(also known as non-celiac gluten sensitivity, or non-celiac wheat sensitivity)
Some individuals who experience distress when eating gluten-containing foods and show improvement when following a gluten-free diet may have what is commonly referred to as gluten sensitivity (GS), instead of celiac disease (CD). It is important to keep in mind that GS is not well understood, and it is still not clear whether other components of gluten-containing grains may be involved in causing symptoms, at least in some individuals. The symptoms seen in gluten sensitivity often resemble those that are associated with celiac disease, but often with a prevalence of non-gastrointestinal symptoms.
Because gluten sensitivity is still poorly understood and no bio-markers have been identified, there are no specific medical tests that can be performed to confirm the condition. Instead, it is a “rule out” diagnosis. To diagnose gluten sensitivity, both celiac disease and wheat allergy must be ruled out. Other conditions which may be causing symptoms should also be ruled out. Antibody testing and small intestine biopsy would rule out celiac disease. Immune-allergy tests to wheat would also be negative. Finally an elimination diet and “open challenge” (monitored reintroduction of gluten-containing foods) are most often used to evaluate whether health improves with the elimination or reduction of gluten from the diet.
If you think you may have gluten sensitivity, It is important to consult with your personal physician before giving up gluten. Other possible causes of symptoms should be ruled out. In addition, the screening tests for celiac disease will not be valid if gluten has already been removed from the diet.
Scientific studies regarding treatment of non-celiac gluten sensitivity are limited at this time; however the recommended course of action is to follow a gluten-free diet. It may be possible for some individuals with gluten sensitivity to tolerate a low-gluten diet instead of a gluten-free diet. Consult a physician or dietitian for dietary guidelines.
Frequently Asked Questions
Will gluten damage my intestines?
If you have an intestinal biopsy which shows that you do not have celiac disease, there is no reason to believe that damage is being done to the intestine.
If I have gluten sensitivity now, will I develop celiac disease later?
There is no research that shows whether or not individuals with gluten sensitivity will develop celiac disease. Continue to be checked by your doctor regularly if you continue to eat gluten.
Why is a gluten-free diet effective for some people with autism, multiple sclerosis or chronic fatigue, even when they do not have celiac disease?
It is possible that they have GS. This may be one reason why eliminating gluten from their diets results in improvement of some symptoms.
My doctor says that I have moderately elevated blood tests but do not have celiac disease. What do I have?
You may have a form of GS that brings about a slight immune response but does not cause intestinal damage. Avoiding gluten may help you to feel better. Talk to your doctor to develop a treatment plan specific to you.
I avoid wheat, but I am still having symptoms. What is wrong with me?
A wheat allergy is different from gluten sensitivity. If your symptoms are due to celiac disease or non-celiac gluten sensitivity, you need to avoid all gluten-containing foods: wheat, rye and barley, as well as any products derived from these grains. (Note: oats should also be avoided unless they are specifically labelled gluten-free, since oats are commonly cross-contaminated with wheat.)
Nonceliac Gluten Sensitivity. Kirgel A, Lebwohl B. Advances in Nutrition. 2016 Nov 15;7(6):1105-1110. doi: 10.3945/an.116.012849. Print 2016 Nov.
This article has been assessed and approved by a Registered Dietitian Nutritionist.