Unpacking Gluten-Related Disorders: More Than Just a Stomach Ache

Navigating the world of gluten can be confusing. You might hear terms like Celiac disease, gluten intolerance, or food sensitivity and wonder what they all mean, especially if you’re experiencing uncomfortable symptoms. At Village Medicine in Seattle, we frequently help patients unravel these complexities and find paths to better health. This article aims to shed light on the differences between these conditions, how they’re diagnosed, and what you can do if you suspect gluten might be an issue for you.

Many people associate gluten issues solely with digestive upset, but the reality is far more nuanced. Gluten, a protein found in wheat, barley, spelt, rye, and triticale can trigger a range of reactions in susceptible individuals, affecting everything from your gut to your brain,
joints, and skin. Let’s explore the main categories:

Celiac Disease: An Autoimmune Response

Celiac disease is not simply an intolerance or allergy; it’s an autoimmune disorder. When someone with Celiac disease consumes gluten, their immune system mistakenly attacks the lining of the small intestine. This damage can lead to:

• Malabsorption: Difficulty absorbing essential nutrients like iron, vitamin D, B vitamins, and calcium. This can manifest as anemia, vitamin deficiencies, or osteoporosis.
• Gastrointestinal Symptoms: While classic symptoms include diarrhea, bloating, gas, and abdominal pain, some individuals may experience constipation or even have seemingly normal stools.

Extra-intestinal Symptoms (Outside the Gut):

These are common and can sometimes be the primary indicators:

• Chronic fatigue
• Joint pain and muscle aches
• Severe brain fog, difficulty concentrating, memory issues
• Headaches or migraines
• Skin rashes (like dermatitis herpetiformis, an itchy,
  blistering rash)
• Mood changes, anxiety, or depression
• Unexplained weight loss or, in some cases, weight gain
• In children, failure to thrive or dental enamel defects.

GETTING THE RIGHT DIAGNOSIS FOR CELIAC DISEASE

Accurate diagnosis is crucial. If we suspect Celiac disease, a specific testing process is necessary:

1. The Gluten Challenge:
This is a critical first step. For antibody tests or an endoscopy to be accurate, you must be consuming gluten regularly. This typically means eating the equivalent of one to three slices of gluten-containing bread (or high gluten food) daily for 30 to 60 days before testing.
Many people make the mistake of going gluten-free before testing, which can lead to false negatives. If a test is positive while on gluten, it’s a firm positive. If it’s negative or equivocal without a proper gluten challenge, we can’t be certain.

2. Blood Tests (Antibody Panel):
We recommend a comprehensive panel, not just the basic Tissue Transglutaminase IgA (tTG−IgA) test. A full panel should include:
a. tTG−IgA and tTG−IgG
b. Deamidated Gliadin Peptide (DGP−IgA and DGP−IgG)
c. Total Serum IgA: This is vital because if your overall IgA levels are low (IgA
deficiency), any IgA-based antibody tests (like tTG−IgA) could be falsely negative. In
such cases, IgG-based tests become more important.

3. Endoscopy with Biopsy:
If blood tests are positive or suspicion remains high, a gastroenterologist will perform an upper endoscopy to take multiple biopsies from the small intestine. It’s important to confirm that specific Celiac biopsies are taken and analyzed.

Untreated Celiac disease can lead to long-term health complications, including an increased risk of other autoimmune diseases, neurological conditions, and certain cancers. The good news is that the treatment – a strict, lifelong gluten-free diet – can halt the autoimmune attack and allow the intestine to heal

Non-Celiac Gluten Sensitivity (NCGS): An Inflammatory Reaction:

What if Celiac disease tests are negative, but you still react adversely to gluten? You might have Non-Celiac Gluten Sensitivity (NCGS).

What it is:
NCGS is not an autoimmune disease like Celiac, nor is it an IgE-mediated allergy (more on that later). It’s characterized by a range of intestinal and extra-intestinal symptoms that occur after gluten ingestion, improve or disappear when gluten is withdrawn, and relapse if gluten is reintroduced.

