Gluten Intolerance and Gluten Sensitivity (GS) Explained
Gluten intolerance or gluten sensitivity (GS) include a number of symptoms, disorders and medical conditions – all of which are caused by the consumption of gluten. Gluten intolerance affects 1 in 7 people (or about 15% of the population) and includes celiac (coeliac) disease, wheat allergy and celiac sprue. This auto immune disorder damages the lining of the small intestine when gluten is consumed by those intolerant to it. For people who ask ‘Am I gluten intolerant?‘, ‘Do I suffer from gluten intolerance or gluten sensitivity?‘ or ‘Where can I find The Best Gluten Free Recipes?‘ there is hope.
Let’s get started with the most frequently asked questions (FAQ) about gluten intolerance and gluten sensitivity (GS):
- What is Celiac Disease?
- What is Gluten Intolerance? What is Gluten Sensitivity?
- What is a Wheat Allergy?
- What is Gluten Ataxia?
- What is Dermatitis Herpetiformis?
- Symptoms of Dermatitis Herpetiformis
- What is Gluten?
- What Happens When a Person with Gluten Intolerance or Gluten Gensitivity Ingests or Consumes Gluten?
- What are the Symptoms of Gluten Intolerance or Gluten Sensitivity?
- Symptoms of Gluten Intolerance and Gluten Sensitivity in Children
- Symptoms of Gluten Intolerance and Gluten Sensitivity in Women and Men
- What Other Health Problems do People with Gluten Intolerance or Gluten Sensitivity Have?
- Why are The Symptoms so Varied?
- How Common is Gluten Intolerance or Gluten Sensitivity?
- How is Gluten Intolerance or Gluten Sensitivity Diagnosed?
- How is Gluten Intolerance or Gluten Sensitivity Treated?
- The Gluten Free Diet
- The Best Gluten Free Recipes
- Points to Remember
glu·ten - noun [gloot-n]
The tough, viscid, nitrogenous substance remaining when the flour of wheat or other grain is washed to remove the starch.
in·tol·er·ance - noun [in-tol-er-uhns]
1. Incapacity or indisposition to bear or endure: intolerance to gluten.
sen·si·tiv·i·ty - noun [sen-si-tiv-i-tee]
The state or quality of being sensitive; sensitiveness: sensitivity to gluten
Although gluten intolerance and gluten sensitivity differ slightly, each is a digestive disorder that causes damage the villi of the small intestine. In the majority of cases, the digestive disorder will prevent proper absorption of essential nutrients, vitamins and minerals from food. People who suffer from this autoimmune disorder are unable to tolerate gluten, a protein in found in wheat, barley and rye. Gluten is found in foods but can also be found in other everyday personal items such as mouthwash, vitamins, lip balms, toothpaste and medicines.
Gluten intolerance can be defined as the body’s inability to properly digest gluten. Some people may suffer mild irritation and others may suffer from major complications that may cause serious damage to the body. Gluten intolerance is similar to a gluten allergy or gluten sensitivity and usually leaves a person feeling uncomfortable or sick when products containing gluten are ingested.
Gluten sensitivity is usually noticed with a defined cause of symptoms (refer below). It usually isn’t apparent with initial examination, however, patients normally fall into a diagnosis of a ‘wheat allergy‘ or gluten sensitive enteropathy (GSE). On rare occasions, patients with GSE or gluten sensitivity are diagnosed as idiopathic. Idiopathic gluten sensitivity (IGS) often arises from an unknown cause and may involve intestinal abnormalities or other physical issues. Clearly more research is needed to properly diagnose gluten sensitivity.
Dermatitis Herpetiformis is a skin condition that causes the skin to swell with usually causes itching round the clock. Dermatitis Herpetiformis is one of the more common gluten intolerance symptoms. What happens is, the antibodies that are formed get deposited beneath the first layer of the skin giving rise to Dermatitis Herpetiformis. As already stated, the skin gets inflamed and shows elevations consisting of fluid filled sacs or cysts. Dermatitis Herpetiformis is the most substantial and evident symptom of gluten intolerance.
