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How to tell the difference: gluten allergy or gluten sensitivity?

It’s hard to open a magazine or walk through the grocery store without experiencing an onslaught of gluten-free (GF) food, recipes, and health advice. The products alone are a multibillion-dollar market. But is a GF diet something you need to spend the extra money on? How can you tell if you’re allergic or sensitive to gluten?

Gluten allergy
The only way to know if gluten—a protein found primarily in wheat, barley, and rye—is detrimental to your personal health is to get tested for a gluten allergy. Approximately 1 percent of the population suffers from celiac disease, the autoimmune disorder that causes immune inflammation in the small intestine and for which the treatment is a strictly GF diet. Left unmanaged, celiac disease may lead to anemia, chronic fatigue, osteoporosis, an impaired spleen, infertility, neurologic disorders, skin rashes, and cancer.

Board-certified gastroenterologists generally need a biopsy of the small bowel with an endoscopy in order to diagnose celiac disease. A blood test is also available, but it’s not 100 percent accurate. Both tests need to be performed while you are still on a regular diet that includes gluten.

Those who have celiac disease need to completely and permanently avoid any form of gluten in their diets. Because GF products can be lower in nutrients and gluten can lurk in unlikely places, a dietician or nutritionist should guide patients as they transition to a new way of eating.

Gluten sensitivity
It is possible to have symptoms of celiac disease, but have normal blood and endoscopy test results.  This is called non-celiac gluten sensitivity (NCGS), or gluten intolerance. With NCGS, symptoms improve when gluten is eliminated from the diet and return when gluten-containing foods are reintroduced.

A gluten intolerance is not an allergy, and there are currently no tests to accurately diagnose NCGS. Additionally, a gluten intolerance does not mean that someone needs other allergy testing. Allergists do not treat NCGS, and patients with this concern should be seen by their primary care provider or gastroenterologist instead.

Talk to your primary care provider if you have concerns about gluten in your diet.

Dr. Gregory Owens is an Allergy, Asthma & Immunology Department specialist. He believes in a patient-centered, friendly, and state-of-the art approach to care.