Gluten Intolerance Symptoms & Treatment Methods
What’s the deal with gluten? It’s a type of protein found in grains including wheat, barley and rye. (1) It makes up about 80 percent of the amino acids (the building blocks of proteins) found in these grains. Although gluten isn’t actually found in many other ancient grains like oats, quinoa, rice or corn, modern food-processing techniques usually contaminate these foods with gluten since they are processed using the same equipment where wheat is processed.
On top of this, gluten is now used to help make many highly processed chemical additives that are found in packaged foods of all kinds. Coupled with the fact that manufacturing can lead to cross-contamination, this means trace amounts of gluten often wind up in food products that are seemingly gluten-free — like salad dressings, condiments, deli meats and candy. This makes a gluten-free diet more challenging than it might initially seem.
In the U.S., it’s estimated that grain flours (especially wheat products containing gluten), vegetable oils and added sugar now make up about 70 percent of the total calories most people consume each day! (2) Clearly, that is not an ideal way of eating, but even if you are consuming a healthy whole foods based diet, are you still struggling with signs of gluten intolerance? You might end up being surprised by how some common unwanted healthy symptoms could be linked to that piece of toast you ate at breakfast this morning.
What Is Gluten Intolerance?
Gluten intolerance is different than celiac disease, which is the disorder that’s diagnosed when someone has a true allergy to gluten. Celiac is actually believed to be a rare disease, affecting about 1 percent or less of adults. Some research suggests that for every person diagnosed with celiac disease, another six patients go undiagnosed despite having celiac-related damage to the gut. (3)
Symptoms of celiac disease or a true gluten allergy include malnutrition, stunted growth, cancer, severe neurological and psychiatric illness and even death. However, even when someone tests negative for celiac disease, there’s still a chance he or she can have a gluten intolerance, which poses many risks of its own.
For many decades in the Western medical field, the mainstream view of gluten intolerance was that you either have it, or you don’t. In other words, you either test positive for celiac disease and have a gluten allergy, or you test negative and, therefore, should have no reason to avoid gluten-containing foods. However, today, ongoing research studies along with anecdotal evidence (people’s actual experiences) show that gluten intolerance symptoms aren’t so “black and white” after all.
We now know that gluten intolerance symptoms fall along a spectrum and having a sensitivity to gluten isn’t necessarily all-or-nothing. That means that it’s possible to have gluten intolerance symptoms without having celiac disease. A new term called non-celiac gluten sensitivity (NCGS) has been given to this type of condition. (4)
People with NCGS fall somewhere in the middle of the spectrum: They don’t have celiac disease, yet they feel noticeably better when they avoid gluten. The extent to which this is true depends on the exact person, since different people can react negatively to gluten to different degrees. In people with gluten intolerance or NCGS, researchers have found that certain factors usually apply, including:
- Test negative for celiac disease (using two types of criteria, histopathology and immunoglobulin E, also called IgE) despite having similar symptoms
- Report experiencing both gastrointestinal and non-gastrointestinal symptoms (for example, leaky gut syndrome, bloating and brain fog)
- Experience improvements in these gluten sensitivity symptoms when on a gluten-free diet
Gluten Intolerance Symptoms
Damage done by gluten-related disorders, including celiac disease and NCGS, goes beyond just the gastrointestinal tract. Recent research over the past several decades suggests that gluten intolerance symptoms show up in almost every system within the body: the central nervous system (including the brain), endocrine system, cardiovascular system (including the health of the heart and blood vessels), reproductive system and skeletal system.
Because gluten intolerance can lead to autoimmune reactions and increased inflammation levels (the root of most diseases), it’s associated with numerous diseases. But the problem is that many people fail to attribute these symptoms to an undiagnosed food sensitivity. Gluten sensitivity symptoms also get ignored and they persist as no dietary changes are made by the person unknowingly suffering with a gluten sensitivity. What are the first signs of gluten intolerance? It’s time to take a look at this gluten intolerance symptoms checklist.
