Last Updated on 17 March 2021 by Brisbane Livewell Clinic
Many of our patients suspect they may have a gluten intolerance. Some have already experimented with a gluten-free diet or present with signs and symptoms indicating gluten could be problematic. Identifying the underlying cause is extremely important, as the extremities can include autoimmune disease or anaphylaxis. In Part One of our guide to Gluten Intolerance, we look at foods containing gluten, a variety of signs and symptoms experienced from ingestion and the different types of diagnoses that can arise from gluten Intolerance
Foods containing gluten
Grains containing gluten include:(1)
- wheat
- wheat varieties including spelt, kamut, farro and durum
- barley
- rye
- triticale
- oats (more on oats in Part Two)
- bulgar (cracked wheat)
- semolina
- couscous
Each type of cereal grain contains differing amounts of gluten.(2) Wheat is the predominant source of exposure for many via consumption of cereal, bread and pasta.
Common Symptoms associated with gluten(2,3,4)
Intestinal symptoms
- abdominal bloating
- abdominal pain
- diarrhoea
- nausea
- mouth ulcers
- constipation
Extra-intestinal symptoms
- inability to concentrate
- tiredness
- headache
- anxiety
- numbness
- joint/muscle pain
- skin rash/dermatitis
- mental disturbances
- irritability
- depression
- attention deficit disorder (ADD)
- tooth enamel defects
- weight loss
- iron deficiency anaemia
- delayed puberty
Diagnosis Details for Gluten Intolerance
When gluten seems the likely culprit, there are firstly 3 different categories to investigate, including Coeliac Disease (CD), Non-Coeliac Gluten Sensitivity (NCGS) and Wheat Allergy.
1. Coeliac Disease
Coeliac Disease (CD) is an autoimmune condition characterised by the presence of specific antibodies to gluten and can only occur in genetically susceptible individuals with HLA-DQ2 and/or HLA-DQ8 genotypes.(5) With a global prevalence of around 1%(6), CD can manifest itself clinically at any age.(4) Early diagnosis prevents complications such as Osteoporosis,(6) higher risk of gastrointestinal cancer(4), and the potential for Reproductive disorders and associated decreased fertility in both males and females.(6)
It’s important to get an accurate diagnosis and feel guided through the testing process. Genotype testing is available via your GP or can be arranged by our Livewell Naturopaths and Nutritionists. The test is useful for individuals to understand if they have a likelihood of developing CD. Since current exposure to gluten is essential to ensure positive antibodies show up in test results for CD, if you have already eliminated gluten and are reluctant to reintroduce it, negative genotyping helps to avoid unnecessary reintroduction of gluten to confirm a diagnosis of CD.
Never perform a blood test for Coeliac antibodies without consuming a moderate amount of gluten for at least 4-6 weeks. The gold standard for CD diagnosis is a small bowel biopsy (tissue sampling) obtained by an endoscopy,(7) observing the damage to the small intestine caused by gluten. CD is treated seriously by medical doctors since it is an autoimmune disease.
2. Non-Coeliac Gluten Sensitivity (NCGS)
NCGS is a condition characterised by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing foods in the absence of Coeliac Disease and wheat allergy.(3) In contrast to CD, NCGS patients must not have detectable coeliac disease-associated antibodies and maybe HLA-DQ2/8–negative.(2) Careful consideration of other factors is involved with this diagnosis, as it is a diagnosis of exclusion of other gastrointestinal disorders. Symptoms of NCGS also overlap with those of IBS.(3) Other extensive testing is recommended to rule out serious conditions such as IBD. We can help you take out the guesswork at the clinic and guide this diagnosis, using a range of techniques, including diet advice, a diet and symptom diary, a time frame for gluten elimination and guided re-challenge and recommend further investigations. Some tests may require referral to your GP, and other testing can be arranged privately, such as IgG Food Intolerance testing.
3. Wheat Allergy
Wheat is one of the five most common food allergens in children. (8) Immunoglobulin (IgE) mediated Wheat Allergy (WA) requires the restriction of wheat from the diet,(2) due to the potential for anaphylaxis. Symptoms develop within minutes up to 1–2 hours after the wheat ingestion and vary greatly based on the age group.(8) In young children, gastrointestinal symptoms mainly occur, such as vomiting and diarrhoea. Intestinal symptoms generally recede with age, replaced with issues such as worsening atopic dermatitis. WA is often accompanied by respiratory disorders (wheeze, persistent cough, hoarse voice, respiratory distress and nasal congestion), which should not be dismissed due to the likelihood of anaphylaxis. If not outgrown after childhood, teenagers and adults tend to suffer the most severe allergy forms, with anaphylaxis symptoms occurring in 45%–50% of sufferers. Adults are more likely to have outgrown a childhood wheat allergy, with only about 10% of patients still suffering as they mature.(8)
Skin Prick testing, IgE blood testing and oral challenge testing can be conducted via your GP and/or Allergy specialist, with IgE food testing also available via the clinic.
Separating the wheat from the chaff with Gluten Intolerance
Understanding the vast differences between types of issues with gluten and wheat-based foods is vital in understanding if your symptoms match the potential for a diagnosis. Knowing something for yourself is different from self-diagnosis – always seek professional advice and get reassurance that you are on the right track. Chances are your instincts are serving you well but always get clarification and support for your health and wellbeing. If you are better for a gluten-free diet, it’s important to understand why. We are here to guide you on all things gluten. Click HERE to read A Guide to Gluten: Part Two – Seeking Solutions
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