Your blood test for celiac disease came back negative, but you still don’t feel well. Now what? If you have been suffering from symptoms that seem related to gluten, it may be possible that you have non-celiac gluten sensitivity (also known as gluten sensitivity or gluten intolerance).
Gluten sensitivity has been coined to describe those individuals who have symptoms when they eat gluten similar to those with celiac disease, but who don’t have the same antibodies and intestinal damage seen in celiac disease.
Gluten sensitivity is sometimes referred to as gluten intolerance. Gluten sensitivity is a medically more accurate way to refer to the condition. To learn more about the current definitions for conditions related to celiac disease, visit our glossary.
Gluten sensitivity has been clinically recognized as less severe than celiac disease because people with gluten sensitivity do not test positive for celiac disease based on blood testing, and do not have damage to their small intestines found in individuals with celiac disease.
Research has also shown that gluten sensitivity does not result in the increased intestinal permeability, also known as leaky gut, that is characteristic of celiac disease. Leaky gut permits toxins, bacteria and undigested food proteins to seep through the GI barrier and into the bloodstream, and research suggests that it is an early biological change that comes before the onset of several autoimmune diseases.
An allergic reaction is when a body’s immune system attacks a foriegn substance. Allergies, including those to wheat, are associated with positive IgE assays. Diagnosis is made through skin prick tests, wheat-specific IgE blood testing and a food challenge. People who have gluten-related symptoms but test negative for a wheat allergy and do not test positive for celiac disease may have gluten sensitivity.
Gluten sensitivity shares many symptoms with celiac disease. However, individuals with non-celiac gluten sensitivity have more extraintestinal or non-GI symptoms, such as headache, brain fog, joint pain, and numbness in the legs, arms or fingers. Symptoms typically appear hours or days after gluten has been consumed.
Learn more about the symptoms of non-celiac gluten sensitivity.
Currently, there are no recommended methods to test for non-celiac gluten sensitivity. It is a diagnosis of exclusion, which means that other causes, including celiac disease and wheat allergy, need to be ruled out and the patient needs to feel better on the gluten-free diet. Some doctors offer saliva, blood or stool testing. However, these tests have not been validated and are therefore not accepted.
The best treatment for gluten sensitivity is the gluten-free diet.
Gluten is the protein that is found in wheat, barley and rye and products that contain them. Therefore, a person on the gluten-free diet needs to avoid conventional breads, pizza, pasta, cakes, cookies and other baked goods, plus a host of other foods and beverages, including soy sauce, beer, malt flavorings and more.
There are many naturally occurring gluten-free foods, such as meat, dairy products, and fruits and vegetables. Learn more about the gluten-free diet.
Some people with symptoms of gluten sensitivity may also want to talk with their healthcare provider or dietitian about considering a low FODMAPs diet. FODMAPs (an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are short chain carbohydrates (sugars) that may be poorly absorbed in the small intestine. This can cause more water to be pulled into the colon and can also rapidly ferment, or be broken down, by bacteria in the bowel. This can cause symptoms like increased gas, bloating, constipation/diarrhea and pain. These symptoms are part of the diagnosis of Irritable Bowel Syndrome (IBS) and also overlap with celiac disease symptoms. FODMAPs are in many foods, and wheat, barley and rye — gluten-containing grains — are all high in FODMAPs. Read more about FODMAPs.