By Lian Cerella, Dietetic Intern
Brigham & Women's Hospital
Gastrointestinal disorders like celiac disease and irritable bowel syndrome are on the rise. It is estimated that 1% of the population (1 in 100 people) have celiac disease. An additional 2.5 million people may be undiagnosed. More than 3% of the population has IBS.
Recently, non-celiac gluten sensitivity has become an accepted diagnosis. People can't tolerate gluten, but tests have ruled out celiac disease. (They have a negative blood test and their intestines don't show the damage common with celiac disease.) Yet they get relief from gastrointestinal problems when they eat gluten-free products.
Let's take a closer look at this syndrome.
What Is Non-Celiac Gluten Sensitivity?
Gluten is a protein naturally found in wheat, barley and rye products. There is limited research regarding non-celiac gluten sensitivity. But it is not a precursor to celiac disease.
The symptoms of non-celiac gluten sensitivity are similar to those of celiac disease and IBS. In celiac disease, the body's immune reaction to gluten causes inflammation on the surface of the small intestine.
Patients with non-celiac gluten sensitivity experience:
- Diarrhea or constipation
- Abdominal pain
- Weight loss
- Joint pain
- Numbness in the legs, arms or fingers
- Skin rash
Back to top
What Are the Symptoms?
IBS is a syndrome of long-term or recurrent disturbances in gastrointestinal functioning that affect motility, sensation and secretion. Some patients with IBS follow a special low "FODMAP" diet to control symptoms.
If you are experiencing symptoms of non-celiac gluten sensitivity, talk to your doctor. You may get an anti-body blood test for celiac disease. Your doctor may also rule out IBS. If you do not have celiac disease and your doctor suggests you may be gluten sensitive, try a gluten-free diet.
Back to top
Tips for Going Gluten-Free
Research is limited on what diet is best for non-celiac gluten sensitivity. In some patients studied, a gluten-free diet has relieved symptoms. If symptoms do not improve on a gluten-free diet, please consult your doctor.
Here are tips for following a gluten-free diet:
- Read ingredient labels on food packages. Avoid foods with wheat, barley, rye, oats (unless the label says "gluten free"), malt and Brewer's yeast.
- Include plenty of protein, fruits, vegetables and gluten-free whole grains in your diet. This will help make sure you eat other foods that provide dietary fiber, iron and folic acid. To eliminate the risk of a nutrient deficiency, try these alternatives:
- Dietary fiber – brown rice, quinoa, lentils, black beans, edamame
- Iron – fish, poultry, red meat, quinoa, dark leafy greens, chickpeas
- Folic acid – lentils, chickpeas, kidney beans, bananas, oranges, asparagus, beets
Back to top
A Word of Caution
Gluten-free products are typically made from refined carbohydrates and contain more carbohydrates than their gluten equivalents. On average, gluten-free products also have an excess of unsaturated fats, sugars and salts. In general, make sure to supplement your diet with wholesome, nutritious foods first. Save processed foods as "treats" in your diet.
Back to top
The Bottom Line
Research on non-celiac gluten sensitivity is still new, but findings show that individuals can reduce their symptoms by following a gluten-free diet. Individuals who can tolerate gluten are not recommended to follow a gluten-free diet.
Back to top
Lian Cerella graduated from Rutgers University with a degree in Nutrition and Psychology. She is currently a dietetic intern at Brigham and Women's Hospital.
Biesiekierski JR., Newnham ED., Irving PM., Barrett JS., Haines M., Doecke JD., Shephard SJ., Muir JG., Gibson PR. 2011. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 106:508-514.
Carroccio A., Mansueto P., Iacono G., Soresi M., D'Alcamo A., Cavataio F., Brusca I., Florena AM., Ambrosiano G., Seidita A., Pirrone G., and Battista G. 2012. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol. 107:1898-1906.
Celiac Disease Foundation. 2013. What is celiac disease? Retrieved from http://celiac.org/celiac-disease/what-is-celiac-disease/.
Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. Oct 2013. Time for a reality check on going gluten-free. Health and Nutrition Letter, 31(8):4-5.
International Foundation for Functional Gastrointestinal Disorders. Dec 2013. About irritable bowel syndrome (IBS). Retrieved from http://www.aboutibs.org/.