Eliminating gluten from the diet has become a hot topic in nutritional circles in recent years, and a lot of people extol the benefits of a gluten-free diet. Gluten is a protein primarily found in wheat, barley and rye. For some people, it can be problematic.
Katrina Plyler, a nutrition and exercise blogger at Katrina Runs for Food, is certainly one of them. Plyler says she had a surface level knowledge of gluten, but it was never important to her until one day when it became extremely important. That was the day Plyler was in her doctor’s office trying to talk him out of sending her to the hospital for dehydration. For months, she’d had some symptoms that gradually increased in severity until she was no longer absorbing vitamins and nutrients from food.
Because she kept “a very detailed food diary in a good old-fashioned notebook,” her doctor was able to review her dietary intake over a few weeks before the symptoms started. Her doctor suggested trying an elimination diet to remove gluten.
Removing gluten meant taking out all the bread, pasta and other sources of gluten — including sauces and salad dressings, where gluten can sometimes lurk unexpectedly. Plyler spent the next four days eating a modified BRA(t) diet, “which consists of bananas, rice, applesauce and tea, with no toast or bread,” she says.
Five days later, “I felt like I had my life back. It was that simple,” she says.
A few weeks later, blood tests confirmed that Plyler was absorbing nutrients and vitamins again, and she received a formal diagnosis of celiac disease after more blood tests and food challenges confirmed that gluten was triggering her symptoms.
Plyler’s experience was actually atypical. For many people with celiac disease, it can take years to gain a definitive diagnosis. People with undiagnosed celiac disease who follow a strict, gluten-free diet may also get a false negative on a blood test for celiac. This is why experts emphasize the importance of not eliminating gluten if you suspect an intolerance until you’ve had blood work to rule out celiac disease.
[ SEE: Top Gluten-Free Diet Meal Delivery Services. ]
Is it Gluten Intolerance?
Strictly speaking, gluten intolerance is different from celiac disease, but the two can travel together. And anyone with celiac has gluten intolerance.
In technical parlance, gluten intolerance in the absence of actual celiac disease is known as “non-celiac gluten sensitivity,” says Liz Weinandy, a registered dietitian with the Ohio State University Wexner Medical Center in Columbus. “Gluten intolerance is when a person just does not tolerate gluten for whatever reason,” she says.
Despite having some similar symptoms, gluten intolerance or non-celiac gluten sensitivity is different from celiac disease, an autoimmune disease where eating gluten leads to damage inside the gastrointestinal tract, Weinandy explains. In people with NCGS, consuming gluten triggers a variety of symptoms that aren’t celiac disease, but can still be problematic. “With non-celiac gluten sensitivity, you don’t see that same damage on the intestinal tract, but it does produce other symptoms,” she explains.
5 Symptoms of Gluten Intolerance
Symptoms of non-celiac gluten sensitivity can manifest in many different ways. Here are the five most common signs of gluten intolerance in the absence of celiac disease:
— Gastrointestinal effects.
— Skin rash.
— Migraines.
— Joint pain.
— Brain fog.
Gastrointestinal Effects
For many people, gluten sensitivity is most obviously signaled by stomach symptoms. They may start out very gradually or be difficult to trace to a specific cause as work stressors or other triggers may add to the problem and obscure the source of the issue. Symptoms such as intense bloating, diarrhea and constipation may indicate that you’re having difficulty with gluten.
Skin Rash
Weinandy notes that a skin rash can sometimes signal a problem with gluten, and a family member of hers gets an “eczema-like rash whenever he eats gluten.” She says on several trials of taking gluten out of the diet and then trying to reintroduce it, the rash came back. “It’s amazing the difference.”
However, some people with celiac disease also present with a skin rash as their primary or only symptom, a condition called dermatitis herpetiformis. If you’ve noticed a skin rash that seems linked to consuming gluten, you should have it biopsied by a dermatologist or have blood tests run by a gastroenterologist to rule out DH. People with DH who don’t have any digestive symptoms may still be doing damage to their intestines when they consume gluten, so obtaining a proper diagnosis is key.
There’s also some evidence that suggests removing gluten can improve symptoms of psoriasis and other skin diseases, even for people who do not have celiac disease.
Migraines
Headaches are one of those nondescript symptoms that can go along with a wide variety of medical problems or conditions, and some people with celiac disease or NCGS report having migraines as an effect of consuming gluten.
Joint Pain
The Arthritis Foundation reports that joint pain has also been associated with gluten consumption. The connection is believed to be because gluten can cause an inflammatory response in the body. What’s more, having one autoimmune disease increases risk for developing others, so if you have rheumatoid arthritis, for example, your risk of developing celiac disease is higher. Inflammation caused by an autoimmune disease can cause arthritis-like pain if it makes its way to the joints.
