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Dr. Shabnam Das Kar MD

Specialist in Functional and Metabolic Medicine

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Should You Stop Eating Gluten?

Should You Stop Eating Gluten?

November 21, 2019 by Dr Kar

(An earlier version was posted in April 2019. Updated November 2019)

What Is Gluten?

Gluten is a family of proteins found in grains like wheat, spelt, rye and barley. It consists of two main proteins, glutenin and gliadin. Gluten is the component of grains that helps them bind together, like when you roll out a roti (Indian flatbread) or while making bread.

Gluten-containing food are

  • Roti made with wheat (Atta, maida)
  • Bread
  • Biscuits
  • Cakes
  • Semolina (Sooji)
  • Pasta
  • Couscous
  • Oats
  • Tabbouleh
  • Many processed food contains gluten …..hidden gluten. These may not be obvious sources but relevant nonetheless. Commonest are soups, and sauces, gravy thickeners in restaurants, the coating (breading) in chicken nuggets, Indian-Chinese food from your neighbourhood pushcart. (Which possibly contains MSG too!)

What Is Non-Celiac Gluten Sensitivity (NCGS)?

Non-celiac gluten sensitivity (NCGS) is a condition where you have abnormal symptoms within a few hours or days of eating gluten-containing food, but you do not have Celiac Disease or wheat allergy. (1) Ref. Your symptoms go away when you stop eating gluten-containing food, but they recur within hours or days of eating gluten again.

Is it gluten or wheat sensitivity?

Recent studies have suggested that besides gluten it could be gliadin (2) Ref or fructans, fructose or FODMAPs that could cause sensitivity symptoms. (3) Ref. Additionally, amylase trypsin inhibitors in wheat could cause an immune reaction as well (4) Ref. Sensitivity to food preservatives and artificial colours in gluten-containing food is another possible explanation for your symptoms.

In research, it is important to know which component of wheat is causing problems because often the goal is to find a drug target. In the real world, I would encourage you to find out about your gluten sensitivity by taking the quiz, then eliminating gluten from your diet for a specific period of time and checking how you feel (The steps are described later).

Wheat allergy and wheat sensitivity are not the same!

Some of these terms may seem mere semantics but from a physician’s perspective, they are very important. This table adapted from a paper by Dr. Alessio Fasano in the journal NEJM explains the differences between celiac disease, wheat allergy and gluten sensitivity. (5) Ref

Differences Among Celiac Disease, Gluten Sensitivity and Wheat Allergy

VARIABLESCELIAC DISEASEGLUTEN SENSITIVITYWHEAT ALLERGY
Interval between exposure to gluten & symptomsWeeks to yearsHours to daysMinutes to hours (often an emergency)
Immune responseAutoimmunityPossibly innate immunity. (Not autoimmune)Allergic immune response
Autoantibodies Almost always presentAlmost always absentAlways absent
Enteropathy (Gut abnormalities)Almost always presentAlways absentAlways absent
SymptomsSimilar to wheat allergy and gluten sensitivitySimilar to wheat allergy and celiac diseaseSimilar to celiac disease and gluten sensitivity

What conditions are associated with gluten sensitivity?

AUTOIMMUNE DISEASES (6) RefNON-AUTOIMMUNE DISEASES (7) Ref
Type 1 DiabetesAtaxia (loss of control of body movements)
Hashimoto’s ThyroiditisNeuropathy (Condition affecting nerves)
Multiple Sclerosis Convulsions/seizures
Sjogren’s SyndromeDepression, anxiety, psychosis
Dermatitis HerpetiformisSchizophrenia, Bipolar Disorder
Autoimmune HepatitisIrritable Bowel Syndrome (IBS)
IgA Nephropathy Fibromyalgia
Psoriasis Skin rash
Mixed Connective Tissue Disorder Asthma
Ankylosing SpondylosisAutism
Rheumatoid ArthritisMigraines
ANA PositivityRhinitis
Scleroderma
Interstitial cystitis

What are the symptoms of Non-Celiac Gluten Sensitivity?

As you can see in the image on the left, the symptoms of NCGS may be related to your gut (Intestinal Symptoms) or completely unrelated to the gut (Extraintestinal Symptoms).

How Do You Detect Non-Celiac Gluten Sensitivity?

There are no blood tests for NCGS or wheat sensitivity.

Diagnosis of NCGS is by eliminating gluten from your diet and tracking your symptoms. If you feel better when not eating gluten but your symptoms return when you reintroduce it, then you have NCGS.