Other than the autoimmune response due to gluten intolerance that triggers the formation of this skin disease, there is no other clinical explanation that would help us understand the relationship between these two diseases.
A recent study suggest that several other skin diseases are also being linked to gluten intolerance however more research is necessary to fully understand the connection.
The first signs and symptoms of Dermatitis Herpetiformis appear during the early stages of adulthood years. You will notice small pink patches near the back of the neck, buttocks and back. The major difference between Dermatitis Herpetiformis and other skin disease is that the former one is an extremely itchy condition. You will have the urge to itch your skin all day long. Most often, the urge to itch appears much before you can spot the skin patches on your skin. During the later stages, or as the patches begin to mature, blisters appear and in extreme conditions they may even burst open.
A word of caution for my readers; when you want to search for the pictures of this skin disorder it might be pretty disturbing. Dermatitis Herpetiformis is closely linked to and is one of the more gluten intolerance symptoms.
Treatment for Dermatitis Herpetiformis
Since research has shown that Dermatitis Herpertiformis is clearly linked to gluten intolerance, a diet free from gluten is the only major treatment that will provide you relief from the symptoms. Any other reason that can be linked to the occurrence of this skin disease requires more research or has yet to be discovered. This disease may require a gluten-free diet in order to avoid re-occurrence of the rash-like symptoms. Apart from this dietary restriction, a drug that can also give you is great relief is called Dapsone (ALWAYS CONSULT A PHYSICIAN BEFORE TREATMENT).
The reason Dapsone is effective in treating this condition is not yet known. It is simply an antibiotic and Dermatitis Herpetiformis is not a bacterial infection. However, many patients are able to live more comfortably when they eliminate gluten from their diet and take Dapsone. PLEASE CONSULT YOUR PHYSICIAN BEFORE YOU BEING TAKING ANY DRUGS OR MEDICATIONS!
Gluten is a protein and is located in the endosperm within grass-type grains such as wheat, barley and rye. It gives food a stretchiness and stickiness and it’s in much of what we eat in the Western world. Gluten also keeps the gases that are released during fermentation in the dough so that it is able to rise when it is baked.
Gluten is found in the obvious things like bread, pasta, crackers but it’s also in sauces, medications, lipstick, imitation crab meat, sometimes oats (due to cross contamination), and other items not normally associated with grains. 
According to Marc Miller, President of Gluten Free Santa Barbara from the University of California, Santa Barbara (UCSB), several grains such as teff, millet, oats and others are often considered gluten-free but in fact contain fewer amounts. Patients suffering from gluten intolerance or gluten sensitivity could still have a reaction if those grains are consumed. Grains such as teff, millet or oats should be labeled as low gluten and NOT gluten-free. Millet is an expecially difficult grain to label because there are about 60 related grains and it is not a single species. Some are gluten free, others low gluten, and still others contain gluten. Marc says “I generally try to avoid it since you never know which grain you will get since all the related grains are just called millet.”
Some examples of foods that do not contain gluten include corn, wild rice, quinoa, buckwheat and amaranth. It also should be noted that one should be aware that there is potential for cross contamination.  It is always up to the patient to be vigilant and always read labels and research products they plan to use to help prevent their symptoms.
Read more to help further answer the question: “What is Gluten?”
What Happens When a Person with Gluten Intolerance or Gluten Gensitivity Ingests or Consumes Gluten?
When gluten is ingested by people who suffer from gluten intolerance or gluten sensitivity the immune system responds by by causing damage to (or in severe cases, destroying) the small, finger-like lining of the small intestine called villi. Villi are an essential part of the digestive system because they help with nutrient absorption into the bloodstream. If a person has damaged on non-existent villi, he or she can rapidly become malnourished because they aren’t getting the nutrients they need to stay healthy. This can lead to a variety of gluten intolerance symptoms, numerous health problems and if left untreated can quadruple the risk of death. 
Villi are small finger-like protrusions that line the small intestine and assist with nutrient absorption.
