Can You Be Sensitive To Gluten Without Celiac Disease?
Is Gluten The Answer To Resolving Irritable Bowel?
We all know how important it is for celiacs to follow a strict gluten-free diet. But what if you don’t have celiac disease and think you’re sensitive to gluten? It’s a common misconception that everyone should follow a gluten-free diet to be healthy (Valenti et al., 2017). You shouldn’t eliminate gluten unless it’s absolutely necessary!
In this article, we’ll explore gluten sensitivity to help you make an informed decision about the role that gluten plays in your life.
Let’s start by asking: what actually is gluten?
Gluten is a mixture of two proteins, gliadin and glutenin. Together with starch, gluten is found in various grass-derived grains:
Modern bread contains 15–20 times more gluten than it did in the past. This is due to advances in plant breeding technology.
We most commonly hear about gluten in relation to celiac disease: an autoimmune condition. If you have an autoimmune condition, your body’s immune system attacks part of your own tissue by mistake. In the case of celiac disease, eating gluten triggers an immune response that attacks the lining of your intestines (Lebwohl, Ludvigsson, and Green, 2015).
It’s not surprising then that celiac disease is associated with nutrient deficiencies (particularly anemia) and digestive symptoms (abdominal bloating, pain, diarrhea, etc) (Rubio-Tapia et al., 2013).
If you continue to consume gluten with celiac disease, your poor nutrient absorption can result in symptoms of fatigue, weight loss, abnormal liver function, joint pain, bone disease, depression, anxiety, headaches, skin disorders, missed periods, and/or recurrent miscarriages (Rubio-Tapia et al., 2013; Lebwohl, Ludvigsson, and Green, 2015; Garcia-Quintanilla and Miranzo-Navarro, 2016).
Many people claim to be sensitive to gluten even though they don’t have celiac disease. What’s that all about?
The official term for gluten sensitivity in someone who doesn’t have celiac disease is non-celiac gluten sensitivity (Vasagar et al., 2017).
Non-celiac gluten sensitivity is much more common than celiac disease, affecting 13% vs 1% of the population.
Digestive symptoms of non-celiac gluten sensitivity are indistinguishable from that of celiac disease. This means that people with non-celiac gluten sensitivity are likely to be diagnosed with “IBS” (irritable bowel syndrome) — particularly if celiac disease has been ruled out (Bardella, Elli, and Ferretti, 2016).
So what are the major differences between celiac disease and non-celiac gluten sensitivity?
Gluten sensitivity can manifest in ways that are not commonly seen in celiac disease patients. For example, symptoms such as “brain fog”, muscle pain, and eczema are often associated with non-celiac gluten sensitivity.
More and more studies are investigating the relationship between gluten ingestion and neurological and psychiatric disorders. Possible associations that have been identified include:
- neuropathy (numbness in hands and feet),
- bipolar disorder, and
- autism (Casella et al., 2017).
Another major difference between non-celiac gluten sensitivity and celiac disease is that there isn’t a biomarker that can be used to diagnose gluten sensitivity (Collyer and Kaplan, 2016).
A biomarker is something that’s naturally produced by an organism (e.g. a human) that indicates the presence of a disease.
Using anti-transglutaminase antibodies as a biomarker, doctors can measure a person’s immune reaction to gluten and use this to diagnose or rule out the possibility of celiac disease.
However, there’s nothing that doctors can measure to determine whether or not you have non-celiac gluten sensitivity (Mansueto et al. 2014). All you can do is undergo strict monitoring of your food intake and symptomatology.
In fact, the only way to diagnose non-celiac gluten sensitivity is to accurately exclude celiac disease and wheat allergy (Elli et al., 2015; Collyer and Kaplan, 2016) — ideally with the aid of blood tests, genetic tests, and biopsies (Kabbani et al., 2014) and alongside medical and dietary specialists (Elli et al., 2017).
Once you have a diagnosis of non-celiac gluten sensitivity, you can start adapting to a gluten-free way of eating to help alleviate your symptoms of “IBS” (Zanwar et al., 2016). For example, research shows that switching to a gluten-free bread reduces symptoms of abdominal pain, bloating, and tiredness in individuals with non-celiac gluten sensitivity (Zanwar et al., 2016).
One of the best ways to adapt to non-celiac gluten sensitivity is to start becoming familiar with alternative grains (e.g. flours and cereals) that are naturally gluten-free, like buckwheat.
People with non-celiac gluten sensitivity who incorporate buckwheat into their diet experience significantly less severe abdominal pain and bloating than those who follow a more ‘conventional’ gluten-free diet (Dinu et al., 2017). Eating buckwheat may also boost your magnesium levels and help to keep inflammation at bay (Dinu et al., 2017).
Can you have irritable bowel syndrome and non-celiac gluten sensitivity at the same time?
Yes! Whether you have an accurate diagnosis of non-celiac gluten sensitivity or not, you may find that going gluten-free doesn’t completely get rid of your symptoms.
“IBS” symptoms are often a manifestation of various imbalances within your intestinal tract (Makharia, Catassi, and Makharia, 2015). These need to be explored by an experienced functional medicine practitioner in order for you to truly heal your gut. This is why it’s vital to work with a dietary specialist if you suspect a gluten sensitivity.
In summary, it’s possible to be sensitive to gluten without having celiac disease. However, eliminating gluten won’t necessarily resolve your digestive symptoms if you have non-celiac gluten sensitivity, as there are usually more infuencing factors at play when it comes to “IBS”.
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Written by Sophie Ash, BSc (Hons), DipION — Research Analyst, Functional Medicine Practitioner, and Gastrointestinal Specialist (www.onyourplate.ca).