This joint pain caused by gluten is sometimes misdiagnosed as rheumatoid arthritis. “After I eliminated gluten, I was shocked at how much joint pain I’d been having,” says Plyler. “When it resurfaced within hours of a gluten contamination, it was almost unbearable.”
Brain Fog
Weinandy says brain fog or frequent difficulty focusing, concentrating or “just an inability to think straight” is also sometimes associated with gluten sensitivity or celiac disease. Again, inflammation seems to be the culprit in triggering this symptom.
[ Read: Should My Kid Go On a Gluten-Free Diet? ]
Or Is It Celiac Disease?
People who have celiac disease may have three additional symptoms that go beyond what’s found with non-celiac gluten sensitivity. These include:
— Malabsorption of nutrients.
— Lactose intolerance.
— Chronic fatigue.
Malabsorption of Nutrients
Over time, the effects of consuming gluten if you have celiac disease can accumulate, and segments of the intestine lose their ability to absorb essential nutrients from food. This can lead to low iron levels and other nutrient deficiencies, such as low levels of vitamin B12, folate, zinc and copper, as well as bone density loss from calcium malabsorption.
When you have celiac disease, removing gluten allows the lining of the gastrointestinal tract to heal itself, thus resolving symptoms and improving your body’s ability to absorb nutrients from the foods you eat.
Lactose Intolerance
Celiac disease is also sometimes found in conjunction with a temporary form of lactose intolerance, or an inability to break down a sugar called lactose that’s found in milk and other dairy products. People with celiac disease can develop secondary lactose intolerance as the result of damage to the intestinal cells that produce lactase enzyme, but it typically resolves when the intestines heal on a gluten-free diet.
If you find that you’re having difficulty digesting dairy in conjunction with some of the other symptoms of gluten intolerance, talk to your doctor. While lactose intolerance is fairly common — affecting an estimated 70% of adult humans — celiac disease is far less common, affecting about 1% to 2% of Americans.
If you think your lactose intolerance issues could be related to celiac, it’s fine to remove dairy or lactose from your diet, but don’t remove gluten from your diet until you’ve been tested. Removing gluten preemptively can result in a false negative when you’re tested.
Chronic Fatigue
Like migraines, chronic fatigue on its own is not a strong indicator of celiac disease because fatigue is associated with many other conditions. However, when chronic fatigue and gastrointestinal problems combine, that could signal celiac disease.
[ READ: How to Eat Gluten Again Without Your Body (or Mind) Going Nuts. ]
Or Is It Something Else?
While many of the symptoms above can be associated with stress or other conditions, it might be worth talking to your health care provider about whether you’ve got celiac disease or a gluten sensitivity if you’re experiencing some of these symptoms. “Many of these symptoms are not always really specific,” Weinandy says, “so that can make it harder to diagnose.”
There’s not currently a test for gluten sensitivity. Usually, sensitivity is determined via an elimination diet. However, you can be tested for celiac disease. That process includes bloodwork and an endoscopy to look for damage to the lining of the small intestine.
Plyler adds that a single symptom might not mean you’re having problems with gluten, but “a combination may be a neon sign that gluten is causing the body to attack itself.” If that’s what you’re experiencing, it’s definitely time to speak with your health care professional.
If it looks like gluten might be the issue after testing has confirmed that you don’t have celiac disease, Weinandy says, “we usually recommend to go ahead and take all the gluten out of the diet. That includes wheat, barley and rye. And I always tell people to make sure to read the labels. Wheat is a common allergen that has to be declared on the label.”
You might be surprised at what products contain it: It’s in everything from salad dressing to soup and marinades. Often, if you have a gluten sensitivity, taking all the gluten out of your diet will make symptoms go away in just a few days. If you have celiac disease, it might take a while longer for your gut to fully heal, so work with your doctor to determine the problem and how best to improve your symptoms.
Lastly, if you’ve been diagnosed with celiac or non-celiac gluten sensitivity, ideally you should speak with a registered dietitian who can help you adjust your meal plan to eliminate gluten without losing the good nutrients that come with the whole grains that contain gluten, such as fiber, and the B vitamins.
Hollie Zammit, a registered dietitian with Orlando Health Cancer Institute in Orlando, Florida, says working with a dietitian can help you find the best way to eat for your body and your specific needs. “Genetics, age and gender play a huge role in how your body reacts to certain food items or diets. It’s also not helpful to compare yourself to anyone else — the human body is incredibly complex.”
What works for one person might not work for you, so contact a dietitian to find the best way forward for you and your body.
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Surprising Signs of Gluten Intolerance originally appeared on usnews.com
Update 11/22/21: This story was published at an earlier date and has been updated with new information.
