Gluten Intolerance or Sensitivity

This article explains the differences between gluten sensitivity, gluten intolerance, wheat allergy, and celiac disease. It provides an in-depth overview of correlating gut-function disorders and detailed information on tests and treatment strategies, including a gluten-free diet. In addition, you’ll discover research on the surprising relationship between gluten exposure and mental health.

What are Gluten Intolerance and Non-Celiac Gluten Sensitivity?

Doctors often use the terms gluten sensitivity, gluten intolerance, and non-celiac gluten sensitivity (NCGS) interchangeably to describe the challenging, but not life-threatening, digestive tract symptoms that characterize this illness. Current research suggests that the small intestine, gut lining, and immune system are all parts of the puzzle in understanding this syndrome and how to heal from it. [2]

• Non-celiac gluten sensitivity (NCGS)
• Gluten intolerance
• Gluten sensitivity

The most unambiguous term is NCGS. It is most precise when an immune reaction to gluten occurs but no celiac disease is present.

Figure: Pathogenesis of gluten-related disorders manifesting via different immune pathways. The differentiation between an allergy, intolerance, and sensitivity to a food can be illustrated with the example of wheat.

Non-Celiac Gluten Sensitivity (NCGS)

It is believed that NCGS (gluten intolerance) is mediated by the innate cellular immune system.

NCGS involves an immune reaction to the protein gluten, resulting in digestive tract symptoms such as gas, bloating, abdominal pain, constipation, and diarrhea and non-digestive symptoms like feeling tired, headaches, skin rashes, and body aches. The symptoms can range from almost unnoticeable to debilitating, although this condition usually causes little to no permanent damage to the gut, small intestine, or other organs.

Thus, a doctor often has difficulty distinguishing between gluten intolerance and Irritable Bowel Syndrome (IBS).

In the past few years, it has become apparent in modern research that celiac disease represents only the tip of the iceberg of an overall disease burden. Scientists discovered different specifications with which neither autoimmune nor allergic mechanisms have been proven – the inflammation causing innate immune cells. Similar symptoms to Celiac disease after gluten-uptake disappear in a little while when gluten-free food is ingested. No antibodies, no heavy inflammation of the mucosa or a significant leaky gut as known from Celiac disease can be found (23).

However, this won’t change the matter that sensitivity against gluten is existent. The potentially involved micro-inflammations can stress the body heavily and trigger other cellular proinflammatory reactions to foods (food intolerances).

Celiac Disease

Common symptoms of celiac disease are chronic diarrhea, abdominal pain, weight fluctuations, weakness, and fatty smelling stool. Celiac disease is a real autoimmune disease triggered by gluten and genetic predisposition (DQ2/DQ8) in CD patients.

Celiac disease is less common than gluten intolerance, affecting about 1%, or 1 in 133 people in the U.S. However, an estimated 80% go misdiagnosed or undiagnosed, potentially leading to osteoporosis from inadequate calcium absorption and anemia from insufficient iron. A “gluten-free diet” is the only effective treatment for celiac disease and other gluten-related conditions. Celiac disease produces antibodies in the blood that a doctor can detect with a test, and ruling out celiac is often one step in reaching a correct gluten intolerance diagnosis. [5]

Untreated celiac disease causes inflammation leading to severe harm to the digestive tract and interference with nutrient absorption. This lack of nutrition deprives bodily systems of the nourishment they need to stay healthy, resulting in untreated celiac disease potentially leading to severe health consequences.

Celiac disease can be verified through proof of antibodies in blood or stool (anti-tTG IgA) and biopsies of the small intestine mucosa. It can only be cured successfully if gluten containing food is strictly avoided consequently and lifelong.

Dermatitis herpetiformis is a skin rash resulting from gluten consumption with symptoms including persistent itchiness and blisters. DH is common in people with celiac disease, but others can also have it. A dermatologist can diagnose DH with a skin biopsy.

Wheat Allergy

Gluten intolerance is not the same as a wheat allergy; wheat allergies engage a different part of the immune system than other adverse gluten responses. This type 1 food allergy, or “classical” food allergy is triggered by so-called allergen specific IgE antibodies.

Common food allergy symptoms include hives, rashes, and other skin problems, vomiting, difficulty breathing, and the possibility of anaphylaxis. Breathing problems are not typical of gluten sensitivity. Health professionals can diagnose wheat allergies using an immunoglobulin (IgE) blood test. Ruling out a wheat allergy is often another step in a non-celiac gluten sensitivity diagnosis. [6]

While there is a distinct difference between these conditions, they all share the common trait of the body reacting to gluten as a toxin. This reaction then activates an immune cell response, resulting in ongoing inflammation unless the person stops eating gluten.

Symptoms of Gluten Intolerance / Sensitivity 

Some studies have revealed that people with gluten sensitivity and CD have higher levels of harmful gut microbes than beneficial ones in their small intestine and colon. The imbalance of gut microbes may be linked to many of the symptoms of gluten intolerance. [8] 

Causes of Gluten Intolerance and Sensitivity

Researchers showed that after one hour of resting, all types of dough contained the most FODMAPS. After four hours, it was only ten percent of the sugars originally contained.

Additives, fertilizers, etc.

