoint the exact source, gluten intolerance may be a factor.
Gluten intolerance is a genetic condition and its most severe form- celiac disease– affects about 1% of the population. But some people suffer from another two conditions related to consuming gluten: non-celiac gluten sensitivity and wheat allergy. The symptoms of these conditions are extremely common making gluten-related issues difficult to spot.
What is gluten?
Gluten is a protein found in wheat, barley, rye, and triticale. This makes it almost ubiquitous in today’s diet because these grains are widely consumed, and often added in many processed foods.
While gluten is not unhealthy and a healthy individual would not have any symptoms after eating it, some people have troubles digesting it.
Gluten related health problems
The inability to process gluten efficiently can manifest in different diseases. Some of these have a strong genetic component, like celiac disease. The best way to manage celiac disease is to completely avoid gluten.
Other problems are vague but they do offer some diet flexibility. Let’s take a look at the different gluten related conditions and what these mean.
Celiac disease – True gluten intolerance
Celiac disease is a genetic, auto-immune condition that affects the body’s ability to digest gluten. It causes the immune system to target and attack parts of the small intestine when a person ingests gluten[1].
This leads to inflammation of the small intestine and to the destruction of the villi.
The villi are small elements disposed in the small intestine, which help with the absorption of nutrients.
As the intestine is damaged by celiac disease, absorption is compromised and this can lead to deficiencies of vitamins such as vitamins A, D and B.
Even if this usually means that the person suffering from celiac disease will lose weight, it is not always the case.
Symptoms of Gluten intolerance:
- Fatigue;
- Bloating and gas;
- Pain, both abdominal but also headaches and joint pain;
- Nausea;
- Diarrhea or constipation;
- Anemia;
- Numbing and tingling in legs or hands.
How is Celiac disease diagnosed?
When your doctor suspects Celiac disease, they will have you go through a simple blood test that would confirm the condition.
While genetic testing is a reliable test to help arrive at the diagnosis, it is rarely used, due to its high cost. There is another test available that looks at specific antibodies in the blood.
It is important to remember the fact that in order to obtain exact results for this test, you will need to consume gluten for a few weeks prior to getting blood drawn. If these tests support the diagnosis of celiac disease, the doctor will recommend a small bowel biopsy, which is considered the gold standard test for celiac disease.
While celiac disease is relatively easy to diagnose, it may be difficult to identify in some cases.
This happens because its symptoms are similar to other digestive conditions.
Also, Celiac disease is a relatively rare condition, with a prevalence of only 1.4% in the general population[i].
For this reason, doctors want to first look for more common diseases like infections, IBS or bacterial overgrowth.
Gluten sensitivity – Non Celiac
Gluten sensitivity is a condition that comes with some of the same symptoms as celiac disease. But it is very difficult to diagnose because it doesn’t damage the intestine.
While we have tests that can diagnose celiac disease, people who suffer from gluten sensitivity have to rely on… trial and error.
Also, there are no specific or accurate tests and since there are no antibodies that react to gluten, it is difficult to understand what is truly happening.
Symptoms of Non Celiac Gluten sensitivity
As with celiac disease these symptoms are easily mistaken for symptoms of IBS or Crohn’s disease.
- Bloating and gas;
- Nausea
- Diarrhea, constipation ;
- Abdominal pain;
- Lightly colored stools;
- Neurologic symptoms such as “brain fog” and memory disorders[ii];
- Fatigue.
How is Non Celiac Gluten sensitivity diagnosed?
Due to the lack of a biomarker[2], diagnostics is difficult. At some point medical professionals tended to dismiss patient’s worries regarding gluten related symptoms.
Recently, gluten sensitivity was recognized as a condition similar to celiac disease and the diagnostic is made based on observation and trials of a gluten-free diet.
To assess gluten sensitivity, the patient has to follow a strict, gluten-free, diet for 6 weeks. After that they must eat gluten rich foods and take note of the change in symptoms.
Wheat allergy
Another condition with symptoms that are very similar to those of celiac disease and gluten sensitivity is wheat allergy.
While symptoms can be similar, they have a wider range.
So, those suffering from wheat allergy may even exhibit respiratory symptoms such as cough or trouble breathing.
In severe cases anaphylactic shock can occur. This is a life-threatening condition that can be deadly if it is not addressed immediately by a medical professional.
Luckily, diagnosing wheat allergy is relatively simple. A blood test or a skin test will offer answers in a short time span and with minimal risks.
How to treat Gluten related conditions?
All the conditions that we discussed are treated the same way: by completely avoiding gluten.
With celiac disease it may take longer to notice improvements, once the diet is started. This happens because the intestine needs to heal.
Six months is the average time it takes to notice major improvements but it could take more time for the intestine to completely regenerate.
Improvements from gluten sensitivity, on the other hand, may happen much faster. The intestine is not damaged by this condition, it is just irritated.
For this reason, a person should notice improvements in the first few weeks of a gluten-free diet.
Wheat allergy should also improve in a few weeks, but in this case too, the intestine will have to heal and this could take months.
Is there anything that can help?
Probiotic bacteria, especially Bifidobacterium lactis bacteria, were shown[iii] to protect the intestinal lining against damage in celiac disease.
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Studies show that adding a mixture of digestive enzymes helps improve symptoms of gluten sensitivity[3].
There is little research about gluten sensitivity and more studies are needed to fully evaluate the benefits of digestive enzymes. But the good news is that they have an excellent safety profile and can be used to see if these supplements help improve the symptoms.
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Gluten sensitivity and gluten intolerance have symptoms that can be encountered in many other diseases. This is why it is very important to first talk to your doctor about your digestive symptoms.
The fact that there are many companies that now sell gluten free products has started a gluten-free trend that may be risky.
While it is true that our diet does have an excessive amount of refined carbs and gluten, not all gut problems are related to it.
Going gluten-free might be a good solution for you as it poses no risk at all. But make sure to talk to a professional about your symptoms, and to first exclude other conditions.
[1] https://www.hopkinsmedicine.org/health/conditions-and-diseases/celiac-disease
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488826/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143542/
[i] https://celiac.org/about-the-foundation/featured-news/2018/08/global-prevalence-of-celiac-disease/
[ii] https://pubmed.ncbi.nlm.nih.gov/29247390/
[iii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453197/
