You probably know at least one person who’s gone gluten-free. They may have been diagnosed with celiac disease, or perhaps they just feel healthier, think more clearly and have better digestion without gluten on their plate. Maybe you’ve even removed it from your own diet (or at least thought about it!). Regardless, you can’t turn around in a grocery store or browse most restaurant menus without seeing the gluten-free label.
Despite the incidence of celiac disease remaining flat, the number of people following gluten-free diets has more than tripled since 2009 (reference). Among those eating gluten-free, 72% are classified as “PWAGs” (people without celiac who avoid gluten). By 2020, the gluten-free food market is projected to be worth $7.59 billion (reference).
Why are so many people going gluten-free if they don’t have celiac disease? Well, there are a number of ways gluten can wreak havoc on your health. In today’s blog, we’re gonna break down the differences between celiac disease, wheat allergy, gluten intolerance and gluten sensitivity. Then we’ll cover four of the most common gluten sensitivity symptoms so you can start figuring out whether or not a gluten-free diet could be for you.
When Gluten Means Trouble
Gluten, Latin for “glue,” is a group of proteins found in wheat, barley, rye, triticale, malt, brewer’s yeast, wheat starch, and wheat derivatives like wheat berries, durum, emmer, semolina, spelt, and farina. There are a few main reasons people experience health issues when they eat gluten: Celiac disease, wheat allergy, gluten intolerance and gluten sensitivity.
Celiac disease is an inherited autoimmune disease. People who have it produce certain antibodies when they eat gluten. Those antibodies destroy villi, which are finger-like projections in the small intestine that assist with nutrient absorption. Symptoms of celiac disease include diarrhea, bloating, iron-deficiency anemia, fatigue, migraines, infertility, miscarriages, stunted growth in kids, weight loss, brain fog and depression.
Doctors test for celiac disease by doing a blood panel that checks for celiac antibodies the body produces when it detects gluten. That’s why it’s important for people being tested for celiac disease to continue consuming gluten during the testing period. When the blood panel finds celiac antibodies, the physician often recommends a biopsy of the small intestine to confirm the diagnosis.
Those with celiac disease must strictly avoid all gluten to live symptom-free. Celiac is not technically a food allergy, but it’s often referred to as such to emphasize how important it is for those with the disease to steer clear of gluten.
A wheat allergy is a disorder in which the immune system treats one or more of the proteins in wheat as foreign invaders and releases antibodies to defend against them. Reactions range from anaphylaxis (when your throat swells up and you can’t breathe—EpiPen needed!) to asthma when wheat is consumed.
Docs usually use skin prick tests to diagnose wheat allergies, which involve pricking wheat extracts into the skin’s surface (usually on the forearm) and observing the reaction. Blood tests looking for wheat-specific antibodies are also an option.
Although gluten is in all wheat products, people with wheat allergies can consume wheat-free foods that contain gluten (such as barley, rye, malt and some oats). Like celiac, wheat allergy is a serious condition that requires strict avoidance of wheat-containing foods.
Gluten Sensitivity and Gluten Intolerance
If you don’t have celiac disease or a wheat allergy, you may still feel crummy after you eat gluten or wheat because you’re sensitive to the stuff. There are no medical tests for non-celiac gluten sensitivity (NCGS) and the complications aren’t yet fully understood. The majority of people who avoid gluten fall into this category. Eating gluten-free gives them relief from symptoms such as bloating, gas, diarrhea, constipation, brain fog, low energy, aches and pains.
The major difference between gluten sensitivity and gluten intolerance is in the severity of the symptoms. It may take folks with gluten intolerance several weeks to feel relief from symptoms once they remove gluten from their diets, whereas people with gluten sensitivity may see improvements almost immediately. Because of this, people with gluten intolerance may want to be as diligent about avoiding gluten as those with a wheat allergy or celiac disease.
Both gluten sensitivity and intolerance aren’t well defined by the medical community. Eliminating gluten and documenting the results is the only “test” available. Researchers are currently trying to determine if gluten exposure for those with sensitivity or intolerance can lead to any long-term complications like damage to the intestinal tract or issues resulting from inflammation.
4 Gluten Sensitivity Symptoms to Watch Out For
So if you don’t have celiac disease and you’re not allergic to wheat but you still feel crappy after eating, how can you tell whether or not gluten is the culprit? Because there are no tests for gluten sensitivity or intolerance, it’s not always easy! But if you pay close attention to how you feel when you eat foods that contain gluten vs. foods that don’t, you may notice a pattern. Start by watching out for these common gluten sensitivity symptoms:
1. Upper GI Issues
People with gluten intolerance or sensitivity are often very burpy and bloated, get heartburn, and feel stomach pain or discomfort after eating. They may feel like food is stuck and isn’t digesting properly, and may even have productive burps (aka regurgitation) soon after eating. It can be difficult to distinguish this symptom of gluten sensitivity from unrelated digestive upset. But if you have persistent upper GI issues, keep track of how you feel when you eat meals with and without gluten so you can start connecting the dots.
One thing to keep in mind: New research indicates that common upper and lower GI gluten sensitivity symptoms could also be connected to a group of poorly digested carbohydrates called FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) such as fruits, certain veggies, wheat, rye, barley, beans, lentils and some nuts (study). If giving up gluten doesn’t help improve your digestive symptoms, you may want to consider working with an integrative nutritionist to eliminate FODMAPs temporarily to help your system heal.
2. Lower GI Issues
Folks who are sensitive to gluten might experience diarrhea or constipation (or both!) after consuming it. These symptoms are very similar to those experienced by people with Irritable Bowel Syndrome (IBS).
People who have especially sensitive digestive systems often experience increased intestinal permeability when they eat gluten. This means that bacteria and toxins pass through the intestinal lining into the rest of the body, which can lead to inflammation, fatigue and skin issues. You may have heard this referred to as leaky gut syndrome. People with leaky gut often eliminate gluten to help heal the lining of their intestinal tract (study). Healing leaky gut also often involves avoiding yeast, dairy, sugar and alcohol, managing stress, and eating a nutrient-dense diet.
3. Mental and Emotional Challenges
Gluten can be the source of brain fog, depression, anxiety and general fatigue in people who are gluten sensitive. These issues are easily overlooked as signs of gluten sensitivity, especially if no digestive symptoms exist. But, once on a gluten-free diet, sensitive individuals feel more mentally clear, energized, and less anxious or moody.
4. Aches and Pains
Feeling a little bit of pain everywhere? People who are gluten sensitive often experience headaches, migraines, joint and muscle pain, and even tingling or numbness in their hands and feet. These symptoms should diminish for sensitive guys and gals after going gluten-free for a few days.
What to do if you have these gluten sensitivity symptoms.
Do these symptoms sound familiar? If you’re regularly experiencing any of the gluten sensitivity symptoms listed above, try eliminating gluten from your diet for at least 3 weeks. You should start feeling better within the first week. Keep gluten out of your diet for a total of 3 weeks and then—if you want to test it—slowly integrate it back into your life and evaluate how you feel after 3 days. If everything else in your diet has stayed the same, you should get a pretty clear feeling as to whether or not gluten is the trigger.
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