Symptoms of gluten intolerance or non-celiac gluten sensitivity (NCGS) are widespread and can include:
- Digestive and IBS symptoms, including abdominal pain, cramping, bloating, constipation or diarrhea
- “Brain fog,” difficulty concentrating and trouble remembering information
- Frequent headaches
- Mood-related changes, including anxiety and increased depression symptoms (5)
- Ongoing low energy levels and chronic fatigue syndrome
- Muscle and joint pains
- Numbness and tingling in the arms and legs
- Reproductive problems and infertility (6)
- Skin issues, including dermatitis, eczema, rosacea and skin rashes (also called a “gluten rash” or “gluten intolerance rash”)
- Nutrient deficiencies, including anemia (iron deficiency)
Gluten intolerance has also been associated with a higher risk for learning disabilities, including autism and ADHD. (7) Additionally, there may be higher risk for neurological and psychiatric diseases, including dementia and Alzheimer’s. (8, 9)
How is gluten capable of causing so many different problems? Despite what most people think, gluten intolerance (and celiac disease) is more than just a digestive problem. That’s because research suggests that non-celiac gluten sensitivity can result in significant changes to the gut microbiome with an increase in pathogenic microbes. This is a big problem considering that our overall health depends heavily on the health of our gut. (9)
Gluten intolerance can affect almost every cell, tissue and system in the body since the bacteria that populate the gut help control everything from nutrient absorption and hormone production to metabolic function and cognitive processes.
There are multiple factors that can make people more likely to experience gluten intolerance symptoms: their overall diet and nutrient density, damage to the gut flora, immune status, genetic factors, and hormonal balance can all play a part.
The exact way that gluten causes varied symptoms in many people has to do with its effects on the digestive tract and gut first and foremost. Gluten is considered an “antinutrient” and is therefore hard to digest for nearly all people, whether they have a gluten intolerance or not.
Antinutrients are certain substances naturally present in plant foods, including grains, legumes, nuts and seeds. Plants contain antinutrients as a built-in defense mechanism; they have a biological imperative to survive and reproduce just like humans and animals do. Because plants can’t defend themselves from predators by escaping, they evolved to protect their species by carrying antinutrient “toxins” (which in some cases can actually be beneficial to humans when they have the ability to fight off infections, bacteria or pathogens in the body).
Gluten is one type of antinutrient found in grains that has the following effects when eaten by humans: (10)
- It may interfere with normal digestion and can cause bloating, gas, constipation and diarrhea due to its effect on bacteria living in the gut.
- It can produce damage to the lining of the gut, causing “leaky gut syndrome” and autoimmune reactions in some cases.
- It binds to certain amino acids (proteins), essential vitamins and minerals, making them unabsorbable.
Leaky gut syndrome is tied to gluten intolerance, which is a disorder that develops when tiny openings form in the gut lining and then large proteins and gut microbes leak across the gut barrier. Molecules that are usually kept within the gut are then able to enter the bloodstream and travel throughout the body, where they can provoke a chronic, low-grade inflammatory response.
In a clinical trial published in 2016, researchers discovered that certain people with high levels of two specific inflammatory proteins in their blood had markers of non-celiac gluten sensitivity although they did not test positive for celiac disease. These individuals were sensitive to wheat (not necessarily just gluten) because of specific physiological factors that improved when they eliminated gluten from their diets. (11)
An entirely different approach to what causes gluten intolerance symptoms lies in unraveling the complex idea of FODMAPs. Thought to be a potential key to healing IBS, understanding FODMAPs (which stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols) may play a major role in reducing symptoms of gluten intolerance.
Another clinical trial, this one published in 2018, discovered that some people who self-reported having NCGS actually didn’t react to gluten strongly but did react negatively to fructans, which are present in high-FODMAP foods. (12)
Natural Treatment for Symptoms
1. Try an Elimination Diet
Doctors are sometimes hesitant to attribute a patient’s symptoms to gluten intolerance when they can be caused by other disorders, so sometimes the patient needs to take matters into her own hands. Following an elimination diet is really the best way to test your own personal reaction to gluten. The results of an elimination diet help pinpoint which of your symptoms can be attributed to gluten and let you know whether or not it’s time to go gluten-free.
An elimination diet involves removing gluten from the diet completely for a period of at least 30 days (but preferably longer, such as three months) and then adding it back in. If symptoms improve during the elimination period and then reappear once gluten is eaten again, that’s a clear sign that gluten was contributing to the symptoms. However, it’s very important to test only one variable at a time (gluten) and not several (such as dairy, gluten and sugar) because this can cause you to falsely attribute symptoms.