Symptoms:
Symptoms can significantly overlap with Celiac disease, including bloating, abdominal pain, diarrhea or constipation, brain fog, headaches, fatigue, and joint pain.

Diagnosis:
There isn’t a specific biomarker for NCGS yet. Diagnosis is typically made by ruling out Celiac disease and wheat allergy, then observing symptom improvement on a gluten-free diet, often confirmed with a gluten challenge.

Why it Matters:
Interestingly, some research suggests that individuals with NCGS who don’t adhere to a gluten-free diet may face earlier morbidity and mortality than those with Celiac disease who do strictly avoid gluten. This underscores the importance of taking NCGS seriously,
as ongoing inflammation can have systemic effects.

If NCGS is suspected, the focus shifts to understanding the underlying reasons for this sensitivity, which often involves investigating overall gut health, including potential dysbiosis (imbalance of gut bacteria) or intestinal permeability (“leaky gut”).

GLUTEN INTOLERANCE & GENERAL FOOD SENSITIVITIES

“Gluten intolerance” is often used as a broad term that can encompass NCGS or other food sensitivities where gluten is a trigger. Beyond specific reactions to gluten, many people experience sensitivities to a variety of foods.

Food Sensitivity Testing (IgG):
Tests measuring IgG antibodies to various foods (like those from US BioTek, Alletess, or the Precision Analytics p88 panel which includes IgE, IgG, IgG4, and C3d complement markers) can sometimes provide clues. However, these tests have limitations. An IgG response can indicate exposure and an immune reaction, but it doesn’t always equate to a clinically relevant sensitivity. If there’s underlying dysbiosis or intestinal permeability, these tests might show reactions to many foods simply because the immune system is overreactive.

That said, for some patients, these tests can help identify major trigger foods and guide an elimination diet.

The Elimination Diet:
This remains a gold standard for identifying food sensitivities. It involves:

Elimination Phase: Removing common trigger foods for a set period (often 1-3 months). Besides gluten, common culprits include dairy, sugar, soy, corn and processed foods. The specific foods and duration depend on the individual’s history and symptoms.

Reintroduction Phase: Carefully reintroducing foods one at a time while monitoring for any returning symptoms. This helps pinpoint specific triggers.

During the elimination phase, we also focus on gut healing and addressing any underlying imbalances like Small Intestinal Bacterial Overgrowth (SIBO) or dysbiosis, identified through tests like a GI Map or SIBO breath test.

What About IgE Food Allergies?
It’s important to distinguish Celiac disease and NCGS from IgE-mediated food allergies, such as wheat allergies.

Mechanism: True allergies involve the IgE antibody and can trigger a rapid, sometimes severe, immune response.

Symptoms: Allergic reactions often include hives, swelling (especially around the mouth or throat), difficulty breathing, wheezing, vomiting, or even anaphylaxis shortly after consuming the allergen.

Testing: IgE antibody testing (blood tests or skin prick tests) can help diagnose these allergies. While a gluten challenge isn’t as stringently required as Celiac testing, recent exposure can make the test more accurate. Note though that exposure should be avoided if
anaphylaxis or similar reactions have occurred with gluten in the patient’s history.

A Note on Secretory IgA (sIgA) and Gliadin: Some stool tests (like the GI Map) measure anti-gliadin sIgA. Elevated levels indicate an immune response to gliadin (a component of gluten) in the gut lining. This doesn’t confirm Celiac disease but suggests gluten is triggering local inflammation and warrants further investigation, potentially including Celiac testing if not already done.

THE IMPORTANCE OF GUT HEALTH AND FOOD SOURCING

Underlying many food sensitivities, including reactions to gluten, is the health of your gut lining. Intestinal permeability, or “leaky gut,” allows undigested food particles and toxins to pass into the bloodstream, potentially triggering immune responses and inflammation.

The Trouble with Modern Wheat:
The wheat consumed by many in the U.S. today is different from ancestral varieties.

Glyphosate: Much non-organic wheat is treated with glyphosate (the active ingredient in Roundup) as a desiccant before harvest. Studies have shown that glyphosate can contribute to intestinal permeability.

