Gluten is a protein found in certain grains, particularly wheat, barley, and rye. It gives elasticity to dough, helping it to rise and keep its shape. While foods that contain gluten are often delicious, they can cause problems for some people. The 3 big categories of problems caused by wheat include wheat allergy, celiac disease and non-celiac gluten sensitivity.

Wheat allergy occurs when a person’s immune system recognizes proteins in wheat as foreign and mounts an allergic response. This usually leads to mild problems such as watery eyes, a stuffy or runny nose, and mouth/throat itching. Less often people can develop more serious reactions such as tongue or throat swelling, hives, a racing heart, or wheezing/shortness of breath. This is called “anaphylaxis” and it can be very dangerous. Though wheat allergy is one of the most common food allergies, particularly in children, it is still considered rare.

Celiac disease is an inherited disease in which eating foods containing gluten leads to inflammation and damage of the lining of the small intestine. This damage impairs the function of the intestines, leading to problems such as belly pain/cramping, bloating, gas, diarrhea, and weight loss. In celiac disease you can also have symptoms outside of the GI tract as well, such as bone problems like osteoporosis, iron deficiency, infertility, chronic fatigue, and depression.

Gluten sensitivity is a disorder in which gluten causes symptoms in certain people who have tested negative for wheat allergy and celiac disease. Persons with gluten sensitivity can experience gut symptoms such as belly pain/discomfort, bloating, gas, diarrhea, or even constipation. They can also suffer from problems unrelated to the gut such as fatigue, “brain fog,” joint pain or skin rash. These symptoms typically improve when a person goes on a gluten free diet. It is unclear how often gluten sensitivity occurs in the general population, but it is likely much more common than wheat allergy or celiac disease. The cause of gluten sensitivity is currently unknown. Diagnosing gluten sensitivity is based upon the identification of symptoms which occur after eating foods with gluten and getting better on a gluten free diet – there is no reliable blood or tissue test to make this diagnosis. Gluten sensitivity does NOT cause damage to the intestine the way that celiac disease does.

Celiac disease affects around 1% of the population, but unfortunately the majority of these people are not diagnosed. People who have family members with celiac disease and people who have other autoimmune diseases (such as type 1 diabetes, rheumatoid arthritis, autoimmune thyroid disease, etc.) are at higher risk for developing celiac disease.

You need to have certain genes to develop celiac disease. However, those genes are common (they are found in about 30% of the population), so not everyone who has these genes goes on to develop celiac disease. This means that there are likely other factors contributing to the development of celiac disease (possibly environmental). If you have a first degree relative (parent, child, or sibling) with celiac disease your risk of developing it is around 10%. If you have an identical twin with celiac disease your risk of developing it is around 75%.

Yes, but we don’t understand why some people develop celiac disease as children while others develop it much later in life.

A consultation with an experienced dietitian specialized in gastrointestinal disorders is recommended to go over the gluten free diet in detail. Gluten can hide in many things and an expert dietitian can help you identify potential culprits.

In addition to providing support for you while you change your approach to eating, we recommend that all first degree relatives (parents, siblings, children) of patients with celiac disease be tested for celiac disease, even if they have no symptoms. Additionally, second degree relatives with symptoms (diarrhea, abdominal pain, etc.) should also be tested.

Usually symptoms will start to improve in a few weeks on a gluten free diet, although it can take upwards of a year for intestinal damage and blood tests to improve. Depending on your age, certain issues such as growth problems may not improve.

Although many patients experience symptoms of celiac disease when ingesting gluten-containing products, only a minority of these have true celiac disease on testing. Sometimes this scenario is called Non-Celiac Gluten Sensitivity (NCGS). The role for recommending a gluten-free diet in these patients is controversial. Furthermore, strict adherence to a gluten-free diet without celiac disease can be costly and lead to unnecessary restriction of nutrients such as whole grains, which are important for cardiovascular health. 

While research continues to emerge, there is decent evidence to suggest that these patients develop symptoms not from gluten itself but from other components of wheat, including poorly digested sugar molecules called fructans. Restricting fructans is part of the now popular low FODMAP diet used for patients with irritable bowel syndrome. While this diet is evidence-based to reduce symptoms in some patients with irritable bowel syndrome, it is quite restrictive and is NOT designed to be a forever diet plan. Thus, our specialized GI dietitians can help you identify possible fructans (or other FODMAPs) in your diet and guide you through a structured protocol to determine the components that trigger your symptoms.