Symptoms of gluten intolerance and gluten sensitivity are different in every patient. Some patients may suffer from mile to moderate symptoms while others may display multiple signs of illness. This often causes difficulty in preliminary diagnosis of the disease because there are variable symptoms from patient to patient. Symptoms may occur in the digestive system or in other parts of the body and can affect many aspects of every day life including relationships and/or physical and emotional health. Gluten intolerance symptoms are sometimes more difficult to recognize in adults and sometimes easier to recognize in infants and small children.
The following is a list of common symptoms in children. These symptoms should be regularly noted and presented to your doctor when attempting to diagnose gluten intolerance.
- Poor appetite, irritability and a failure to gain weight are usually the first gluten intolerance symptoms
- chronic diarrhea
- abdominal bloating or swollen stomach and pain
- pale, foul-smelling, or fatty stool
- arm and leg muscles may become wasted and thin
- Juvenile Idiopathic Arthritis
- weight loss
- failure to thrive
- Attention Deficit Disorder (ADD)
As a child grows, nutrients are an essential part of physical and mental growth. Malabsorption of nutrients can result in other problems such as delayed puberty, delayed growth and short stature and dental enamel defects of the permanent teeth. If one or both parents is diagnosed with gluten intolerance, the child should also be tested due to the high likelihood he or she will also suffer from the disorder.
As mentioned above, symptoms of gluten intolerance in adults can often be more difficult to diagnose. Adults may not have digestive symptoms due to gluten intolerance and may suffer from one or more signs of the disorder.
The following is a list of common gluten intolerance symptoms in adults. These symptoms are common in both men and women and should be regularly noted and discussed with your physician when you hope to diagnose the disease.
- fatigue or extreme tiredness
- an itchy skin rash called dermatitis herpetiformis
- iron-deficiency and/or anemia
- bone loss or osteoporosis
- bone or joint pain and sometimes even fractures – which are due to thinning of the bones
- tingling (pins and needles) or numbness in the fingers and toes or even hands and feet
- canker sores or ulcers inside the mouth
- missed menstrual periods
- repeated miscarriage
- abdominal pain and cramping
- alternating bouts of diarrhea and constipation
- lactose intolerance
- hair loss (Alopecia)
- malodorous flatulence
- headaches and migraines
- vitamin and mineral deficiencies
- unexplained weight loss
Another complication related to this digestive disorder is that many patients suffering from gluten intolerance may have no visible symptoms but can, within time, develop one or many of these symptoms. These long-term complications may include cancers of the intestine and bowel, liver diseases, malnutrition—which can lead to anemia or osteoporosis.
Patients suffering from gluten intolerance tend to develop diseases that healthy tissues and cells are attacked by the immune system. Gluten intolerance and the diseases listed below are now known to be linked by genetics and they include:
- rheumatoid arthritis
- autoimmune thyroid disease
- autoimmune liver disease
- type one diabetes
- Turner Syndrome
- Addison’s disease
- Sjögren’s syndrome
Another issue with understanding gluten intolerance is that scientists and researchers are having difficulty determining why the disorder affects people differently. There are three major factors and they include: the amount of foods that contain gluten consumed by a patient, the age at which a person started to consume foods containing gluten and the length of time a person was breastfed. 
It has also been discovered that gluten intolerance symptoms and gluten sensitivity symptoms may vary depending on the amount of damage caused to the villi of the small intestine and the age of the patient. Many adults suffer from the disease for over ten years before being diagnosed and most men are not being checked for the disorder. The longer the disease goes undiagnosed and untreated, the more likely a patient will develop long-term complications.
Gluten intolerance is increasingly common throughout the world. Although it is more common in ‘western civilization’ an emerging trend in the consumption of wheat products and processed foods that contain gluten in other parts of the world is increasing the rates of gluten intolerance and gluten sensitivity in people in those areas.
The disorder was originally thought to be a rather uncommon childhood syndrome but recent research has found that to be untrue and can affect anyone of any age.
