Going against the grain

When chatting with friends and family, we often misuse the term “gluten intolerance” to describe our gluten-related issues. This can lead to a fair amount of confusion and unsuccessful DIY treatments if we haven’t figured out the underlying cause of the problem.

Gluten intolerance is an umbrella term encompassing three distinct conditions: celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS), all of which are triggered by different mechanisms.

Although all three conditions benefit from eating a gluten-free (GF) diet, it’s important to understand which condition is the cause of your gluten woes, so you can customize your approach for rebuilding health in the long term.

What’s in a name?

Wheat allergy

Wheat allergy is an IgE-mediated hypersensitivity reaction in the immune system against wheat as a whole, rather than the gluten protein specifically. If your symptoms only occur after ingesting wheat but not after ingesting other gluten-containing grains, like rye and barley, then wheat allergy may be the cause.

Celiac disease

Celiac disease occurs when environmental factors, such as viral infections and gut dysbiosis, trigger an autoimmune response upon the ingestion of gluten, among genetically susceptible individuals who have HLA-DQ2 and/or HLA-DQ8 genotypes.

Celiac disease can be triggered at any age. Gastrointestinal symptoms occur from the immune system attacking one’s own tissues. The disease can progress to become multisystemic, affecting major organs including the heart and liver.

Non-celiac gluten sensitivity (NCGS)

NCGS is a reaction against gluten that is neither a hypersensitivity reaction nor an autoimmune one. Some researchers suggest that NCGS originates in the innate immune system, but we haven’t yet determined the mechanism underlying the condition.

Spot the symptoms

Celiac disease, wheat allergy, and NCGS can all present with nonspecific gastrointestinal symptoms, including bloating, abdominal discomfort, diarrhea, and flatulence. Based on digestive symptoms alone, it is difficult to differentiate between these conditions.

Both NCGS and celiac disease are associated with other syndromes as well. NCGS is associated with Hashimoto’s thyroiditis, dermatitis herpetiformis, psoriasis, and rheumatologic diseases.

Celiac disease can cause or contribute to serious complications including autoimmune thyroiditis, peripheral neuropathy, epilepsy, infertility, osteoporosis, dermatological conditions, and ataxia (poor balance, coordination, and speech).

Testing and diagnosis

When you tell your doctor about your gluten-related symptoms, you may be given a referral to an allergist for testing. Your allergist will likely perform an in-office skin prick test and order blood work to measure wheat-specific IgE. Having a positive result from either of these tests indicates a wheat allergy.

Receiving negative results from these two tests (no wheat allergy) usually begins the process of screening for celiac disease. Blood tests for celiac include immunoglobulins such as tissue transglutaminase IgA. If this is positive, then a confirmatory small intestinal biopsy is performed.

Non-celiac gluten sensitivity is a diagnosis of exclusion, only reached following negative results for all the above tests.

Treatment

Wheat allergy

Treatment for wheat allergy requires a wheat-free diet; it may also benefit from gluten-free, too, since many grains are cross-contaminated with wheat. It’s possible for a wheat allergy to subside with time after implementing a wheat-free diet, but allergy severity and duration are different for everyone.

Celiac disease and NCGS

These both require a gluten-free diet for treatment. In celiac disease, complete adherence to a gluten-free diet is crucial. Those with NCGS may be able to tolerate a small amount of gluten in the diet, but the amount of gluten and timing of its reintroduction are different for everyone and should be discussed with a healthcare provider.

It’s also key for your treatment to address nutrient deficiencies that occur from digestive malabsorption, as well as ones that commonly occur from a gluten-free diet.

Speak with your healthcare provider to treat extraintestinal symptoms of gluten intolerance, such as headache, neuropathy, brain fog, and anxiety. If you have celiac disease, remember to regularly screen for associated conditions, like autoimmune thyroiditis and osteoporosis.

Naturopathic doctors frequently help people with all types of gluten intolerance manage their condition and rebuild health.