Web Only ArticleMay 8, 2014

Non-Celiac Gluten Sensitivity?

For years, many people reported having celiac-like symptoms—abdominal pain, fatigue, foggy mind, joint pain, tingling of the extremities, even depression— but they repeatedly tested negative for celiac disease and responded positively to the gluten-free diet.

Doctor holding hands out photo

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Now specialists recognize that these patients may have non-celiac gluten sensitivity, a condition that is distinct from celiac disease.

How common is non-celiac gluten sensitivity?

Studies have now demonstrated that non-celiac gluten sensitivity is a distinct medical condition that differs from celiac disease. Celiac disease is considered a subset of gluten sensitivity. Anyone with celiac disease, by definition, is gluten sensitive. However, not all gluten sensitive people have celiac disease.

Stefano Guandalini, MD, founder and medical director of The University of Chicago Celiac Disease Center, underlines the fact that there is no data yet on the actual prevalence of this condition but a reasonable guess is that between 1 and 3 percent of the population may be gluten sensitive.

How does it differ from celiac disease?

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Unlike celiac disease, non-celiac gluten sensitivity causes no measurable intestinal damage. Classic symptoms are gastrointestinal, such as diarrhea, bloating or constipation. Some people report symptoms ranging from clumsiness, brain fog and depression to ADHD or autistic-like behaviors.

Non-celiac gluten sensitivity appears to be possibly related to the innate immune system—the body’s first line of defense against invaders—whereas celiac disease involves both the innate and the adaptive immune system— a more sophisticated arm of the immune system that is slower to respond but capable of producing the autoimmune attack.

Patients with non-celiac gluten sensitivity might have various reactions to gluten. In a study of 347 gluten-sensitive patients conducted by the University of Maryland, 68 percent experienced abdominal pain, 40 percent had eczema or a rash and approximately a third reported headache, diarrhea, fatigue or “foggy mind.” Depression, anemia, numbness in the legs, arms or fingers and joint pain were also frequently reported.

How is it diagnosed?

Currently, non-celiac gluten sensitivity is a diagnosis of exclusion; it’s diagnosed only after other conditions are ruled out. Non-celiac gluten sensitivity is not an allergic condition, not an autoimmune reaction to gluten, does not cause any significant damage to the small intestine and you do not need to have HLA genes to develop it (as you do with celiac disease).

There are no genes that are currently known to be associated with non-celiac gluten sensitivity and no diagnostic markers, such as anti-gliadin antibodies, stool tests, saliva tests or biopsy, for conclusively diagnosing the condition. Non-celiac gluten sensitivity is typically determined by a positive response to the gluten-free diet. The defining element of non-celiac gluten sensitivity is feeling better when you don’t eat gluten.

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