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What is Gluten Sensitivity?

Content provided by the Faculty of the Harvard Medical School

Gluten sensitivity, a separate condition from celiac disease, is associated with many of the same symptoms as lactose intolerance — gas, bloating, and diarrhea — but also with additional and more troubling symptoms, including fatigue and dizziness. The condition has baffled clinicians and patients alike for years, because it has been difficult to even imagine how gluten could trigger such a host of seemingly unrelated symptoms. One theory is that gluten sensitivity is part of the "undersea" portion of the "celiac iceberg"; However, studies of people who do not have celiac disease but still develop symptoms when they ingest gluten indicate that gluten sensitivity is separate and distinct from celiac disease.

In March 2011, a group of researchers in Italy and the United States reported evidence for a potential mechanism to account for gluten sensitivity. Patients with many of the symptoms of celiac disease but no signs of intestinal damage were found to produce an abnormally high number of proteins that play a role in activating inflammation — the immune system's first line of defense — and an abnormally low number of suppressor T cells, which dampen down inflammation once the "threat" is removed. The inflammatory response, like that brought against the flu virus, can cause fatigue and dizziness. However, because the intestinal villi are not damaged, nutrient absorption isn't affected.

The evidence has established gluten sensitivity as a real condition apart from celiac disease, but it hasn't yet yielded a diagnostic test or new treatment for gluten sensitivity. Thus, gluten sensitivity is still a diagnosis of elimination. Patients in whom celiac disease has been ruled out are asked to eradicate all gluten from their diet. If their symptoms improve, they are deemed gluten sensitive.

Gluten sensitivity can be avoided by excluding all gluten-containing foods and products from your diet. Unlike people with celiac disease, those with gluten sensitivity aren't risking intestinal injury, defective nutrient absorption, and serious complications by eating a little gluten. So if you have gluten sensitivity, you have a little more latitude to experiment than do people with celiac disease. You may want to test whether you can eat foods like soy sauce that have minimal gluten concentrations, or enjoy a bite of cake now and then without repercussions.

Symptoms of gluten sensitivity

Gluten-free eating

Going gluten-free doesn't mean forsaking all of life's starchy pleasures. It just requires enjoying them in slightly different forms. Flour isn't synonymous with wheat — it can also be milled from rice or potatoes as well as amaranth, buckwheat (no relation to wheat), millet, quinoa, sorghum, or chickpeas. Xanthan and guar gums can be substituted for gluten to supply elasticity, so more gluten-free pastries are making their way into bakeries and into packaged cake and cookie mixes. In fact, "gluten-free" is becoming increasingly more common in the labeling of everything from soup to nuts and even beer.

Gluten is found in foods such as pasta, bread, wheat cereals, and many baked goods. But many other less obvious items, such as sauces, soups, salad dressings, toothpaste, medications, and candy may contain gluten. Even corn and rice cereals can have gluten-containing ingredients, such as barley malt extract or flavoring.

You have to be a dedicated food-label reader and pay close attention to all ingredients. Fortunately, an increasing number of companies offer gluten-free products, which keeps the guessing and sleuthing to a minimum.

Restaurants are also jumping on the gluten-free bandwagon, and for many ethnic cuisines, it's not a big leap. The more authentic Ethiopian, Indian, Mexican, and Thai cooking is, the less likely you are to find gluten on the menu.

Last Annual Review Date: 2011-08-01 Copyright: 2011 Harvard Health Publications

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