What Is Non-Celiac Gluten Sensitivity?

To make matters more complicated, someone may be sensitive to gluten without developing full-blown celiac disease.

Gluten sensitivity occurs on a spectrum, with celiac representing the most severe end. On the other, there’s non-celiac gluten sensitivity, which can range from mild to intense. “We’re seeing dramatic increases in the number of people sensitive to gluten in the United States,”  says functional-medicine practitioner and clinical researcher Datis Kharrazian, PhD, DC, MS, FACN, author of Why Isn’t My Brain Working?. “Research shows gluten sensitivity has risen sharply in the last 50 years.”

So, what’s the difference between celiac and gluten sensitivity? “Patients with gluten sensitivity develop an adverse reaction when eating gluten that does not usually lead to small-intestinal damage,” Fasano explains.

While there can be overlap with some of the symptoms of celiac, the overall clinical picture of non-celiac gluten sensitivity is generally less ­severe. “Non-celiac gluten sensitivity is a pretty mysterious space we occupy, in which people experience symptoms that go away or are improved when they eliminate gluten,” says functional nutritionist Jesse Haas, CNS, LN. “That data may be validated by lab testing, but it’s not always measurable in an immune reaction, which makes it kind of hard for the general public — or even the medical establishment — to trust that it’s valid.”

“Patients with gluten sensitivity develop an adverse reaction when eating gluten that does not usually lead to small-intestinal damage.”

Like celiac disease, a non-celiac gluten sensitivity triggers a reaction from the immune system. The difference is that when someone with a sensitivity eats gluten, their immune system doesn’t attack the villi in the small intestine; it goes after the gluten molecules themselves, producing specific immunoglobulin G (IgG) antibodies to combat them. Many tests claim to identify sensitivities by testing for IgG antibodies. But false positives are common, and a test may indicate that someone is creating IgG antibodies against a food that isn’t causing any negative reactions.

“We and many others are working diligently to identify the biomarkers that will tell us if you have gluten sensitivity or you do not,” says Alessio Fasano, MD, director of the Center for Celiac Research and Treatment at Massachusetts General Hospital and author of Gluten Freedom. “We have these biomarkers for celiac disease; we have biomarkers for allergies; but we don’t have them yet for non-celiac gluten sensitivity.”

For now, the most reliable approach is to observe the effects of gluten — and its absence — on the body. “We have to show a relationship between exposure and symptoms,” Fasano says. “When you have gluten, you get worse. When gluten is out of your system, you get better. That’s how we make the diagnosis of non-celiac gluten sensitivity.”

Signs of gluten sensitivity can be broad, including symptoms of systemic inflammation, such as joint pain, rashes, and fatigue. “It can also be ambiguous mental health symptoms like brain fog or memory challenges, depression, anxiety, or even neurological symptoms — there are reports of seizure disorders being resolved on gluten-free diets,” says Haas. (For more on checking your gluten sensitivity, see “Are You Gluten-Intolerant? Here’s How to Find Out.”)

For people without celiac disease, gluten sensitivity can change over time, Fasano notes. “With non-celiac gluten sensitivity, there is a possibility you may eventually change the level of sensitivity to gluten or even grow out of it. This is not the case with celiac disease, which is a lifelong condition.”

Haas ate a strict gluten-free diet for eight years to address her own digestive issues. But for the past few years, she’s been eating gluten-containing foods a few times a week, with far less reactivity than she experienced in her 20s.

“If you can address intestinal permeability, shore up the boundaries of the small intestine, and improve its ability to digest and absorb nutrients, then it’s less impactful when you eat the same foods that gave you trouble before, as long as you’re not eating them to such a great extent,” Haas explains. “It’s about improving the resilience of your system overall.”

Unfortunately, there’s no wiggle room for those with celiac disease. They will likely need to avoid gluten permanently, Kharrazian says, as well as foods that are cross-reactive. (The body’s immune system can confuse cross-reactive foods for gluten; they ­include corn, oats, dairy, rice, and yeast.)

People with autoimmune conditions may also do well to steer clear of gluten for the long term. (For more on this later see “A Guide to Understanding Gluten and Gluten Sensitivity.”)

This was excerpted from “A Guide to Understanding Gluten and Gluten Sensitivity” which was published in Experience Life.