Gluten-free products are becoming more and more accessible these days, and a rise in awareness of what we call celiac disease is evident; however, in the wake of all this gluten talk, it’s important to know what being a celiac really means, and to understand that every reaction to gluten is not necessarily related to celiac disease. In this article, Dr. Bristow outlines the fundamental differences between celiac disease and non-celiac gluten sensitivity, and discusses how naturopathy can help.
Did you know that non-celiac gluten sensitivity is a real medical diagnosis? There are various markers that can tell you if you have this condition, but despite a growing awareness of these conditions, there are still a number of individuals who believe that gluten sensitivity is “not a real thing.” The information below is designed to help uncover symptoms that may be overlooked and to offer insight to the skeptics out there!
Let’s start off by taking a look at these two diagnoses:
| Celiac Disease (CD) | Non-Celiac Gluten Sensitivity (NCGS) |
| Permanent genetic autoimmune disorder. | Not an autoimmune disease. |
| Gluten = trigger. It causes inflammation and damage to particular cells of the small intestine. | Gluten = trigger. It causes inflammation and a change in the immune system. |
| The products of inflammation in the gut can travel anywhere in the body and cause inflammation and damage. A wide range of symptoms can occur in any organ, tissue, or gland. | In order to have NCGS you must have definitively ruled out celiac disease. |
| The estimated prevalence of the disease in North America is 1% (1/133 people)1 | The estimated prevalence is 40% of the population! |
| Diagnosis is very poor: in North America we have only identified 10% of the CD population. This has to do with both improper and a lack of testing. | Officially became a diagnosis by Gastroenterology associations in 2011, but individuals have been presenting with it since the 1970’s. |
| Roughly 30% of the population have the genes for CD, but only 1% develop the disease. Having the genes doesn’t mean you will have CD, but you can’t have CD without it. | NCGS are at a 2.5X greater risk than healthy individuals of developing an autoimmune disease! |
More about celiac disease (CD):
- Non-genetic factors are crucial in the development of celiac disease. The most obvious risk factor is gluten exposure. In settings with a high gluten load, such as refugee camps of the Saharawi people in Africa and formula-fed Swedish infants born in the early 1990s, over 1% of the population was affected.
- Individuals with celiac disease have an increased risk of all cancer (with the exception of breast), shorter life expectancy, and an increased rate of collecting other autoimmune diseases with age.
- The KEY to improving your health and decreasing your odds of damage and disease is getting diagnosed properly and early.
Now, let’s look at the symptoms of the two:
| Celiac Disease symptoms | Non-Celiac Gluten Sensitivity symptoms |
| Most of my patients are under the impression that if they don’t have debilitating stomach pain or diarrhea that they don’t have celiac disease. This is a false assumption. Diarrhea prompts testing by health care providers, but most adults have one of the many ‘non-classic symptoms’ such as: | According to investigators at the University of Maryland Center for Celiac Research, gluten sensitivity symptoms overlap with celiac disease symptoms. They include: |
| Anemias (B12 or iron deficiency anemia) | Anemia (20%) |
| Osteoporosis/Osteopenia | Headache (35%) |
| Particular Skin Conditions | Eczema or rash (40%) |
| Abdominal Pain | Abdominal Pain (68%), Diarrhea (33%) |
| Neurological Symptoms (clumsiness, dizziness, nerve pain, numbness and tingling) | Numbness in legs, arms, or fingers (20%) |
| Psychiatric Problems (including Depression and Anxiety) | Foggy mind (34%), Depression (22%) |
| Infertility or Hormonal Imbalances that can present with PMS and Menstrual concerns | Fatigue (33%) |
| Vitamin Deficiencies | Joint Pain (11%) |
As you can see, there’s a lot of overlap in the symptoms between these two.
Diagnosing celiac disease
The top markers for celiac disease are:
- tTG (Tissue Transglutaminase Antibody): The most sensitive and specific blood test for celiac disease.