Because FODMAPs may cause gluten intolerance-like symptoms, you may want to try an elimination diet that involves eliminating high-FODMAP foods from your diet. This may be particularly beneficial if a traditional elimination diet reveals you are not actually sensitive to wheat products.
In addition, you can consume digestive enzymes for gluten intolerance, such as those found in papaya. In fact, researchers from Japan administered a digestive enzyme mixture to patients with non-celiac gluten sensitivity. They concluded:
In this human clinical study, we demonstrated the efficacy of the enzyme mixture derived from microorganisms and papaya in improving the symptoms of NCGS.
2. Follow a Gluten-Free Diet
According to the Celiac Disease Foundation, there is no cure for gluten sensitivity, and the only treatment is to follow a gluten-free diet. (13)
Once you do an elimination diet/gluten challenge and can determine if, and how drastically, you are intolerant to eating gluten-containing foods, you’ll know how important it is for you to follow a gluten-free diet. If you have a serious reaction to gluten when you add it back into your diet after the elimination period, you might want to get tested for celiac disease to know whether you need to avoid 100 percent of gluten indefinitely. If you’re sure you don’t have celiac disease, you should still plan to avoid gluten as much as possible in order to prevent gut irritation, further digestive issues and ongoing symptoms.
A gluten-free diet is one without wheat, rye and barley. This means you must avoid most baked products found in stores, flour-containing foods (like pizza or pasta at restaurants), the majority of packaged foods (bread, cereals, pastas, cookies, cakes, etc.) and some types of alcohol, including beer. Check ingredient labels carefully since gluten is hiding in many packaged foods.
If you don’t have celiac disease, it’s likely that occasionally eating gluten-containing foods won’t cause long-term damage or serious health concerns, but you’ll feel better and get more accustomed to a gluten-free diet the longer you stick with it. With gluten out of the picture, focus on including more anti-inflammatory foods in your diet to repair your digestive system and heal any nutrient deficiencies. These include organic animal products, raw dairy products, vegetables, fruits, nuts, seeds and probiotic foods.
When it comes to baking, try some of these naturally gluten-free flour alternatives over wheat flour:
- Brown rice
- Sweet potato
- Almond flour
- Coconut flour
- Chickpea flour
What if your symptoms don’t improve when you remove all sources of gluten?
Keep in mind that gluten isn’t the only thing that can cause digestive issues. (14) Conventional dairy products, nuts, shellfish and eggs can also cause sensitivities or be a source of food allergies. Again, FODMAPs may also be the real culprit behind your problems. (12)
3. Consider Having Tests Done
Experts typically recommend that you first get tested for a wheat allergy and for celiac disease. Researchers believe that patients who test negative for two main genes that are associated with celiac disease (HLA-DQ2 and HLA-DQ8) are also significantly less likely to have gluten intolerance or NCGS. (15) If celiac disease or gluten intolerance runs in your family, you might want to speak to your doctor about testing for these genes, as well as antibodies that can reveal how active your immune system is.
Remember that celiac disease is an autoimmune disease and will show high levels of certain antibodies (including transglutaminase autoantibodies or autoimmune comorbidities), but this might not be true for people with a gluten intolerance — or the antibody levels could be less severe. (16) Either way, knowing for sure where you stand can be helpful if you’re more susceptible to having reactions to gluten than the average person.
So how do you test for gluten sensitivity? Unfortunately, there is no standard gluten sensitivity test. Some doctors offer saliva, blood or stool testing. Other tests to consider include a zonulin test (also called a lactulose test) and a IgG food allergy test. These types of leaky gut tests can indicate if gluten (or parasites, candida yeast and harmful bacteria) is causing gut permeability. Zonulin controls the size of the openings between your gut lining and your bloodstream, so high levels indicate permeability.
Over time, if the gut lining continues to become permeable, “microvilli” (tiny cellular membranes that line the intestines and absorb nutrients from food) can become damaged, so knowing the severity of your condition can be important for stopping the problem from getting worse.
