Should I Be Gluten Free?

What’s the difference between celiac disease, gluten intolerance, non-celiac gluten sensitivity and wheat allergy?

We use “gluten intolerance” when referring to the entire category of gluten issues: celiac disease, non-celiac gluten sensitivity and wheat allergy. Celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine.

“Non-celiac gluten sensitivity”, or “gluten intolerance”, causes the body to mount a stress response (often GI symptoms) different from the immunological response that occurs in those who have celiac disease (which most often causes intestinal tissue damage).

As with most allergies, a wheat allergy causes the immune system to respond to a food protein because it considers it dangerous to the body when it actually isn’t. This immune response is often time-limited and does not cause lasting harm to body tissues.

More than 55 diseases have been linked to gluten, the protein found in wheat, rye, and barley. It’s estimated that 99% of the people who have either gluten intolerance or celiac disease are never diagnosed. It is also estimated that as much as 15% of the US population is gluten intolerant. Medical science doesn’t actually recognize the term “gluten allergy” so if you present symptoms, it can be one of four different conditions: celiac disease, non-celiac gluten sensitivity, dermatitis herpetiformis or gluten ataxia. None of these four are true allergies, however, it is possible that someone who refers to a “gluten allergy” actually means a wheat allergy, which is a true allergy.


Conditions of gluten intolerance:

  1. Digestive issues such as gas, bloating, diarrhea and even constipation. I see the constipation particularly in children after eating gluten.
  2. Keratosis Pilaris, (also known as ‘chicken skin’ on the back of your arms). This tends be as a result of a fatty acid deficiency and vitamin A deficiency secondary to fat-malabsorption caused by gluten damaging the gut.
  3. Fatigue, brain fog or feeling tired after eating a meal that contains gluten.
  4. Diagnosis of an autoimmune disease such as Hashimoto’s thyroiditis, Rheumatoid arthritis, Ulcerative colitis, Lupus, Psoriasis, Scleroderma or Multiple sclerosis.
  5. Neurologic symptoms such as dizziness or feeling of being off balance.
  6. Hormone imbalances such as PMS, PCOS or unexplained infertility.
  7. Migraine headaches.
  8. Diagnosis of chronic fatigue or fibromyalgia. These diagnoses simply indicate your conventional doctor cannot pin point the cause of your fatigue or pain.
  9. Inflammation, swelling or pain in your joints such as fingers, knees or hips.
  10. Mood issues such as anxiety, depression, mood swings and ADD.


Celiac Disease

Celiac disease occurs when your immune system mounts an attack on your small intestine in response to ingestion of gluten-containing foods. Celiac affects about one in every 133 Americans and there are more than 100 different symptoms potentially caused by celiac disease But there are some symptoms that appear frequently in people ultimately diagnosed with celiac disease, including:

  • Diarrhea and/or constipationGluten1
  • Abdominal pain and/or heartburn
  • Bloating
  • Fatigue
  • Brain fog
  • Anemia
  • Joint pain
  • Rashes
  • Depression and/or anxiety

The absence of these symptoms doesn’t necessarily mean you can rule out celiac disease, some people may have no symptoms at all, or suffer mainly from neurological symptoms (such as migraines and tingling in their arms and legs).


Non-Celiac Gluten Sensitivity

Gluten sensitivity is a condition that’s only been accepted by researchers and clinicians over the past couple of years and presents symptoms that are really similar to those of celiac disease. In fact, it’s not possible to tell the two conditions apart without medical testing. Here’s a partial list of what you might experience if you have non-celiac gluten sensitivity:

  • Diarrhea and/or constipation
  • Heartburn and/or “stomach ache”
  • Bloating
  • Flatulence
  • Fatigue
  • Brain fog
  • Headaches (including migraine)
  • Rashes and/or eczema

Like those with celiac disease, people with the non-celiac gluten sensitivity form of “gluten allergy” also report joint pain, anxiety and/or depression, and even tingling in their arms and legs.


Wheat Allergy

People who are allergic to wheat — actually, truly allergic to it — sometimes also experience gastrointestinal symptoms and rashes, but they also experience more “typical” allergy symptoms, like a runny nose. People occasionally refer to a wheat allergy as a “gluten allergy,” but true wheat allergy doesn’t necessarily involve gluten — it’s possible to be allergic to many different components of the wheat plant. Symptoms of true wheat allergy include:

  • Nasal congestion
  • Itchy, red, watery eyes
  • Hives and/or itchy rashes
  • Swelling of lips, tongue and/or face
  • Nausea, vomiting and/or abdominal pain
  • Diarrhea
  • Difficulty breathing

The most dangerous potential symptom of wheat allergy is anaphylaxis, a potentially life-threatening systemic allergic reaction. People experiencing anaphylaxis from wheat allergy may find themselves coughing, wheezing or having difficulty swallowing; their hearts may beat rapidly or slow down; and they may have a large drop in blood pressure. Anaphylaxis is a medical emergency, so if you experience these symptoms, call 911 immediately. For more information on true wheat allergy symptoms, diagnosis and management, see: Wheat Allergy