- IgA (Immunoglobulin A): detects IgA deficiency, which is present in 2-3% of people with celiac disease. It should always be ordered along with the above tTG since, if you have an IgA deficiency, the test for tTG may turn up negative even if you have celiac disease.
- anti-DGP (Deamidated Gliadin Peptide Antibodies): a test that is used in some people with suspected celiac disease who are negative for tTG (especially children younger than 2 years old).
- AGA (Anti-Gliadin Antibodies): A test that identifies those with a negative tTG who would not have been diagnosed by tTG screening.2
The takeaway: Make sure that you know what was screened when a doctor tells you your celiac disease screen was negative. Given the high prevalence in the population but the low diagnosis rate, you need to get more information, and if you’re not sure, ask your naturopath! You also must be eating gluten on a regular and frequent basis for a minimum of three weeks prior to testing for the results to be valid.
Diagnosing non-celiac gluten sensitivity
The top markers for non-celiac gluten sensitivity are:
- testing for AGA (Anti-Gliadin antibodies): IgA and IgG.
- note that food sensitivity testing reports typically test AGA IgG, but not IgA
- AGA is positive in roughly 56% of those with the symptoms of non-celiac gluten sensitivity.
- When a gluten-free diet was followed, the above marker disappeared in 93% of people. The small remainder of those who still had elevated markers had poor adherence to the diet.3
In summary: the best way to diagnose non-celiac gluten sensitivity is through a gluten-free diet while diligently tracking ALL related symptoms and monitoring blood markers (such as AGA, but also iron, b12, vitamin D, etc). All of these blood markers are expected to improve.
Symptoms are vast and can be difficult to identify. If you aren’t familiar with them, it’s best to do this under supervision of a medical professional who understands non-celiac gluten sensitivity in order to maximize your understanding of the changes and ensure that you’re following a gluten-free diet correctly.
Gluten-free diet and reintroduction in non-celiac gluten sensitivity
For those with a positive AGA marker, there is no question as to their sensitivity. After a period of time on a gluten-free diet and after the AGA marker has disappeared for them, some people choose to include a small, infrequent amount of gluten in their diet with minimal negative effects.
For those who were negative for the AGA marker but improved on a gluten-free diet, some choose to reintroduce gluten to a high degree to stimulate a response in order to help them understand their specific symptoms. And others choose not to include it at all. I help my patients make this decision by weighing the pros and cons: it’s an individual choice that’s guided by severity, health outcomes on the gluten-free diet, and prevention of disease.
As I mentioned before, AGA tests positive in just over half of those with non-celiac gluten sensitivity, so the other half do improve with a gluten-free diet, but they do not have positive AGA markers. This is most likely due to the fact that gluten makes up 70% of the proteins in wheat, but the other 30% can also pose a problem.
There are also other molecules we’ve been able to identify within the wheat grain that are problematic, such as lectins, gluteomorphin and prodynorphin (responsible for wheat addiction), and gliadin toxic peptides (responsible for leaky gut). I’ll often run a comprehensive wheat reactivity test for patients that includes all of these markers and can easily identify non-celiac gluten sensitivity when compared to the basic AGA test.4
If you have questions about either of these conditions, I’d love to hear from you. Getting an accurate diagnosis is crucial; make sure the testing you’ve done is up to snuff! And if it isn’t, come see me and we’ll figure it out together!
You can book an appointment with me online or by calling our clinic at (403) 452 0029 during business hours.
1 Rubio-Tapia A, Ludvigsson JF, Brantner TL, et al. The prevalence of celiac disease in the United States. Am J Gastroenterol 2012;107:1538-44.
2 Benson BC, Mulder CJ, Laczek JT. Anti-gliadin antibodies identify celiac patients overlooked by tissue transglutaminase antibodies. Hawaii J Med Public Health. 2013;72(9 Suppl 4):14–17.
3 Caio G, Volta U, Tovoli F, De Giorgio R. Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. BMC Gastroenterol. 2014;14:26.
4 https://www.cyrexlabs.com/CyrexTestsArrays/tabid/136/Default.aspx