Gluten sensitivity, often called non-coeliac gluten sensitivity, describes symptoms that improve when gluten-containing foods are removed and return when they are reintroduced, after coeliac disease and wheat allergy have been excluded.
The term is sometimes used loosely. Good assessment matters because coeliac disease, wheat allergy, irritable bowel syndrome and other bowel conditions can produce similar symptoms but need different management.
Symptoms
Reported symptoms include bloating, abdominal pain, diarrhoea, constipation, nausea, reflux, tiredness, headache, joint or muscle aches, "brain fog" and a general feeling of being unwell.
Symptoms vary and are not specific to gluten sensitivity. Some people react to wheat components other than gluten, including fermentable carbohydrates such as fructans.
Difference from Coeliac Disease and Wheat Allergy
Coeliac disease is an autoimmune condition in which gluten damages the small intestine and can lead to nutritional deficiency and other complications. Wheat allergy is an immune reaction to proteins in wheat and can cause rapid allergic symptoms, including anaphylaxis in some people.
Non-coeliac gluten sensitivity does not show the same small-bowel damage seen in coeliac disease and does not follow the same IgE allergy pattern as wheat allergy.
Diagnosis
There is no single reliable blood test for non-coeliac gluten sensitivity. Assessment usually involves checking for coeliac disease and wheat allergy before a long-term gluten-free diet is started.
People should not remove gluten before coeliac testing unless advised, because testing can become falsely reassuring if gluten has already been removed. A supervised elimination and reintroduction plan may be used after other causes have been considered.
Management
Management is usually dietary. Some people avoid gluten strictly, while others can tolerate small amounts or find that reducing wheat, rather than all gluten, is enough.
Dietitian input can help prevent unnecessary restriction, especially in children, pregnancy, eating disorders, weight loss, nutritional deficiency or multiple suspected food reactions.
See Also
References
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