Dermatitis Herpetiformitis

It’s not unusual for a true allergic reaction to result in a skin rash, so it makes some intuitive sense to call dermatitis herpetiformis a “gluten allergy,” as it causes a remarkably itchy, persistent rash. But this rash is not the result of a true allergy: dermatitis herpetiformis is an autoimmune skin condition that occurs when (you guessed it) you’ve eat gluten grains. Symptoms include:

  • Reddened skin
  • Multiple small bumps that look like pimples
  • Itching and burning
  • Purple marks where bumps are healing

Dermatitis herpetiformis can occur anywhere on your body, but the most common locations for this rash are your buttocks, elbows, knees and on the back of your neck. If you’re about to have an outbreak, the itching usually starts even before you see the bumps appear. The condition is closely related to celiac disease. Full information on the condition appears here


Gluten Ataxia: Scary Brain Disorder

The last of the potential “gluten allergy” conditions is also the most uncommon: a brain disorder called gluten ataxia. When you suffer from gluten ataxia, gluten consumption actually causes your immune system to attack the part of your brain called the cerebellum, potentially resulting in damage that’s eventually irreversible. Symptoms of gluten ataxia include:

  • Problems with walking and your gait
  • Clumsiness and lack of coordination
  • Deterioration of fine motor skills
  • Slurring of speech
  • Difficulty swallowing

Gluten ataxia is progressive: sufferers may start out with what may seem like a minor balance problem, but can ultimately wind up significantly disabled. While about one in four people diagnosed with gluten ataxia has the characteristic villous atrophy of celiac disease, only about one in 10 (and not necessarily the same people) has gastrointestinal symptoms. Here are more details on the condition: Gluten Ataxia Symptoms


So How Can You Tell Which ‘Gluten Allergy’ You Have?

It’s clear you can’t tell from symptoms alone. The truth is you’ll need to see your doctor and have some medical testing to determine which of these gluten-related conditions, if any, you might actually have. If you have gastrointestinal symptoms that may point to celiac disease, you’ll likely start with celiac blood tests. If those are positive, your doctor will likely recommend you undergo an endoscopy, a procedure that enables your physician to look directly at your small intestine and take samples for laboratory examination. If, on the other hand, your celiac blood tests are negative, then your doctor may consider the possibility of non-celiac gluten sensitivity or another condition such as irritable bowel syndrome.

Wheat allergy is usually diagnosed with skin prick tests, although your doctor may also use a blood test that looks for specific antibodies to wheat proteins. For people with rashes they believe may be dermatitis herpetiformis, the first step is likely a visit to a dermatologist, who may recommend a skin biopsy of characteristic deposits of antibodies in your rash area. If your symptoms are indicative of gluten ataxia, the path to diagnosis unfortunately isn’t straightforward, although there are several tests your neurologist may want to perform. Regardless of which of these “gluten allergies” you think you have, your first step should be a call to your doctor’s office to make an appointment. Your physician can help you determine what medical testing, if any, you may need.


These foods have wheat protein: Gluten2

  • Bran
  • Bread crumbs
  • Bulgur
  • Couscous
  • Durum, durum flour, and durum wheat
  • Einkorn
  • Farina
  • Farro (also known as emmer)
  • Kamut
  • Semolina
  • Sprouted wheat
  • Triticale
  • Wheat (bran, germ, gluten, grass, malt, starch)
  • Wheat berries
  • Wheat flour (all types, including all-purpose, cake, enriched, graham, high protein or high gluten, and pastry)

Check labels when buying food or ask at restaurants whether a dish has wheat or wheat products in it. These foods often do:

  • Acker meal
  • Ale and beer
  • Baking mixes
  • Baked goods, including cookies, cakes, and crackers
  • Breaded and batter-fried foods
  • Cereals
  • Hot dogs and processed meats
  • Ice cream
  • Salad dressing
  • Pasta
  • Sauces and soups
  • Soy sauce
  • Surimi (mock crab meat)

If you see any of these listed on a label, the food may have wheat in it:

  • Gelatinized starch
  • Gluten or vital gluten
  • Hydrolyzed vegetable protein
  • Natural flavoring
  • Starch, modified starch, modified food starch
  • Vegetable gum or starch

Ask your doctor about other grains. When you have a wheat allergy, you may or may not be allergic to some other grains, too. Gluten, one of the wheat proteins that can cause a reaction, is also in barley, rye, and oats. Ask your doctor if they are safe to eat.

Always check labels. Allergic reactions to wheat can range from stomach upset to asthma-like symptoms to anaphylaxis, which is an emergency. Foods that have wheat must say so on the label. Check them to avoid a reaction. Beware of wheat outside the kitchen. Wreaths and garlands may include wheat or wheat products as decorations. Some children’s play dough also has wheat in it. Other non-food items may, too. Bake with other flours. If a recipe calls for wheat flour, try rice flour, potato starch flour, corn flour, or soy flour instead. Experiment to find the one that gives you the best texture.


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