Hybridization: Modern wheat has been hybridized for higher gluten content and yield, which can make it harder to digest for some individuals.

For those with NCGS or general gluten intolerance (but not Celiac disease), sourcing matters. Some individuals find they can tolerate heritage grains, organic wheat, or wheat products from Europe (where glyphosate use on wheat is restricted and different wheat strains are common) much better than conventional U.S. wheat. This is not an option for those with Celiac disease, as all forms of gluten must be avoided.

Living Gluten-Free: Challenges and Significant Rewards

Embarking on a gluten-free lifestyle, whether for Celiac disease or NCGS, can seem daunting, but the improvements in health and wellbeing can be profound.

NAVIGATING A GLUTEN FREE WORLD:

Cross-Contamination is Key (Especially for Celiacs):
Gluten can hide in unexpected places, and even tiny amounts can trigger a reaction in Celiacs. This means vigilant label reading
and careful food preparation.

At home:
This might involve separate toasters, cutting boards, utensils, and condiments. Wooden or scratched plastic utensils can harbor
gluten.

Dining out:
Communicate your needs clearly. Look for Celiac safe restaurants using apps like Find Me Gluten Free, or Gluten Dude and shopping apps such as Fig, Spokin and Spoonful.

Focus on Whole Foods:
While many gluten-free processed foods are available, they aren’t always the healthiest. Prioritize naturally gluten-free whole
foods: fruits, vegetables, lean proteins, legumes, nuts, seeds, and gluten-free grains (like rice, quinoa, millet, buckwheat). Paleo
and Whole30 resources can offer excellent gluten-free meal ideas, as can many Celiac friendly recipe sites and books.

Digestive Enzymes and Binders:
For accidental exposure, digestive enzymes formulated to help break down gluten (containing DPP-IV) or binders like activated
charcoal may help reduce the severity or duration of symptoms. However, these are not a license to knowingly eat gluten if you
have Celiac disease or significant NCGS. They are for rescue situations only.

THE UPSIDE OF GOING GLUTEN-FREE (WHEN MEDICALLY NECESSARY):

Patients who identify and remove gluten as a trigger often report transformative changes:

• Improved Digestive Health: Resolution of bloating, pain, diarrhea, or constipation.
• Increased Energy Levels: Fatigue often lifts as inflammation subsides and nutrient
  absorption improves.
• Enhanced Mental Clarity: “Brain fog” clears, and concentration improves.
• Better Nutrient Status: Iron, Vitamin D, and B vitamin levels often normalize.
• Reduced Pain: Joint and muscle aches can diminish significantly.
• Clearer Skin
• Improved Mood
• Improved Immune Status

For those with Celiac disease, a strict gluten-free diet is essential not just for symptom relief but also to reduce the long-term risk of complications, including other autoimmune diseases.

Finding Your Path at Village Medicine

Understanding whether gluten is impacting your health requires careful investigation and a personalized approach. Many patients come to us after seeing multiple practitioners without answers, still experiencing symptoms like chronic pain, fatigue, digestive issues, or brain fog that haven’t been resolved.

If you suspect Celiac disease, NCGS, or other food sensitivities, or if you have a family history of these conditions, we encourage you to seek guidance. At Village Medicine in Seattle, we can help you navigate the appropriate testing, interpret the results in the context of your overall health, and develop a comprehensive plan that may include dietary changes, gut healing protocols, and lifestyle support.

Don’t let confusion or unresolved symptoms hold you back from feeling your best. Contact Village Medicine today to schedule a consultation and take the first step towards clarity and better health.

* This post was originally printed in the Village Medicine Seattle’s Wellness Quarterly Magazine, 3Q25 Edition. Read and download the full publication

About The Author

Dr. Misty Story, ND  is a Digestive health, SIBO, IBD, IBS, GERD/reflux specialist at Village Medicine Seattle. Her goal is to assist patients in their journey through education, encouragement and continued research as her first Naturopathic Doctor did for her. Learn more about Misty