The past ten years has seen an explosion in the variety and assortment of gluten-free foods that are available in markets and specialty stores. You may begin to think that nearly everyone you know has Celiac disease! However, there are number of different conditions that may benefit from a gluten-free diet, that aren’t considered true Celiac disease. If you have been experiencing digestive issues, or a host of other strange symptoms, you may have developed a wheat allergy, or an intolerance to gluten. Each year thousands of people are misdiagnosed with other conditions, when their symptoms may be easily resolved by adhering to a wheat or gluten-free diet. It’s estimated that over 75% of people with gluten intolerance will never be diagnosed. Make sure you aren’t one of them!
A wheat allergy is a condition similar to seasonal hay fever or an allergy to seafood or peanuts. In certain individuals, wheat can cause a histamine response that can lead to hives, stomach pain, and watery or itchy eyes. Some people have such a bad reaction that even smelling bread, or getting flour on their hands can lead to an outbreak or difficulty breathing. Like all allergies, this type of hypersensitivity that can pop up at any point in your life. An allergist can test you for a wheat allergy. It is best treated by completely avoiding all wheat-based products, though many gluten-based products that do not contain wheat may still be tolerated.
Gluten intolerance is a poorly understood condition that is getting significantly more attention these days. Individuals with gluten intolerance can suffer from a startling array of symptoms that negatively impact their daily life and well-being. These individuals will not test positive for a wheat allergy, nor do they have Celiac disease, as determined by blood tests and a biopsy. But their symptoms are no less real, and some experts estimate that there are over 200 different symptoms that may be encountered. In addition, recent surveys indicate that well over 10% of the US population is gluten intolerant. Let’s take a look at some of the more common symptoms of gluten intolerance. You may experience only a few of these symptoms, or may have many of them.
This chart provides a quick overview of these three conditions:
Comparison of Gluten-Related Disorders
|Celiac Disease||Non-Celiac Gluten Sensitivity||Wheat Allergy|
|Definition||Genetic, autoimmune disorder; gluten ingestion triggers damage to small intestine||Intolerance to gluten or other wheat components without damage to small intestine||Immune response to one or more of the proteins found in wheat (can include gluten)|
|Gastrointestinal symptoms||Diarrhea, bloating, abdominal pain||Diarrhea, bloating, abdominal pain||Naseua, vomiting, diarrhea, bloating, irritation of mouth or throat|
|Extra-intestinal findings (e.g. anemia, bone loss)||Weight loss, malnutrition iron deficiency, dental caries, bone loss, skin issues, neurological disorders, liver dysfunction, joint pain, hair loss, fatigue||Brain fog, neurological disorders, joint pain, fatigue||Hives, rash, nasal congestion, eye irritation, difficulty breating|
|Positive antibody test||Yes||Variable||No|
|Abnormal intestinal biopsy||Yes||No||No|
|Treatment||Strict adherence to a gluten-free lifestyle||Adherence to a wheat free/gluten-free diet (level of adherence variable)||Strict adherence to a wheat free lifestyle|
Symptoms of Gluten Intolerance
As previously mentioned, there is a wide range of symptoms that may be associated with either Celiac disease or gluten intolerance. Here is a list of the top 40 symptoms, some of which may surprise you.
Digestive Issues and Symptoms
The most common symptoms of gluten intolerance occur in the digestive tract and include the following:
- Excess gas
- Abdominal cramping or pain
- Abdominal distention
- Borborygmi (rumbling stomach)
- Pale and odorous stools
- Nausea and vomiting
- Lactose intolerance
Skin and Hair Symptoms
- Hives (or urticaria)
- Keratosis pilaris (commonly called chicken skin’ ). Looks like small red raised bumps on the back of your arms.
- Dry hair that breaks easily
- Alopecia (hair loss)
- Cracked and brittle nails
- Canker sores and ulcers in the mouth
- Loss of dental enamel
- Bad breath (halitosis)
- Gum soreness and bleeding
- Tooth pain or sensitivity
Mental Health Concerns
- Unexplained irritability
- Sudden dizziness
- Attention deficit hyperactivity disorder
- Brain fog’ – feeling unfocused or forgetful
- Mood swings
- Peripheral neuropathy (tingling or painful feelings in the fingers and toes)
- Sjogren’s Disease
- Unexplained weight gain or loss
- Deficiencies in vitamins and minerals
- Joint pain, swelling, or arthritis
- Chronic fatigue
- Fatigue after eating a meal with gluten
- Hormonal imbalances such as premenstrual syndrome
- Migraine headaches
By themselves, many of these symptoms are not considered indicative of gluten intolerance. However, if you have several of these symptoms together, you should definitely suspect an issue with gluten intolerance. For instance, migraine headaches that shortly follow a serving pizza or a sandwich for lunch, along with frequent diarrhea and a skin rash would most certainly point to gluten intolerance. The same can be said for frequent joint pain. Gluten intolerance leads to an inflammatory response in the body that can have a direct impact on your joints, and is often mistaken for rheumatoid arthritis. However, it is not uncommon for joint pain to subside dramatically when on a gluten-free diet. Finally, while chronic fatigue alone is not a common symptom of gluten intolerance, but when fatigue is combined with anemia, dry hair (due to lack of absorption of iron and other vitamins and minerals), and stomach cramping with gas, then it is logical to look to gluten as the culprit.
If you have a number of the symptoms listed above, you need to make an appointment with a health care provider. The only way to diagnose gluten intolerance is to get the screening for Celiac disease that includes an endoscopy and biopsy of the small intestines and the villi, which absorb nutrients. Your physician will also order a tTG –IgA test. Individuals who have Celiac disease will show inflammation, and be staged from March 0 to March IV, depending on the extent of their disease. Individuals with gluten intolerance will not test positive to these screening procedures, and typically do not have small intestine damage, or any tTG antibodies. The next step in your diagnosis is a gluten-free diet for at least 3 weeks. Gluten is a large sized protein and will take months or years to fully removed from your system. However, many people start to feel better within days of being on an elimination diet. If a gluten product is reintroduced and the symptoms return, this is then considered proof of a positive diagnosis of non-celiac gluten sensitivity.
Most people with gluten insensitivity will feel much better after being on an elimination diet that focuses on fresh vegetables, fruits, rice, beans, organic meats, and gluten-free products. To maintain a healthy and active lifestyle, those with gluten intolerance should adhere to the same strict standards for their diet as a Celiac patient. Even small amounts of gluten can cause you to experience problems again. Why risk it?