In the recent years, gluten has attracted some really bad publicity. For some time, almost everyone heard or even believed that gluten was evil and it had to be eliminated to improve the quality of your diet and be able to call your menu healthy eating. However, dieticians who are engaged in explaining evidence-based medicine have finally reached the mainstream with official and accurate information and have broken the spell on gluten by clarifying that gluten-free does not equal healthy. Most people can definitely eat gluten without any adverse effects. Nevertheless, there is still a small group who will actually benefit from going gluten-free: it depends on the person. Check whether you belong to this group and if you should also consider ditching gluten. Stay alert to these symptoms!
Who should not eat gluten?
Most of the population digest and absorb gluten very well, and their bodies treat gluten as any other protein, extracting valuable amino acids from it. However, there are exceptions. A gluten-free diet is necessary for people suffering from:
- coeliac disease (celiac sprue), an autoimmunological condition where gluten becomes an actual toxin to your body;
- non-coeliac gluten sensitivity (NCGS), disorders that are different from coeliac disease but make meals containing gluten cause unpleasant symptoms;
- wheat allergy, which simply means sensitisation to gluten.
Sometimes people decide to eliminate gluten temporarily or altogether in other diet protocols, such as the low FODMAP diet used in irritable bowel syndrome. These three conditions are still the fundamental cases warranting a gluten-free diet, the only ones that are fully clinically justified.
What are the odds that you should eliminate gluten?
You already know that going gluten-free is necessary primarily in 3 conditions. Now let’s see how likely it is that you are affected by any of them.
Around 1% of the Polish population are coeliac. However, this figure might be higher. Organisations in Finland estimate that 2.5% of the Finnish people suffer from the disease, but due to its complex aetiology and ambiguous symptoms, there might be more sufferers than what the official statistics show.
A bit more people, around 6% of the population, experience non-coeliac gluten sensitivity (NCGS). Gluten is bad for them, too, and while it’s not an autoimmune disease, the condition causes distinct symptoms.
Less than 0.5% of the population are allergic to wheat, which means that due to sensitisation, they can’t consume gluten and all other wheat derivatives.
So what are the odds that you should go gluten-free, too? Statistically speaking, around 7 to 8 in 100 Poles should follow a gluten-free diet.
Symptoms of gluten intolerance and coeliac disease – how to recognise that you should stay away from gluten?
How do you know that your body doesn’t tolerate gluten well? Identifying this could be harder than it seems. The heaviness after having a pizza or pasta dish does not mean gluten is the culprit.
In coeliac disease, the symptom can be really non-specific and will not bring out any associations with food at all. That’s why it’s so important to educate doctors across all specialties about the non-specific symptoms of coeliac disease and gluten sensitivity. Despite this, it takes 9 years on average to diagnose a coeliac patient! That’s how much time may elapse from the onset of the initial concerning symptoms until deciding that gluten is the issue! Therefore, it’s good to learn the symptoms of a bad response to gluten and to be aware that the related conditions can result in a range of health problems. The signs that you may need a deeper diagnosis towards bad response to gluten are:
- Stomach problems (diarrhoea, constipation, nausea) of unknown cause.
- Bad test results (such as iron, calcium, vitamin deficiencies) despite a well-balanced and diverse diet.
- Non-specific skin issues (rash, urticaria, skin itching, AD).
- Chronic fatigue.
- Fertility problems, delayed puberty or early menopause.
- Persistent headaches of unknown origin.
- Recurrent mucosal lesions (mouth ulcers, mucosal inflammation, dermatitis herpetiformis).
Gluten intolerance and coeliac disease can be triggered at any age! Here are the specific symptoms broken down by specific gluten tolerance disorders that may mean your body does not metabolise gluten too well. The symptoms can be divided into several subgroups based on the cause.
Symptoms of classical (and rarer) coeliac disease – most common in children, pregnant women and the elderly
If you have classic coeliac disease symptoms combined with a malabsorption syndrome, you stand a better chance of obtaining a quick and accurate diagnosis. Here are the traditional manifestations of coeliac sprue:
- bloated stomach (typical especially in children);
- weight loss or signs of malnutrition despite good appetite;
- diarrhoea;
- stomach pains of unknown cause.
While coeliac disease usually affects the intestines, most often it manifests itself elsewhere, in a less characteristic manner, and it is called non-classical coeliac disease.
