Is Gluten Sensitivity Overdiagnosed?

Ever scarf down pizza and find yourself feeling bloated and fatigued? You might start questioning your eating choices and blame your abdominal pain on a lack of discipline. As a result, you establish a diet and stick to it. And for your next lunch, you enjoy a turkey sub with vegetables on wheat bread. You even skip the mayo! But here it comes again: bloating, pain, constipation, acid reflux — you name it.

The common denominator in these meals appears to be bread, meaning you may be suffering from some sort of gluten sensitivity or intolerance: likely either celiac disease or non-celiac gluten sensitivity (NCGS).

Celiac Disease and NCGS Similarities and Differences

The gastrointestinal symptoms of celiac disease and NCGS are numerous: irritable bowel syndrome, abdominal pain, bloating, and bowel abnormalities such as constipation or diarrhea. Symptoms outside of the digestive system include headaches, fatigue, joint and muscle pain, extremity numbness, dermatitis, and anemia. Though the symptoms of celiac disease and NCGS may be similar, the causes, diagnoses, and effects on your body are quite different.

For celiac disease, it's all about prolamin, a type of gluten protein found in grain seeds such as wheat, barley, rye, corn, and oats. People with celiac disease have an autoimmune response upon exposure to certain types of prolamin, leading to that uncomfortable inflammation in the bowel tissue.

Celiac disease is diagnosed with blood testing, and treatment comes down to one thing: diet. Because consumption of gluten results in a breakdown of the small intestine and a reduced capability to absorb nutrients, you have to cut it out. Fortunately, this autoimmune disorder affects only one in 133 people, according to the National Foundation for Celiac Awareness (NFCA).

In contrast to celiac disease, there are no officially recognized biomarkers to objectively diagnose NCGS. Rather, diagnosis is made through excluding gluten disorders, such as celiac disease or a wheat allergy. If an individual presents the aforementioned symptoms but has tested negative for gluten disorders, they are often diagnosed with NCGS, especially if they show improvement from a gluten-free diet. It is unknown, however, whether individuals with NCGS are sensitive to gluten or other substances within wheat, and this may have led to an overdiagnosis of the condition and an overpromotion of a gluten-free lifestyle. In fact, according to the NFCA, 18 million Americans have NCGS, but because the correlation between NCGS and gluten is still uncertain, gluten-free measures are not yet a proven solution.

Is a Diet Change in Order?

As the adage goes, it's better to be safe than sorry. You should seek a medical professional's opinion if you're experiencing chronic gastrointestinal symptoms, are deficient in iron and essential B vitamins, or have a genetic predisposition to celiac disease. If the celiac disease tests return negative, further consult with a physician to determine whether gluten-free is the way to go, as this diet comes with drawbacks in terms of missing out on the vitamins that bread and wheat have to offer (including B vitamins and dietary fiber).

More and more Americans are choosing a gluten-free diet, and many restaurants and markets now offer gluten-free food options. But before you jump aboard that train, seek your doctor's advice to ensure you're doing what's best for your body. Maybe your intestinal pain doesn't stem from the bread, but rather from the fact that you're eating pizza and subs every day!