FacebookDiagnosing celiac disease can be difficult when symptoms overlap with numerous digestive disorders. Brain fog, diarrhea, constipation, headaches, and joint pain are just a few on the long list of symptoms that have been linked to celiac disease. But individuals with non-celiac wheat sensitivity can experience these symptoms as well.
While these two conditions may present with outward similarities, the internal mechanisms of the diseases are very different. More study is needed to understand the differences between celiac disease and non-celiac gluten or wheat sensitivity, but new research provides some clues.
What is Non-Celiac Wheat Sensitivity?
Celiac disease presents differently in children than in adults, and some people with the disease have no symptoms at all. If you’re experiencing symptoms but do not test positive for celiac disease, it’s still possible that gluten lies at the heart of your problems.
The term non-celiac gluten sensitivity (NCGS) – also known as non-celiac wheat sensitivity (NCWS) – refers to a condition in which tests for celiac disease and wheat allergy are negative but removal of gluten from the diet resolves symptoms.
Some of the most common symptoms of NCWS include:
- Depression
- Brain fog
- ADHD-like behavior
- Abdominal pain
- Diarrhea
- Bloating
- Constipation
- Headaches
- Bone or joint pain
- Chronic fatigue
Individuals with NCGS tend to experience more non-gastrointestinal symptoms than individuals with celiac disease. These symptoms may present hours or days following gluten consumption. Diagnosis of NCGS involves ruling out other potential causes for symptoms such as celiac disease or wheat allergy.
How Is It Different from Celiac Disease?
For years, it was thought that non-celiac gluten sensitivity differed from celiac disease in one primary way. First, that individuals with NCGS/NCWS experience symptoms similar to celiac disease but do not develop intestinal damage related to gluten-mediated immune reactions.
New evidence collected by a team of Columbia University Medical Center researchers in 2016 suggests otherwise. Individuals in the study with non-celiac gluten or wheat sensitivities experienced systemic immune reactions to wheat exposure accompanied by intestinal cell damage. These results suggest that the population impacted by NCGS may be equal to or larger than the population affected by celiac disease – a significant portion of which remains undiagnosed.
Application of this new research is limited by the fact that it hasn’t been confirmed that gluten is responsible for the observed immune reaction, as it is with celiac disease. Two other possibilities include fructans, a component of FODMAPs, or amylase-trypsin inhibitors (ATIs). Dr. Armin Alaedini, head researcher of the study, notes that intolerance can also be triggered by medications, surgery, or gastrointestinal infections.
More research is required in this area, but existing research points to a second difference between celiac disease and non-celiac wheat sensitivity. Leaky gut, or increased intestinal permeability, is a key component of celiac disease. Research appears to indicate that leaky gut is not characteristic of gluten sensitivity, but unmanaged gluten intolerance can increase the risk of developing leaky gut.
Tips for Management
As is true for celiac disease, the best treatment for gluten sensitivity is often a gluten-free diet. Some individuals with NCGS also find it helpful to remove or limit FODMAPs from their diets. The term FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols which are short-chain carbohydrates that tend to be poorly absorbed by the small intestine.
Because gluten is a protein found in wheat, barley, and rye, individuals with NCWS may need to avoid foods containing these grains and other food products that contain them.
Fortunately, there are plenty of naturally gluten-free foods around which a healthy and satisfying diet can be built. Fruit, vegetables, meat, and dairy products are largely gluten-free, and it has become easier than ever to find gluten-free versions of convenience foods like pasta and baked goods. With an all-purpose gluten-free flour blend, you can even adjust your favorite recipes to be gluten free.
After an NCGS diagnosis, it’s best to completely remove gluten from your diet for an extended period of time (months or years). Certain evidence suggests, however, that some individuals are able to reintroduce small amounts of gluten in their diet without issue. Individual tolerance varies, however, so it’s important to pay attention to your body.
If you are experiencing symptoms related to gluten sensitivity or have been diagnosed with non-celiac gluten sensitivity, paying attention to your body's reactions to certain foods can be very helpful. Eliminating gluten from your diet can significantly reduce symptoms such as bloating, abdominal pain, and diarrhea. However, some individuals may still experience symptoms even after removing gluten from their diet.
In such cases, following a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet might be a good option. This diet limits the intake of foods that contain certain types of carbohydrates that are known to be poorly absorbed in the gut, leading to symptoms such as gas, bloating, and abdominal pain.
A low FODMAP diet typically involves avoiding or limiting types of carbohydrates found in foods like wheat, onions, garlic, beans, lentils, and certain fruits and vegetables. Instead, it emphasizes the consumption of low-FODMAP foods such as rice, quinoa, meat, fish, eggs, and certain fruits and vegetables.
It's important to note that following a low FODMAP diet should be done under the guidance of a healthcare professional or registered dietitian, as it is a restrictive diet that may lead to nutrient deficiencies if not followed properly. With the right guidance, however, a low FODMAP diet can be an effective way to manage symptoms related to gluten sensitivity and improve overall gut health.