How To Detect Non-Celiac Gluten Sensitivity?

  1. Complete the quiz Do You Have Gluten Sensitivity.

    At baseline, you have to remain on a gluten-containing diet.

  2. Stop eating gluten/wheat-containing food for at least 2 weeks. Here is a list created by my associate, digestive health expert Michal Ofer.

  3. Repeat the quiz after stopping gluten/wheat-containing food. (If you have completed the quiz you will receive a reminder email to retake the quiz in 2 weeks time)

    Though the time frame recommended here is two weeks, some of you feel better within 2-3 days of stopping gluten. Others may take 6 weeks or longer.

  4. Compare your before and after scores. If your “after” score is at least 30% less than your “before” score, you are likely to be gluten sensitive.

    You will receive your “before” and “after” scores by email.

Take The Quiz ” Do You Have Gluten Sensitivity?”

Quiz

Celiac Disease Tests Cannot Diagnose Gluten Sensitivity!

This is what I hear from some of my patients:” My doctor says I don’t have a problem with gluten because my celiac disease tests are negative.”

Differences Between Celiac Disease and Non-celiac Gluten Sensitivity

CRITERIA CD NCGS
Genes HLA DQ 2 & DQ 8 Present Absent
Autoantibodies Present 
(Autoimmune Disease)
Anti-gliadin IgG antibodies may be positive. (8) Ref
Immune-mediated intestinal problem  detected on intestinal biopsy. Present Absent
Gut related symptoms Present Present
Symptoms outside the gut May be present Usually 
present
Specific tests to detect disease Available Not available
Treatment Stop eating 
gluten
Stop eating 
gluten 

Important

  • Symptoms: Celiac Disease and NCGS both have similar symptoms, therefore it is not possible to differentiate between the two based on symptoms alone. However, nutrient depletions like iron deficiency and bone loss are more common in CD.
  • A diagnosis of Celiac Disease requires blood tests and intestinal biopsies (in some cases).
  • Celiac Disease blood tests are relevant only if you have been eating gluten. If you haven’t been eating gluten-containing food, the tests for celiac antibodies may be negative even if you have celiac disease.
  • The treatment for Celiac Disease and gluten sensitivity (NCGS) and wheat allergy is to eat a gluten-free diet.

How long should you remain gluten-free?

  • If you have Celiac Disease or wheat allergy, then you have to stay away from gluten for life. (Difficult, eh?)
  • If you have an autoimmune condition, ideally you have to stop eating gluten long term. This is because of the association of gluten with “leaky gut”.
  • If you are gluten or wheat sensitive and do not have any autoimmune condition, you may consider reintroducing gluten and tracking your symptoms again. Studies recommend using 8-10 grams of gluten as a challenge. One slice of bread contains approximately 2-4 grams of gluten.
  • How much is too much? Gluten sensitivity is like a spectrum. Some of you cannot tolerate even minuscule amounts of gluten, while others can tolerate occasional transgressions.

Being gluten-free as opposed to going gluten-free.

What do I mean by that? Many of you replace gluten-containing food with store-bought gluten-free sugary, ultra-processed, high carbohydrate food. A lot of you are pre-diabetic and I have recommended a low carbohydrate diet for you. Unfortunately, most gluten-free food contains a considerable amount of carbohydrates.

To quote my associate Michal Ofer,

I like to tell people to be gluten free as opposed to going gluten free. This means eating in new and inventive ways and not placing too much emphasis on replacing previously enjoyed foods with a less than optimal gluten free option.

Michal Ofer

Summary

  • Gluten sensitivity or wheat sensitivity and celiac disease are different. Non-celiac gluten sensitivity (NCGS) is a known clinical condition.
  • The symptoms of NCGS may not be related to the gut.
  • Wheat allergy is completely different from celiac disease and NCGS. Wheat allergy may be a medical emergency.
  • There are no blood tests (or genes) for NCGS. The best way to find out is to eliminate gluten from your diet and tracking symptoms before and after stopping gluten (Quiz).
  • Celiac Disease tests cannot detect NCGS.
  • If you have Celiac Disease your blood tests may be negative if you haven’t been eating gluten.
  • If you have autoimmunity, you may need to stay away from gluten long-term.

Other articles you may be interested in:

  • “Leaky Gut”
  • IBS

References[+]

References
↑1 Ref
↑2 Ref
↑3 Ref
↑4 Ref
↑5 Ref
↑6, ↑7 Ref
↑8 Ref

Filed Under: Celiac Disease, Non-celiac Gluten Sensitivity

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