In my office, I get asked about gluten-related gut diseases from many patients. It’s not unusual for people to say they feel much better after dropping gluten from their diets, even though they don’t have celiac disease. This area is medicine is still very new and poorly understood.
Let’s break down 3 types of gluten-related diseases:
- Celiac disease
- Non-celiac gluten sensitivity
- Wheat allergy
Celiac disease is one of the most common autoimmune conditions affecting approximately 1 in 133 people. Even though celiac disease is very common, more than 80% of celiac disease patients remain undiagnosed. Celiac disease is a chronic, autoimmune digestive disorder that results in inflammation of the small intestine of genetically susceptible individuals when they ingest gluten. In patients with celiac disease, ingestion of gluten results in an abnormal immune response that results in inflammation within the small intestine. Gluten is the protein fragments of wheat, rye and barley that triggers the disease. Gluten is the compound that gives elasticity to dough and makes bread chewy. The only treatment at this time for celiac disease is adherence to a gluten-free diet.
Symptoms of celiac disease can include abdominal bloating, diarrhea and even constipation. Celiac disease can also cause fatigue, iron deficiency anemia, osteoporosis, weight loss and malnutrition.
Non-Celiac Gluten Sensitivity
Non-celiac gluten sensitivity (NCGS) is a poorly understood condition that has recently received a lot of attention from patients, care providers, researchers and the media. NCGS is a condition that produces symptoms similar to those seen in celiac disease, however, unlike celiac disease, it is not an autoimmune disorder and does not have a genetic component. This means that when someone with NCGS eats gluten, it will not cause damage to the small intestine but will still produce symptoms.
Common symptoms of NCGS are mental fatigue (“brain fog”), lack of energy or lethargy, gas, bloating, abdominal pain or cramps, diarrhea and even constipation. At this time it is unclear if gluten is the cause of NCGS or if it might be a reaction to a specific sugar or chemical component found in wheat.
Unfortunately, unlike celiac disease, there is no diagnostic test for NCGS…it is a diagnosis of exclusion. This means that your gastroenterologist will only diagnose you with NCGS if both celiac disease and wheat allergy have been ruled out.
In order to be tested for celiac disease YOU MUST BE EATING GLUTEN! Please do not initiate a gluten free diet until you have been tested for both celiac disease and wheat allergy.
Gluten food allergy is caused by a specific, reproducible immune response to a particular structural aspect of a “problem food.” Food allergies most commonly are caused by allergic antibodies (IgE) to the food(s) in question, or more rarely may result from other specialized immune pathways (non-IgE mediated). Once the allergy is identified, avoidance of the specific problem food will resolve the symptoms. Most allergic reactions to foods result from unintentional exposures in individuals with a known food allergy.
Nine problem foods are responsible for 90 percent of all IgE-mediated food allergies: I would list these in a line
Peanut, Tree Nuts (e.g. almonds, walnuts, etc), Milk, Soy, Egg, Fish, Shellfish, Wheat, Sesame
- Tree nuts (e.g. almonds, walnuts, etc)
Most young children with an IgE-mediated food allergy will outgrow the allergy by adolescence; however only 20 percent of children allergic to peanuts will outgrow the allergy.
These “classic food allergies” usually have an almost immediate onset of symptoms that are related to anaphylaxis. In general, allergic symptoms can occur within two hours of eating the problem food. Typically, reactions start within minutes. Most people experience skin irritation, particularly itchy rashes with hives or facial swelling. Like anaphylaxis, signs include rash, rapid tissue swelling, vomiting, diarrhea, eye-nose-throat swelling, breathing problems, heart palpitations, and/or fainting.
Comparison of Gluten-Related Disorders