If you don’t have celiac disease can gluten still be the cause of your symptoms?

Hi Dr. Kimberley,I recently got tested for celiac disease because I have had a lot of digestive problems and have been very tired lately. My doctor told me that the test showed I don’t have celiac disease. I heard from a friend that I might be allergic to gluten even if I don’t have celiac disease. Would this have showed up on the doctor’s test? I am confused, and don’t know whether I have an issue with gluten. I do feel as though my symptoms are worse after foods such as pasta and bread.Thanks.Hi Kaleigh,This is a question that I am asked quite frequently by my patients. I am so glad that you asked for this to be answered because it is such an important topic!

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Hi Kaleigh,

This is a question that I am asked quite frequently by my patients. I am so glad that you asked for this to be answered because it is such an important topic!

There are 2 main types of reactions that people experience in response to gluten: Celiac disease and immune-mediated gluten sensitivity. Celiac disease occurs when gluten (a protein in wheat and other grains such as barley, rye and spelt) triggers an autoimmune reaction against the lining of the small intestine. This means that the body initiates a reaction against itself by destroying the parts of the small intestine responsible for food and nutrient absorption. The intestinal damage causes approximately 50% of people with celiac disease to experience bloating, diarrhea, constipation, nausea and other digestive symptoms. However, approximately half of celiac sufferers do not experience any significant digestive distress. Instead they might suffer from joint pain, headaches or migraines, skin rashes, acne, fatigue, hair loss and other seemingly unrelated symptoms.

So how does immune-mediated gluten sensitivity differ from celiac disease? Although gluten sensitivity is also caused by an immune reaction against gluten, the damage is not directed specifically against the small intestine. When tested, these individuals do not demonstrate the same antibodies and intestinal damage as do those with celiac disease. For this reason, the testing that you received from your medical doctor would have only screened you for celiac disease and would not have tested you for gluten-sensitivity.

Testing for gluten sensitivity is available through specialized laboratories. While I use these tests quite frequently in my practice, one of the best ways to screen for gluten sensitivity is through a dietary elimination and challenge. If you remove 100% of the gluten from your diet for 4-6 weeks, you can then reintroduce gluten-containing foods and see if you have a return or exacerbation of any of your symptoms. If you do experience an aggravation of your symptoms, then gluten should continue to be avoided and you can conclude that you are gluten-sensitive. Make sure to journal your symptoms throughout the process, and to include those such as fatigue, anxiety and other concerns that people don’t often associate with food.  

I hope that my recipes provide you with plenty of culinary inspiration if you try the gluten elimination and challenge! Thankfully there are so many delicious gluten-free options that you don’t need to feel deprived of your favorite foods.

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