Close to 1 in 133 people are known to suffer from celiac disease. Of those that have celiac disease, the chances their child could also have the disease could be as high as 1 in 22 people.  Some experts feel that about 1 in 20 have some form of gluten intolerance or gluten sensitivity and suffer from a one or more of the symptoms. 
Recognizing gluten intolerance symptoms can be difficult because they are sometimes linked to and have very similar symptoms as other, better understood diseases. Gluten intolerance can be confused with or misdiagnosed as inflammatory bowel disease, irritable bowel syndrome, iron-deficiency anemia (often caused by heavy menstrual blood loss), chronic fatigue syndrome, diverticulitis, intestinal infections. Because of this, gluten intolerance is sometimes confused with these or other diseases and is often completely misdiagnosed or usually under-diagnosed. As the disease becomes more widely recognized, medical professionals are becoming more aware of the symptoms of gluten intolerance and learning how to better diagnose it because blood tests and other screening methods are becoming more accurate and reliable. Over time correct diagnosis rates are increasing and that is why most feel that even more than 1 in 133 suffer from the disease.
Gluten Intolerance Blood Tests:
There are a number of ways to determine if a patient suffers from gluten intolerance and blood tests are the most common and least invasive. Patients suffering from celiac disease will have higher than normal levels of certain autoantibodies (proteins that react against and sometimes destroy the body’s own cells or tissues) in their blood. To diagnose celiac disease, doctors will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be required. Similar blood tests can determine if gluten intolerance is present.
Here is a list of blood tests that will be recommended by your doctor:
- Anti-tissue transglutaminase antibody (tTG – IgA and IgG) – commonly used whether or not symptoms are present and the most sensitive test available
- Anti-endomysial antibody (EMA-IgA) – highly specific marker for celiac disease
- Anti-deaminated gliadin peptide (DGP – IgA and IgG) – used when tTG or EMA is negative and in cases where patient is IgA deficient
- Total serum IgA – used to check levels to exclude selective IgA deficiency that results in a false negative test
- Anti-gliadin antibody (AgA – IgG and IgA) not considered sensitive or specific enough for adults, but used for children under 2 because tTG and EMA antibodies may be absent. The anti-DGP test is sensitive in this group
It is VERY important to note that before a blood test is taken, a patient MUST continue on a regular diet that contains gluten that includes breads, cereals and pasta. If a patient reduces or eliminates gluten intake prior to the test, a negative diagnosis may occur, even if gluten intolerance is present. A patient may also notice a decline in gluten intolerance symptoms when they eliminate gluten from their diet and that can further complicate the diagnosis.
Endoscopy or Internal Biopsy:
If you have gone through all of the blood tests and the doctor still has some concerns they may order a biopsy of the small intestine. The procedure is done using a small flexible biopsy instrument called an endoscope down the throat, through the stomach and into the upper end of the small intestine where patchy, multiple snippets of tissue are gathered. The tube is removed and the tissue samples are examined under a microscope for signs of injury.
Gluten Intolerance Screening:
Screening for gluten intolerance means testing for the presence of the aforementioned auto-antibodies in the blood in people who do not display any symptoms. Americans, especially men, are not usually screened for gluten intolerance, however and increased awareness about the disorder are changing that trend. As mentioned earlier, it is genetic and if a family member is diagnosed around four to 12 percent of first-degree relatives will also have the disease. Another complication is that sometimes a patient may display few or mild gluten intolerance symptoms or in some cases none at all.
The main way to treat the disease is a gluten free diet. Newly diagnosed patients should work with a dietitian to help create a gluten free diet plan. What you must accept early on are two truths:
- There is no cure for gluten intolerance, the only treatment is to completely eliminate all sources of gluten to prevent the prevalence of gluten intolerance symptoms. You must follow the gluten-free diet strictly.
- There are no short cuts, and there will be no time in which you cannot follow a gluten free diet. If you eat gluten, even a small amount, your symptoms will return and you will do damage to your small intestine.
