Gluten intolerance: a.k.a. the non-celiac gluten sensitivity

Gluten intolerance (also known as non-celiac gluten sensitivity) is a condition that causes both digestive and non-digestive symptoms, which improve when gluten is removed from the diet. Gluten is a protein found in wheat, rye, and barley. It is primarily present in foods but can also be found in other products like medications, vitamins, and supplements.

Gluten intolerance differs from celiac disease (also known as coeliac disease), which is an autoimmune disorder where the small intestine is progressively damaged. In gluten intolerance, this chronic damage to the small intestine does not occur, and symptoms resolve once gluten is eliminated from the diet.

The most common symptoms of gluten intolerance are abdominal pain and fatigue. Additionally, this condition may cause other digestive symptoms, such as gas, diarrhea, and constipation. It can also include non-digestive symptoms like headaches, joint pain, and skin rashes.

Researchers are still studying gluten intolerance, and many other symptoms have been linked to the condition, including:

• Gastroesophageal reflux
• Headaches and migraines
• Hallucinations
• Fibromyalgia
• Asthma
• Iron-deficiency anemia
• Folic acid deficiency
• Anxiety
• Depression

Over 20% of individuals with gluten intolerance experience allergic reactions to one or more inhalants, foods, or metals. Common allergens include dust mites, grasses, pellitory plants, cat, rabbit, or dog hair, shellfish, and nickel. Additionally, many individuals with gluten intolerance also have lactose intolerance.

Currently, the risk factors for gluten intolerance are not fully understood. However, it is believed that individuals with a family history of celiac disease or gluten intolerance may have a higher risk of developing the condition, as both disorders are thought to have a genetic basis. On the other hand, age, high gluten consumption and certain gastrointestinal infections (mainly those caused by enterovirus and rotavirus) are currently being studied as potential risk factors for both conditions.

Diagnosing gluten intolerance requires ruling out celiac disease first. The diagnostic process includes:

• Excluding celiac disease through serological tests and histological examination of the duodenal mucosa, as well as testing for wheat allergy. In celiac disease, villous atrophy (damage to the intestinal lining) will be observed in the duodenum. This atrophy is absent in patients with gluten intolerance
• Observing symptom remission after starting a gluten-free diet
• Reintroducing gluten in a controlled manner through a double-blind placebo-controlled gluten challenge test, where gluten is alternated with a placebo over a specific period to confirm the recurrence of symptoms

Gluten intolerance does not typically have a cure. However, treatments used for celiac disease also help alleviate symptoms in patients with gluten intolerance. These treatments mainly involve the elimination of gluten from the diet.

Currently, there is no way to prevent gluten intolerance. However, the adverse effects associated with this condition can be avoided by:

• Avoiding self-diagnosis
• Following a gluten-free diet that remains balanced and varied
• Maintaining proper hygiene when cooking
• Being cautious with processed foods