As a functional nutritionist serving the people of Brussels, U.K., and East Africa, it’s become apparent that going “gluten free” has become trendy and there has been an increased awareness of gluten-related disorders. Many people with intestinal symptoms are looking to understand the nuances between conditions such as celiac disease, gluten sensitivity, wheat allergy and other non-celiac disorders. While these terms are often used interchangeably, they represent distinct conditions that require individualized approaches to diagnosis, management, and dietary adjustments. What you really want to know is “am I sensitive to gluten? Do I need to go gluten-free? Will going gluten free help my symptoms?” As a functional nutritionist, I want to break down the differences between the different gluten-related disorders, how we distinguish the difference and what you can do to resolve your symptoms.
Celiac Disease: The Classic Gluten-Related Disorder
Celiac disease (CD) is an autoimmune disorder triggered by the ingestion of gluten in genetically susceptible individuals. Gluten is a protein found in wheat, barley, and rye. When individuals with celiac disease consume gluten, their immune system responds by attacking and often destroying the lining of the small intestine. This immune reaction can lead to various symptoms. The list ranges from gastrointestinal symptoms to extra-intestinal symptoms.
Symptoms of Celiac Disease may include:
- Gastrointestinal symptoms i.e. abdominal pain/cramp, bloating, chronic diarrhea, smelly/fatty stool
- Neurological symptoms i.e. ataxia, depression, anxiety, brain fog, forgetfulness, seizures
- Weight loss
- Bone and joint pain
- Tingling/numbness in hands and feet
- Restless leg syndrome
- Muscle cramps
- Missed menstruation, infertility, recurrent miscarriage
- Delayed growth, malnutrition
- Tooth discoloration
- Hair loss
Celiac disease affects approximately 1% of the global population and is diagnosed through a combination of tests and a biopsy of the small intestine.
Non-Celiac Gluten Sensitivity: A Milder Response
Non-celiac gluten sensitivity (NCGS), often referred to as gluten sensitivity or non-celiac wheat sensitivity. Like celiac disease, there is an immune response that can also lead to damage to the intestinal barrier. People with NCGS may experience gastrointestinal and/or extra-intestinal symptoms after consuming gluten-containing foods. These symptoms usually appear a couple of days after consuming gluten and usually improve upon adopting a gluten-free diet. It’s important to note that the symptoms of NCGS can be similar to those of other digestive disorders, making accurate diagnosis a challenge. In fact, it’s estimated that 83% of patients with these symptoms are undiagnosed or misdiagnosed, potentially increasing their risk of developing Celiac Disease.
Symptoms of Non-Celiac Gluten Sensitivity may include:
- Gastrointestinal symptoms i.e. abdominal pain/cramp, bloating, dysmotility (diarrhea and/or constipation)
- Neurological symptoms i.e. ataxia, brain fog, forgetfulness, mood disorders
- Weight loss
- Muscle pain
- Skin rash, eczema
Other Non-Celiac Disorders
Beyond celiac disease and non-celiac gluten sensitivity, there are several other conditions that involve reactions to gluten or wheat but do not fall under the celiac disease umbrella. Some of these disorders include:
a. Wheat Allergy: This is an allergic reaction to proteins found in wheat, including but not limited to gluten. Symptoms can range from mild skin reactions to severe anaphylaxis. Unlike gluten sensitivity and celiac disease, wheat allergy involves the immune system’s production of IgE antibodies.
b. Irritable Bowel Syndrome (IBS): IBS is a functional gastrointestinal disorder characterized by abdominal pain, bloating, and changes in bowel habits. Some individuals with IBS may find that certain foods, including those containing gluten, trigger their symptoms. However, IBS is distinct from gluten-related disorders in that it doesn’t involve an immune response.
c. FODMAP Sensitivity: Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) are a group of carbohydrates that can be poorly absorbed in the small intestine. Some people may experience digestive symptoms when consuming foods high in FODMAPs, which can include certain gluten-containing foods. However, this sensitivity is not a direct response to gluten.
How do I know if I need to be Gluten Free?
Given the overlapping symptoms and the complexity of these conditions, accurate diagnosis is crucial for effective management. Functional nutritionists use a systematic approach to distinguish between gluten-related disorders and other gastrointestinal issues, however the diagnosis can only be performed by a physician. From a functional medicine perspective, the decision to go gluten-free is a complex decision that requires getting to the root cause of your symptoms and understanding gluten and its impact on your body.
Factors to Consider in the Decision-Making Process
Individual Health Goals: One size does not fit all when it comes to nutrition. Individuals considering a gluten-free diet should assess their specific health goals. If the goal is weight management, energy enhancement, or improved digestion, consulting with a functional medicine practitioner can provide personalized guidance on whether going gluten-free aligns with these objectives.
Genetic Predisposition: Genetic testing can offer insights into an individual’s susceptibility to conditions like celiac disease. However, genetics is only one piece of the puzzle, and environmental factors play a significant role. Functional medicine takes into account both genetic and environmental factors to provide a holistic view of a person’s health status.
Symptomatology: Chronic symptoms like fatigue, gastrointestinal distress, joint pain, and neurological disturbances (ataxia, anxiety, depression, brain fog, inability to concentrate), headache, and skin disorders (eczema, skin rash) can often be attributed to gluten sensitivity. Functional medicine practitioners delve into an individual’s medical history, lifestyle, and symptom profile to identify potential triggers and formulate targeted dietary recommendations.
Elimination and Reintroduction: An elimination diet involves temporarily removing gluten-containing foods and observing any changes in symptoms. Subsequently, systematically reintroducing gluten can help determine whether it’s a trigger. A functional medicine practitioner can guide this process, ensuring it’s done methodically and comprehensively.
Nutritional Balance: Going gluten-free requires careful consideration of nutrient intake, as many gluten-containing foods are sources of essential nutrients like fiber, B vitamins, and iron. Functional medicine emphasizes maintaining a well-balanced diet that provides necessary nutrients while addressing individual sensitivities.
Gut Health: The gut plays a crucial role in overall health and immunity. Functional medicine practitioners often assess gut health through comprehensive testing to identify imbalances that may be exacerbating gluten-related symptoms. Addressing gut health can influence the body’s response to gluten and other dietary components.
The decision to go gluten-free is multifaceted and should be based on a comprehensive understanding of individual health, genetic predisposition, symptomatology, and lifestyle. Functional medicine offers a holistic approach that considers the intricate interplay between these factors. Whether motivated by medical necessity such as celiac disease or another gluten-related disorder, or a desire for optimal well-being, individuals contemplating a gluten-free diet can benefit from the guidance of a functional medicine practitioner. If you are seeking help from a functional nutritionist, I’d be happy to schedule a discovery call.
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