Gluten Intolerance vs. Celiac vs. Wheat Allergy
People who have a non celiac gluten sensitivity (they’re gluten intolerant) or are wheat intolerant can experience similar symptoms to people who have celiac disease including abdominal pain, bloating, diarrhea, constipation, “foggy brain”, headaches, or rash when they eat offending foods. Celiac disease can also cause more severe symptoms including anemia, osteoporosis, mouth ulcers, nervous system injury, acid reflux, and reduced functioning of the spleen (hyposplenism). (17, 18)
Individuals with celiac disease must avoid gluten, found in wheat, rye, barley and sometimes oats. A gluten intolerant person should avoid the same foods, but their potential non celiac gluten sensitivity symptoms are less severe than someone who has celiac disease.
A wheat allergy should not be confused with gluten intolerance or celiac disease. A wheat allergy is a food allergy, which is an overreaction of the immune system to a specific food protein. If someone with a wheat allergy consumes any of the four classes of wheat protein, including gluten, it can trigger an immune system response that causes an allergic reaction. Wheat allergy symptoms can include itching, swelling, difficulty breathing and even anaphylaxis. However, people with a wheat allergy typically don’t experience intestinal damage. (13)
A food allergy, unlike a food intolerance, can potentially be fatal. (19)
Gluten Intolerance vs. IBS vs. Lactose Intolerance
Gluten intolerance, lactose intolerance IBS can all cause similar symptoms like stomach cramps, gas and bloating.
A recent review of research into gluten sensitivity and irritable bowel syndrome published in the journal, Nutrients, concluded that a gluten-free diet can benefit both gluten sensitive patients who report gluten-related symptoms as well as IBS patients who are also gluten or wheat sensitive. The researchers say, “Regardless of the identification of the offending components, the scientific community agrees that the withdrawal of wheat from the diet can significantly improve symptoms in a subset of IBS patients, who can sometimes be diagnosed as NCGS.”Is gluten free good for IBS? It certainly may be, especially for IBS patients who have “gluten sensitive IBS.” (20)
Lactose intolerance symptoms can certainly be similar to symptoms of gluten intolerance or IBS. However, lactose intolerance symptoms are definitely brought on by exposure to one thing: lactose, which is mainly found in dairy products. Common symptoms of lactose intolerance include diarrhea, gas, bloating/swelling in the abdomen, abdominal pain/cramping, nausea, vomiting, headaches or migraines, and acne. These warning signs of lactose intolerance can arise anywhere from 30 minutes to two days after the consumption of dairy products, and can range from mild to severe.
Foods to Avoid
What foods are high in gluten? Whole grains definitely top the list. For decades, there has been a growing emphasis on whole grains in the American diet. We’ve always been told that they are full of fiber, nutrients and should be consumed multiple times every day. There are a few reasons why this is true: Whole grains are cheap to produce, shelf-stable, can easily be shipped and stored and are used to make various processed products that have a big profit margin.
All things considered, the nutrient density for grains is pretty low, especially when you consider the bioavailability of their nutrients. Many of the vitamins or minerals that are present in grains cannot actually be utilized by the body because of the presence of antinutrients, including gluten, described earlier.
While whole grains are a part of some of the healthiest diets in the world (like the Mediterranean diet), they’re also usually balanced by plenty of nutrient-dense foods including healthy fats (like beneficial olive oil), vegetables, protein and fruit. Grains can certainly play their role in a balanced diet, but overall they are somewhat of a suboptimal food source when compared to more nutrient-dense foods like grass-fed animal products, fish, vegetables, fruits, seeds and nuts. Therefore, having them less often than other sources of carbohydrates (like starchy veggies or fruit, for example) is a smart idea.
When consumed in moderation by people without gluten intolerance, it’s possible that whole wheat diets can lower inflammation, may reduce all-cause mortality (death), are correlated with less risks for or deaths from heart disease, might lower the risk of diabetes and could support a healthy weight. (21, 22, 23, 24)
Even grains that don’t contain gluten — like corn, oats and rice — do have proteins that are similar in structure to gluten, so even these can cause an immune response in some people. Many people feel better without any gluten, grains or legumes in their diets, but they wouldn’t even know this because they have never experienced an extended period of time without eating these foods. You may want to try a grain-free diet to test this, which involves removing all grains, gluten-free or not.
