How Do You Know if You’re Gluten Intolerant?

Watching the evening news the other night was enlightening, not for the content, but for the commercials and what they say about the American demographic. Just about every-other commercial was advertising another product for gastrointestinal problems: Dulcolax, Immodium, Prilosec, Nexium, Alka Seltzer, Pepto Bismol, probiotics, and on and on. Clearly, the market for tummy issues is booming. But is this normal? Just a part of the aging process? As a functional nutritionist, as you might guess, I would say definitely not. There are many factors contributing to the erosion of the Western population’s gut health, but most functional nutrition practitioners will tell you that about 90% of clients who walk through their clinic doors feel better after removing one thing from their diets: gluten.

How common is gluten intolerance?

Studies show that about 1% of people worldwide are diagnosed with celiac disease, and about 10% self-report having non-celiac gluten or wheat sensitivity (NCGS/WS), with some areas as low as 4% and some as high as 15% (Barbaro et al., 2020). So in any given population, based on available data there’s a 5-16% chance of having gluten intolerance. However, the odds may be higher for a number of reasons. 

Due to the pain-dampening effects of gluten-derived opioid peptides, the majority of those with celiac are shown to have asymptomatic celiac disease, and don’t know they have a problem with gluten until blood tests show the antibodies found in celiac (Pruimboom & de Punder, 2015). Assuming these effects are also present in those with NCGS/WS, the true count of those with gluten intolerance could be much higher. Also, because there is not yet tangible diagnostic criteria such as a blood test for NCGS/WS, most conventional medical practitioners are unwilling to diagnose or report it, preferring the more nebulous label of irritable bowel syndrome (IBS), to which they don’t attribute a cause. Finally, most of those with NCGS/WS self-report having it based on symptoms that abate when gluten is removed from the diet, but cultural disdain or social pressures against avoiding gluten could inhibit some from awareness or admission that they are gluten or wheat sensitive. 

What are the signs and symptoms of gluten intolerance?

Gastrointestinal disturbances such as alternating constipation and diarrhea, abdominal pain, bloating, indigestion, a burning sensation in the intestines or acid reflux are some of the first clues that you may have gluten intolerance.

As intolerance progresses, you may experience signs and symptoms resulting from impaired nutrient absorption, including thinning hair, nails that are brittle, soft, deformed or have white flecks, keratosis pilaris (bumps on the backs of the arms), painful cracks in the corners of the mouth, bruising easily, slow wound healing, low energy or high susceptibility to illness.

Increased intestinal permeability leads to inflammation in the tissues surrounding the intestines, and inflammatory chemicals, bacteria and gluten peptides making their way into the bloodstream (Costa et al., 2019). Systemic inflammation can be felt in joints and muscles, so joint pain, stiffness and soreness may be present. Chronic inflammation may also trigger hormone imbalances such as estrogen dominance, where cortisol, a potent anti-inflammatory, is overly-produced and reduces the progesterone-to-estrogen ratio (Amasi-Hartoonian et al., 2022).

Depression and anxiety are more often seen in those with gluten intolerance than in the general population, with inflammation and other factors such as the gut-brain axis and nutrient malabsorption thought to play a role (Peters et al., 2014).

Histamine, a chemical that can cause or contribute to itchiness, environmental allergies, hives, eczema, migraines and asthma, is present in many foods. An enzyme produced by intestinal cells breaks it down, keeping it from entering the body and triggering symptoms. When inflammation damages or impairs the function of intestinal cells, symptoms of high histamine can result (Comas-Basté et al., 2020).

Could you have gluten intolerance but not have GI symptoms?

