Gluten is a collective term for proteins found in wheat, barley, and rye. It helps foods maintain their shape, acting as a binding agent that gives dough elasticity and bread its chewy texture. Determining whether one needs to follow a gluten-free diet requires professional medical evaluation.
Understanding Gluten and Related Conditions
Three primary conditions involve adverse reactions to gluten. Celiac disease is an autoimmune disorder where consuming gluten triggers an immune response in genetically predisposed individuals. This reaction damages the small intestine’s lining, specifically the villi, which are small, finger-like projections that absorb nutrients. Untreated celiac disease can lead to malabsorption and other health issues.
Non-celiac gluten sensitivity (NCGS), sometimes called gluten intolerance, describes a condition where individuals experience symptoms after eating gluten, but without the autoimmune response or intestinal damage characteristic of celiac disease. This condition is diagnosed by ruling out other gluten-related disorders.
A wheat allergy is distinct from both celiac disease and NCGS, representing an immune system reaction to proteins found in wheat. This allergic response can manifest rapidly, ranging from mild symptoms to severe, life-threatening reactions. Unlike celiac disease, a wheat allergy involves an IgE-mediated immune response.
Recognizing Potential Symptoms
A wide range of symptoms can suggest a gluten-related issue, affecting both the digestive system and other parts of the body. Digestive symptoms commonly include bloating, gas, abdominal pain, diarrhea, and constipation. Individuals might also experience nausea, vomiting, or acid reflux after consuming gluten.
Beyond the digestive tract, systemic symptoms can arise, such as fatigue, brain fog, and headaches. Other non-digestive manifestations include joint and muscle pain, skin rashes like dermatitis herpetiformis, and numbness or tingling in the extremities. Some individuals also report depression, anxiety, or unexplained weight changes. These symptoms are not specific to gluten-related conditions and can indicate many other health problems, highlighting the need for medical evaluation.
The Path to Diagnosis
For celiac disease, the process begins with specific blood tests that check for elevated levels of antibodies. These include tissue transglutaminase IgA (tTG-IgA) and endomysial antibody (EMA). If an individual has an IgA deficiency, deamidated gliadin peptide (DGP-IgA or IgG) testing may be used.
Following positive blood test results, a small intestine biopsy is performed to confirm celiac disease. This procedure, conducted during an upper endoscopy, allows a doctor to examine the intestinal lining for characteristic damage to the villi. It is important to continue consuming gluten regularly before and during these diagnostic tests, as beginning a gluten-free diet beforehand can lead to inaccurate results.
Diagnosing non-celiac gluten sensitivity (NCGS) is a process of exclusion. Celiac disease and wheat allergy must first be ruled out through appropriate testing. If these conditions are absent, a healthcare professional might then recommend a supervised gluten elimination diet, followed by a careful reintroduction of gluten to observe symptom recurrence and confirm NCGS.
Next Steps and Professional Guidance
If you receive a diagnosis of a gluten-related condition, consulting with a healthcare professional is important. A gastroenterologist can provide medical guidance, while a registered dietitian specializing in celiac disease or gluten sensitivity can offer personalized dietary advice. These professionals can also help address potential nutritional deficiencies and monitor your health over time.
Even if gluten-related conditions are ruled out but symptoms persist, continue working with your doctor. Persistent symptoms indicate an underlying issue that warrants further investigation. Professional medical advice is essential for accurate diagnosis and effective management of any health concerns.