I don't have celiac but still feel uncomfortable after eating gluten. Why?
Reaction to gluten may not always cause celiac. Here we discuss non-celiac gluten reaction and other possible reactions from eating gluten and wheat.
Eating wheat can cause different kinds of problems. They are mainly from three different reasons:
due to wheat allergy (in 10% cases);
due to non-celiac gluten reaction (in 6% cases);
from celiac (in about 1% of population).
The table above compares these different scenarios in which the reaction to wheat play out.
Both celiac and wheat allergy are immune responses.
Exposure to these foods triggers an immediate response: in wheat allergy, it's the spike in IgE antibodies due to our natural immune system, along with histamine & mucous in GI tract.
In celiac it's the autoimmune system that triggers auto-antibodies such as tTG. In short, your body remembers gluten as a foreign invader (such as a virus or bacteria during an infection), and tries to fight it off.
But non-celiac gluten sensitivity, the gluten is just a nuisance to the body.
Often it is due to our body's inability to digest gluten properly.
Sensitivity to gluten among people who do not have celiac is gaining more and more attention.
First case of non-celiac gluten sensitivity was first described in 1978 by Ellis & Linaker.
Nobody has studied it carefully, to know how common it is, but most likely about five percent of population has such reaction to gluten.
It is most often seen in people with other conditions, e.g., 15-40% in people with IBS, irritable bowel syndrome show signs of discomfort after eating gluten.
It shows up in digestive & other non-digestive symptoms after eating gluten and other proteins from wheat.
A clear point to note is that non-celiac gluten sensitivity doesn't show up as damage to intestinal wall in a biopsy, as often seen in celiac.
Also, no high tTG antibodies in lab tests, or DQ2, DQ8 genes in a celiac genetic test. Immune response is also completely different as it's not an autoimmune disease.
Triggers: gluten and many proteins, e.g., alpha-amylase & trypsin inhibitors, certain short chain carbohydrates (FODMAPs), some yeasts.
Symptoms: abdomen pain (4 in 5 people); chronic diarrhea (2 in 3 people); fatigue (1 in 3 people); bloating (1 in 4 people); less common symptoms include eczema, headache, anemia, depression, blurry vision, foggy brain, tingling.
Differences from Celiac: not related to family history, not dependent on other autoimmune conditions (e.g., diabetes, rheumatoid arthritis, etc.), no malnutrition or stunted growth.
Diagnosis: difficult to separate from celiac but requires the following:
a negative tTG test
negative IgE allergy test
no small intestine wall damage seen with a biopsy
improvement in symptoms after three weeks of gluten-free diet
re-appearance of symptoms when gluten is added to the diet
However, some studies suggest that anti-gliadin IgG antibodies might be higher in non-celiac gluten allergy (e.g., in a study here and here).
Also, DQ2, DQ8 genes are not required but can increase the risk.
Treatment: follow gluten-free diet; but it doesn't need to be as strict as in celiac since small amounts may not trigger the symptoms and no long term impacts have been reported.
Recommendation: use of food exclusion method; start with an elimination diet, remove or rotate suspect foods to see any benefits; then, 'challenge' yourself by reintroducing small amounts of gluten-containing foods.
Reaction to wheat is more common in children and they often grow out of it.
But it ranges from 0.5 to up to 9% children. For adults, it might persist for life.
Wheat allergy shows up in many different ways, beyond digestive problems. These include trouble breathing, excessive mucous, itching & red skin.
Symptoms appear when in contact with wheat by eating or breathing.
Symptoms are similar to any other food allergy with IgE antibody production by immune system.
Different forms of known reactions to wheat include:
Baker's asthma and rhinitis (stuffy nose, sneezing, and red, itchy, watery eyes): well known condition when wheat floor is inhaled.
Gastrointestinal reactions: that can cause common symptoms of red itchy skin (hives) but sometimes serious problems such as anaphylaxis from strain to the body (e.g., during heavy exercise). These are often caused by the omega-5 gliadin protein in wheat.
Other reactions include eczema, hives, anaphylaxis, etc.
Diagnosis of wheat allergy can be extremely difficult.
The tests have low sensitivity, and cross-reaction from pollens, grass & other common triggers can be difficult to isolate.
But one should carefully monitor the exposure to suspect items (e.g., wheat, barley, rye) and notice the time when symptoms are triggered.
IgE test and anti-alpha-amylase testing might also be good starting point.
If allergy to wheat is confirmed, lifelong avoidance of wheat is the only solution.
One should avoid exposure through mouth, breath or skin to prevent immune system triggering the symptoms.
Order an at-home Celiac Antibody Test.
What is Celiac? History, Present and Genetic Risk - A detailed look at celiac.
Sensitivity to Food – Allergy, Intolerance, and Celiac Disease - a comprehensive review.
Celiac – FAQs - key facts about gluten intolerance.
Food Allergies in Children - a short summary.
How Can You Test Yourself for Celiac Disease From Home? - in just a few steps.
The 5 Most Common Types of Food Sensitivities Among Adults - a short summary.
5 Things You Should Know About Food Sensitivity Testing - things to know before you test.
What to Do With Your Food Sensitivity Test Results? - follow these steps to get most out of your test.
Food Sensitivities vs Food Allergies: What's the Difference? - learn about the key differences.