Gluten can form peptides called gluten exorphins that attach to opioid receptors in the body, blocking pain signals caused by inflammation and bloating. Eating a lot of gluten can overwhelm the enzyme that breaks down the peptides, so those who eat the most are most likely to be asymptomatic. However, extraintestinal symptoms like brain fog, depression and anxiety, skin issues, hormone imbalances and symptoms of nutrient insufficiencies will remain. A strong attachment to eating gluten-containing foods and fear of giving them up may be signs of gluten addiction as a result of gluten exorphins (Pruimboom & de Punder, 2015). Reducing gluten intake may free up enough enzyme to break down the remaining gluten exorphins and trigger GI symptoms.

What should you do if you think you have gluten intolerance?

First, you should confirm or rule out celiac disease, as it could have severe implications for long-term health and require strict adherence to the gluten-free diet (GFD). Ask your doctor to run a blood test for anti-tissue transglutaminase antibodies, a genetic test to reveal presence of the HLA-DQ2/8 genes and/or a biopsy of the small intestine to look for damage. If you’re already on a GFD, antibodies or intestinal damage may not be present, but a genetic test such as the 23andMe test that includes health traits will show if you have the genes for celiac. If you have the HLA-DQ2/8 genes, celiac is more likely (though not guaranteed) and a GFD should be strictly followed. If not, you may have NCGS/WS. 

Currently, the only way to diagnose NCGS/WS is to remove all gluten from your diet and see if your symptoms resolve. However, gluten or wheat sensitivity is more of a marker of a dysfunctional gastrointestinal system than a single root cause, so all of your signs and symptoms may not be cured by simply removing gluten from your diet. Replacing gluten-containing foods with their processed gluten-free counterparts can cause weight gain, exacerbate dysbiosis and lead to other health issues, so switching to a whole-foods, nutrient-rich GFD is essential. 

Alimental’s Gut Restoration Program is designed by a functional nutrition specialist and gives you all the nutrition information and resources you need to remove gluten and other triggers, replace them with healthy whole-foods options, and restore your gut health. Give it a try here.

References

Amasi-Hartoonian, N., Sforzini, L., Cattaneo, A., & Pariante, C. M. (2022). Cause or consequence? Understanding the role of cortisol in the increased inflammation observed in depression. Current Opinion in Endocrine and Metabolic Research, 24, p. 100356. https://doi.org/10.1016/j.coemr.2022.100356

Barbaro, M. R., Cremon, C., Wrona, D., Fuschi, D., Marasco, G., Stanghellini, V., & Barbara, G. (2020). Non-celiac gluten sensitivity in the context of functional gastrointestinal disorders. Nutrients, 12(12), 3735. https://doi.org/10.3390/nu12123735

Comas-Basté, O., Sánchez-Pérez, S., Veciana-Nogués, M. T., Latorre-Moratalla, M., & Vidal-Carou, M. D. C. (2020). Histamine intolerance: The current state of the art. Biomolecules, 10(8), 1181. https://doi.org/10.3390/biom10081181

Costa, A. F., Sugai, E., Temprano, M. P., Niveloni, S. I., Vázquez, H., Moreno, M. L., Domínguez-Flores, M. R., Muñoz-Suano, A., Smecuol, E., Stefanolo, J. P., González, A. F., Cebolla-Ramirez, A., Mauriño, E., Verdú, E. F., & Bai, J. C. (2019). Gluten immunogenic peptide excretion detects dietary transgressions in treated celiac disease patients. World Journal of Gastroenterology, 25(11), 1409–1420. https://doi.org/10.3748/wjg.v25.i11.1409

Peters, S. L., Biesiekierski, J. R., Yelland, G. W., Muir, J. G., & Gibson, P. R. (2014). Randomised clinical trial: Gluten may cause depression in subjects with non-coeliac gluten sensitivity - an exploratory clinical study. Alimentary Pharmacology & Therapeutics, 39(10), 1104–1112. https://doi.org/10.1111/apt.12730

Pruimboom, L., & de Punder, K. (2015). The opioid effects of gluten exorphins: Asymptomatic celiac disease. Journal of Health, Population, and Nutrition, 33(24). https://doi.org/10.1186/s41043-015-0032-y