Health Issues That Are Sometimes Mistaken for Gluten Sensitivity
The protein found in wheat, barley and rye is often blamed for similar but unrelated symptoms.
This article is based on reporting that features expert sources.
SOURCES
The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our editorial guidelines.
Hilary Jericho, MD
Jericho is a pediatric gastroenterologist at the University of Chicago Medical Center who specializes in the treatment of celiac disease.
Benjamin Lebwohl, MD, MS
Lebwohl is a gastroenterologist and Louis and Gloria Flanzer Scholar, Columbia University Medical Center, and director of clinical research at the Celiac Disease Center at Columbia University, both in New York City.
Julie Stefanski, MEd, RDN, CSSD, LDN, CDE, FAND
Stefanski is a registered dietitian for Stefanski Nutrition Services in York, Pennsylvania, and a spokesperson for the Academy of Nutrition and Dietetics.
Guy A. Weiss, MD
Weiss practices general gastroenterology, with particular focus on gluten-associated disorders. He is director of the UCLA Celiac Disease Program and an assistant professor of medicine in the division of digestive diseases at David Geffen School of Medicine at UCLA. He is also the editor of “Diagnosis and Management of Gluten-Associated Disorders: A Clinical Casebook,” published by Springer.
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Gluten intolerance symptoms checklist
These are symptoms of possible gluten intolerance:
- Abdominal pain.
- Bloating.
- Gas.
- Diarrhea.
- Constipation.
- Nausea and vomiting.
- Anxiety or depression.
- Fatigue.
- Brain fog.
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Could something else be causing your symptoms?
Technically speaking, you could have a problem specifically with wheat – such as a wheat allergy – but not specifically with gluten, which is found in other foods that don’t contain wheat, such as barley and rye. There’s even debate among clinicians and researchers about whether or not the umbrella term non-celiac gluten sensitivity (used to broadly describe what’s believed to be a sensitivity to gluten when a person doesn’t have celiac disease) should be reframed – and renamed – to wheat intolerance syndrome or other alternatives.
If you are allergic to wheat, symptoms such as hives, itchy or red eyes, swelling in the mouth, abdominal issues or difficulty breathing tend to appear more rapidly and should be treated with antihistamines, epinephrine and/or a visit to the doctor.
But however it’s couched, there’s general agreement that patients need to take time to talk with their health professionals to really hone in on what’s causing their symptoms, instead of just taking matters into their own hands and making drastic dietary changes.
Could something else be causing your symptoms?
Technically speaking, you could have a problem specifically with wheat – such as a wheat allergy – but not specifically with gluten, which is found in other foods that don’t contain wheat, such as barley and rye. There’s even debate among clinicians and researchers about whether or not the umbrella term non-celiac gluten sensitivity (used to broadly describe what’s believed to be a sensitivity to gluten when a person doesn’t have celiac disease) should be reframed – and renamed – to wheat intolerance syndrome or other alternatives.
If you are allergic to wheat, symptoms such as hives, itchy or red eyes, swelling in the mouth, abdominal issues or difficulty breathing tend to appear more rapidly and should be treated with antihistamines, epinephrine and/or a visit to the doctor.
But however it’s couched, there’s general agreement that patients need to take time to talk with their health professionals to really hone in on what’s causing their symptoms, instead of just taking matters into their own hands and making drastic dietary changes.
Celiac disease vs. NCGS
Certain tests can help differentiate celiac disease from look-alike conditions.
“Celiac disease is an autoimmune condition, affecting about 1% of the population, in which the immune system is triggered in response to gluten exposure, leading to gut inflammation,” explains Dr. Guy A. Weiss, director of the UCLA Celiac Disease Program and an assistant professor of medicine in the division of digestive diseases at David Geffen School of Medicine at UCLA. “Diagnosis is based on blood tests showing high celiac-associated antibodies and typical biopsy findings from the small bowel.”
With non-celiac gluten sensitivity, the diagnosis is less clear-cut. “NCGS is not a well-understood syndrome,” says Weiss, who is the editor of “Diagnosis and Management of Gluten-Associated Disorders: A Clinical Casebook.” NCGS, which affects an estimated 2% to 3% of people, “is diagnosed clinically after excluding celiac disease and wheat allergy, in those with symptoms that are associated only with gluten exposure,” he says. “People with NCGS do not have the above-mentioned abnormal laboratory or biopsy findings.”
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Cases of mistaken identity
Going gluten-free without the guidance of a registered dietitian nutritionist can have unintended health consequences.
Research led by Lebwohl, published in May 2017 in the journal BMJ, notes avoiding dietary gluten may result in reduced consumption of whole grains, which could increase cardiovascular disease risk. What’s more, previous research Lebwohl was involved with found that many different alternative diagnoses were made for 25 of 84 patients studied who didn’t have celiac disease but had reported gluten was making them ill.
“The take-home from that study is that just because a patient is making a connection (between) gluten and symptoms does not automatically mean that that patient has non-celiac gluten sensitivity,” Lebwohl says.
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Another food intolerance
One of the alternate diagnoses made for some patients who originally thought they had a gluten sensitivity is another food intolerance.
That could include lactose intolerance – in which a person has difficulty digesting the sugar found in dairy – and fructose intolerance. Fructose is a type of sugar found naturally in fruits, fruit juices, some vegetables and honey.
Julie Stefanski, a registered dietitian nutritionist in York, Pennsylvania, and a spokesperson for the Academy of Nutrition and Dietetics, points out that fructose intolerance produces similar symptoms to gluten intolerance. For example, “fructose intolerance can cause gas, bloating and diarrhea,” she says. But it’s caused by high amounts of fructose in things like juice or candy. That includes high-fructose corn syrup found in many processed foods and drinks.
Part of the confusion surrounding these intolerances is that people often co-ingest wheat with other foods, such as dairy or sugar. For instance, pizza, pasta with cheese or cream sauces and lattes with pastries or desserts are common pairings. Experts suggest consulting with a dietitian instead of trying to do the food sleuthing yourself.
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Added fiber, artificial sugars and alcohol