The use of fertilizers and so-called fertilizers should not be underestimated in agriculture. Of course, many additives are also used today in bread and all finished products for processing, color, shelf life, texture, and so on.

A person can react directly to chemical additives and fertilizers with an inflammatory reaction. In the long term, they could negatively affect the microbiome.

Infections

Infections in the digestive system, abdominal surgery, and certain medications can also cause gluten intolerance. In addition, some researchers have found similarities between gluten sensitivity and histamine intolerance, suggesting there might be an overlap between these two health issues. [11]

How to Diagnose Gluten Intolerance and Sensitivity 

Gluten Intolerance Tests (NCGS)

If coeliac disease could be ruled out, a direct approach can further answer the question of whether gluten intolerance (NCGS) is present. Paradoxically, there are very few diagnostic approaches where cellular defenses are used as biomarkers, although neutrophils and eosinophils are direct indicators of inflammation.

It is therefore worth looking at this interesting and promising, but little-known approach.

One study was able to show that NCGS could be identified very reliably with this leukocyte activation test (Alcat Test). This cellular food sensitivity blood test has demonstrated in various very well-controlled studies, e.g., at Yale School of Medicine, that this approach also enables significant improvements in irritable bowel syndrome.

Gluten-Elimination Diet

Another way of testing gluten sensitivity is by doing a gluten-elimination diet. It is best to do an elimination diet with the supervision of a doctor or other health provider. The steps for an elimination diet are as follows:

• Eat a diet containing gluten products for several weeks.
• Keep daily records of food intake and digestive symptoms during this time.
• Next, eliminate all gluten products for several weeks and track the results.
• Finally, reintroduce gluten and watch for returning digestive symptoms that went away while staying on the elimination diet. [13]

If you suspect you have gluten intolerance, consult a doctor for an accurate diagnosis.

The cellular Alcat Food Sensitivity Test (NCGS)

Treating Gluten Sensitivity and Intolerance 

Food Sources that May Help

Adding probiotics to the diet can also help with gluten sensitivity. Probiotics are healthy gut bacteria performing numerous tasks in the small intestine, digesting food, producing vitamins, and assisting in the immune response. Probiotic bacteria are found in:

• Live culture yogurt, kefir, and sour cream
• Naturally fermented sauerkraut, kimchi, and pickles
• Miso, natto, and tempeh
• Some cheeses

Including some of these foods in your daily diet – unless, of course, you have a food allergy or sensitivity – can help boost and balance the populations of beneficial microorganisms in the gut, which can help heal the digestive system after eliminating gluten from the diet. [14]

For people who are not sensitive to gluten, this protein is an excellent source of prebiotics – the preferred diet of probiotic microorganisms. However, if you go on a gluten-free diet, eating other prebiotic foods to replace gluten and keep the gut microorganisms nourished and thriving is essential.

In addition, when switching to a gluten-free diet, it’s wise to avoid processed gluten-free products made from potato flour, tapioca, rice flour, corn meal, sugar, artificial sweeteners, unhealthy fats, and other additives. [16]

The most successful treatment strategy for wheat protein intolerance is tailored by a doctor to the individual and their unique food sensitivities and intolerance profile (Havard University School of Public Health). [15]

Gluten Sensitivity and Mental Health

The connection between gluten and mental health is complex and under investigation. However, research suggests several ways gluten can affect emotions, cognition, and behaviors, including through ongoing inflammation of the brain and malabsorption of nutrients in the small intestine. [17]

In one study, researchers looked at the neurology of people with celiac disease, finding that neurological symptoms were common. For example, 67% of participants had frequent headaches, and most had abnormalities in gait and balance. Later studies used brain imaging to confirm abnormalities in brain structures in participants with a positive test for gluten antibodies. Those who stayed completely gluten-free did not have the same brain changes. [18]

Now let’s look at other research results into gluten sensitivity and specific mental health conditions.

Gluten, Depression, and Other Mood Disorders

There have been mixed results in research on gluten’s effect on depression. Still, several studies show a significant improvement in depression symptoms and other mood disorders when gluten-sensitive individuals remove it from their diets. [21]

Gluten and ADHD

One study of 67 people with ADHD found that 10 had undiagnosed celiac disease, a larger proportion than expected in a random sample. For these patients, removing gluten from their diet significantly improved ADHD symptoms. [22]

Gluten and Schizophrenia 

Research into a connection between gluten and schizophrenia goes back many decades, and researchers have noted shared immunologic features in those with schizophrenia and those with celiac disease. Some studies find a gluten-free diet improves daily life for people diagnosed with schizophrenia, while a minority of studies have found no significant benefit. [23]

Science Behind the Role of Food Reactions & Inflammation

Personalized Diet Based on Laboratory Data

FAQ’s

3) How do I know if I’m gluten intolerant or celiac?

Celiac disease can be reliably diagnosed with blood tests. Testing for celiac disease and wheat allergy is often the first step in reaching a diagnosis of gluten intolerance. While there are no direct tests for non-celiac gluten sensitivity, after ruling out celiac and allergies, you can use indirect blood tests for food allergies, sensitivities, and intolerances and a gluten elimination diet challenge to verify a gluten intolerance diagnosis.

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