There is no way around this truth. The resolution of the problems associated with gluten intolerance will progressively get better. The degree and speed of the recovery will depend largely on how long the person has had the disease and how much damage was done before they are diagnosed.
In order to be gluten free you must begin to learn how to read labels on food. Even small amounts ingested can begin to cause health difficulties so you have to be aware what is going in your mouth.
If a patient has been diagnosed MUST completely avoid gluten for the rest of their lives. Damage to the small intestine may occur and symptoms may once again become present even if a tiny amount of gluten is ingested. Even if a patient does not show symptoms of gluten intolerance, damage can occur. That is why it is extremely important to read labels and avoid ALL products containing gluten.
Some of the problems and damage done by the digestive disorder may never be reversed such as short stature or defects in dental enamel.
In most cases a gluten free diet will quickly reduce or completely eliminate symptoms and the small intestine will begin to repair itself. In some cases, overall health will notice improvements within days of starting a gluten free diet. In children or infants, the small intestine should completely repair itself within three to six months. Depending on how long an adult lived with the disorder, the small intestine will usually repair itself within one to several years. A completely healthy intestine means that the villi can once again absorb nutrients into the bloodstream.
It should be worth noting that in some rare cases, people will show no improvement, despite following a gluten free diet. This is caused by a number of factors and can often be attributed to the fact that small amounts of gluten are still being consumed through ‘hidden sources of gluten’ in items such as cosmetics, medications, modified food starch, preservatives and stabilizers made with wheat. Some factories may also produce food or products that have been contaminated by gluten. It is important to know what is going into your body and where each product is coming from. This takes time, but can easily become part of your gluten free lifestyle.
A gluten free diet means completely avoiding foods that contain rye, wheat and barley. The foods and products made from these grains should also be avoided. In other words, a person with gluten intolerance should not eat most cereal, pasta, grain, and many processed foods.
A person with gluten intolerance can still enjoy a healthy, well-balanced and delicious diet with replacements such as rice, potato, quinoa, soy, amaranth, buckwheat, or bean flour instead of wheat flour. Because gluten-free products are becoming increasingly available in most major stores, people can easily purchase gluten-free bread, pasta, and other products.
“Plain” meat, fish, fruits, vegetables and rice do not contain gluten and are completely safe for consumption.
Many people suffering from gluten intolerance can safely eat small amounts of oats, as long as the oats have not been contaminated with wheat gluten during processing. It is wise to work closely with a nutritionist or doctor when deciding whether to include oats in your diet.
The gluten free diet requires a completely new approach to eating. The best way is to educate your family and friends and be open about your gluten intolerance. You may need to bring food with you when you are visiting a friend or family member for a meal. Tell the host ahead a time and tell them that they should not feel obligated to prepare gluten free foods and offer to bring enough to share with others.
As mentioned earlier, gluten is sometimes used in medications or other non-food products such as lip stick or lip balm. People with gluten intolerance should ask their pharmacist if prescribed medications contain wheat or gluten. It is important to do a lot of your own research because in many cases a pharmacist or doctor may not know the answer. Because gluten may be used as an additive in unexpected products—such as play dough or lipstick—it is important to read ALL product labels that may be consumed. If you want a detailed description of all ingredients, the manufacturer should provide a list upon request. With practice, screening for gluten and enjoying a gluten free lifestyle will become second nature and you will gradually see a reduction in all of your symptoms.
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- People with gluten intolerance cannot tolerate gluten (a protein in wheat, rye, and barley).
- If left untreated gluten intolerance will damage with villi of the small intestine and will interfere with nutrient absorption.
- Without treatment, patients can develop complications such as osteoporosis, anemia, and cancer.
- A person with the disease will not always display symptoms.
- A simple blood test or a biopsy of the small intestine will usually diagnose the disease.
- It is know that gluten intolerance is hereditary and more common in those of European ancestry.
- The only known cure or treatment for is a gluten free lifestyle. The gluten free diet is a lifetime requirement.
- A dietitian or nutritionist can help a patient manage the disease and teach about food selection, label reading, and other strategies.
4. Mayo Clinic