Wondering what foods to avoid with gluten intolerance? In addition to avoiding the more obvious grain culprits like wheat, rye and barley, there are also some unexpected places gluten can be hiding so check your labels:
- Canned soups
- Beer and malt beverages
- Flavored chips and crackers
- Salad dressings
- Soup mixes
- Store-bought sauces
- Soy Sauce
- Deli/processed meat
- Ground spices
- Certain supplements. Is glutamine gluten-free? Turns out, many glutamine supplements are derived from wheat.
Best Foods to Eat
In general, you’re going to want to look for foods that are labeled as certified gluten-free, as this ensures that a product is free from gluten as well as cross-contamination.
If you’re mostly healthy and do choose to eat grains, try to focus on eating gluten-free grains like rice, gluten-free oats, buckwheat, quinoa and amaranth. It’s also a good idea to properly prepare grains (especially types that contain gluten) by soaking, sprouting and fermenting them. Sprouting grain helps improve nutrient bioavailability, reduces the presence of gluten and other inhibitors, and makes them more digestible. Look for sourdough or sprouted grain breads (like Ezekiel bread),which are better tolerated than ordinary wheat-flour breads.
These are some naturally gluten-free foods that are nutrient-rich and can help you consume a well-rounded diet while avoiding gluten:
- Brown rice
- Gluten-free oats
- Nut flours (like coconut and almond flour)
- Nuts and seeds
- Fruits and vegetables
- Beans and legumes
- High quality organic meats and poultry
- Wild-caught seafood
- Raw/fermented dairy products like kefir
The good news is that it’s easier than ever before to eat a gluten-free diet these days. There’s an almost endless amount of healthy gluten-free recipes to choose from on a daily basis. Here are a few of my favorites:
- Crustless Spinach Quiche Recipe
- Sweet Potato Hash Browns Recipe
- Tropical Acai Bowl Recipe with Mango and Hemp Seeds
- Moo Shu Chicken Lettuce Wraps
- Baked Chile Relleno Casserole Recipe
- Gluten-Free Pumpkin Bread Recipe
Some estimates suggest that six to 10 times more people have a form of gluten intolerance than have celiac disease. (25) That means 1 in 10 adults might have some form of NCGS or gluten intolerance. However, that being said, at this time it’s difficult for researchers to estimate the exact prevalence of gluten intolerances and NCGS because there still isn’t a definitive diagnostic test that’s used or consensus over which symptoms must be present. (26)
It’s also hard to diagnose NCGS accurately because many of the symptoms caused by gluten are broad and very similar to symptoms caused by other disorders (like fatigue, body pains and mood changes). As I mentioned earlier, there especially seems to be a big overlap between irritable bowel syndrome (IBS) symptoms and gluten intolerance. (27)
Many people with IBS feel better when they follow a gluten-free diet. In people with IBS, gluten might cause symptoms to worsen, but it’s also a possibility that other attributes of wheat besides gluten (like amylase-trypsin inhibitors and low-fermentable, poorly absorbed, short-chain carbohydrates) can lead to poor digestion. (28)
If you suspect that you may have a gluten intolerance, talk to your doctor about testing options and following an elimination diet. If you decide to follow gluten-free diet, it’s very important that your diet is well-rounded and nutritious.
If you think you’re noticing gluten intolerance symptoms in children, it’s important to know that a gluten-free diet for kids is not advisable unless medically necessary or done under the supervision of a doctor or dietitian, as it can be lacking in important nutrients if not properly planned.
It’s also important to note that rice, a common replacement for grains on a gluten-free diet, can contain arsenic and mercury, heavy metals that are harmful in large quantities. It’s wise to consume a wide variety of gluten-free grains rather than turn to rice as your go-to carb replacement. (29)
Although once thought to be little more than myth, science has revealed that gluten intolerance does exist in individuals who do not also have celiac disease.
A person may have this intolerance, medically referred to as non celiac gluten sensitivity, if they do not test positive for celiac disease but still experience gluten intolerance symptoms and notice an improvement when eliminating gluten from their diet.
For some, gluten is the culprit behind symptoms. There is also some evidence that wheat, not just gluten, causes these symptoms in certain individuals. However, it’s possible that conditions like IBS or an intolerance to high-FODMAP foods actually cause these issues.
A natural treatment plan to treat gluten intolerance symptoms includes doing the following:
- Try an elimination diet
- Follow a gluten-free diet
- Consider having tests done