Signs of non-classical coeliac disease
- Vitamin and mineral deficiencies despite a sound and balanced diet.
- Miscarriages of unknown cause and fertility problems.
- Delayed puberty compared to peers.
- Early menopause.
- Low haemoglobin levels and iron or vitamin B12 deficiency anaemia (fainting, pale skin).
- Frequent mouth ulcers.
- Frequent nasal bleeding.
- Drowsiness and chronic fatigue despite having enough rest.
- Frequent bone fractures and diagnosed early-onset osteoporosis.
- Non-specific skin lesions (dermatitis herpetiformis, urticaria, AD or psoriasis).
- Joint, bone and muscle pain.
- Various mental disorders.
- Elevated cholesterol levels and poor lipid profile (HDL, LDL, triglycerides) or even early-onset atherosclerosis.
- Obstructive sleep apnoea.
Signs of non-coeliac gluten sensitivity
The list of symptoms of non-coeliac gluten sensitivity is even longer and less specific than the signs of coeliac disease. Most symptoms of the two conditions overlap. Other signs that you may be suffering from NCGS include:
- nausea;
- irregular bowel movements: diarrhoea and constipation;
- non-specific rash;
- limb numbness;
- hyperactivity;
- muscle cramps;
- mucosal lesions.
Signs of gluten allergy
Gluten and wheat protein allergy manifests itself quite soon after you eat gluten (a few minutes to a couple of hours after). The mechanism of gluten protein allergy is totally different from that of coeliac disease or gluten sensitivity. The symptoms are also different:
- sudden urticaria or rash;
- allergic nasal congestion or cough;
- vomiting and diarrhoea.
As you can see, the spectrum of signs of gluten intolerance, gluten allergy and coeliac disease is very broad. All those signs may but don’t need to indicate that your body doesn’t tolerate gluten well. If you are concerned, you really need to undergo appropriate testing in accordance with the protocol of procedure, preferably overseen by a doctor who will be able to interpret the results.
Do you suspect you could suffer from gluten intolerance or coeliac disease? Here’s what you should do
First of all, keep in mind you should never eliminate gluten from your diet on your own, without proper confirmation by testing. If someone advises you to do so, this is contrary to current practice and standards in dietary management. There are many reasons why, but most of all: any later testing may be unreliable, you may be depriving yourself of valuable nutrients and increase the odds of nutritional deficits without a reason. You will also miss the chance of getting the right diagnosis, you should rather complete the diagnostic process before you rule out gluten on your own.
The tests which help diagnose gluten intolerance are:
- testing for serum IgE antibodies to gluten (which may detect gluten allergy)
- testing for IgA anti-tTG antibodies (one of the tests to detect coeliac disease)
- testing for IgG anti-DGP antibodies (a test useful in diagnosing coeliac disease)
- testing for total IgA levels (not essential to coeliac disease diagnosis, but improves testing accuracy),
- HLA-DQ2 and HLA-DQ8 genetic testing (the tests show the genetic predisposition to coeliac disease and are capable of ruling it out very quickly)
- biopsy of the intestine (to assess the degree of damage to intestinal villi).
Non-coeliac gluten intolerance is not detected by testing. Instead, it is diagnosed by observing the symptoms and ruling out other conditions.
The interpretation of results and diagnosis will be performed by a physician, who will either rule out or confirm your suspicions and will order additional testing if necessary. Remember that you must not follow a gluten-free diet before testing, as it would distort the results.
I have gone gluten-free and I feel better – does it mean that gluten was bad for me?
So you ditched gluten on your own and now you feel better? It doesn’t mean that gluten was the actual cause of your health issues. Eliminating gluten could result in the formation of new (better) eating habits, or exclusion of products which were bad for you but happened to contain gluten (such as products rich in FODMAP carbohydrates). Before you start a gluten-free diet, first you should obtain a diagnosis or consult a doctor who is in the best position to assess if eliminating gluten once and for all is the right move for you.
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Sources:
1. Husby S., Koletzko S., Korponay-Szabó I. et al. European Society Paediatric Gastroenterology, Hepatology and Nutrition guidelines for diagnosing coeliac disease 2020. J Pediatr Gastroenterol Nutr 2020; 70 (1): 141–156.
2. Polskie Stowarzyszenie Osób z Celiakią i na Diecie Bezglutenowej celiakia.pl; access: 12/10/2022.