Gluten free diets are all the rage, especially in the U.S. where up to 1 in 4 people believe eating gluten free is better for their health.[1]  However, is this really a lifestyle for everyone?  Who has the most to gain from gluten free living?  

Of course, removing gluten from the diet is a no-brainer for people with celiac disease and gluten sensitivity, but today an increasing number of people are going gluten-free, irrespective of a diagnosed illness or allergy. 

If you’re wondering, “should I follow a gluten-free diet?” you’ll want to know the typical signs and symptoms of gluten intolerance.  However, even if you don’t have any symptoms, you will want to take a close look at how a gluten free diet benefits everyone.  With professional athletes embracing the lifestyle leading to new levels of performance and longevity in their careers, it just may be something for you to consider for both feeling better and improving your performance.  

Who is Jumping on the Gluten Free Living Bandwagon?

Gluten is a protein found naturally in cereals like wheat, barley, and rye. It has been a staple in almost every American’s diet for some 10,000 years. However, over the past century, we’ve witnessed the emergence of several gluten-related disorders, the most serious of which is Celiac Disease, an autoimmune disorder that causes damage to the small intestine and results in digestive issues and nutritional deficiencies. 

The disorder affects around 1% of the population.[2] However, another 13% of the population may also suffer from a condition now recognized as Non-Celiac Gluten Sensitivity. People with a “gluten sensitivity” experience celiac-like symptoms, which resolve with the removal of gluten, however, these individuals typically don’t exhibit the same intestinal damage seen in celiac patients.[3] 

In fact, some 3.1 million Americans currently adhere to a gluten-free diet, despite receiving a negative diagnosis.[4] And it’s easy to understand why with renowned medical experts like Dr. William Davis, author of the highly controversial and New  York Times Bestselling book Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health, claiming we can all lose weight by dropping the wheat. Not to mention professional athletes, like tennis superstar Nojack Djokovic, attributing grand slam titles to gluten-free eating and the ever-increasing array of affordable gluten-free products in supermarkets.

Intra-Intestinal Symptoms 

Both celiac disease and gluten sensitivity cause a complex host of widespread symptoms that manifest both inside the intestinal tract and outside the intestinal tract. The most common intra-intestinal signs to look for are:

Diarrhea and Constipation

Occasionally experiencing diarrhea and constipation is normal. However, if you suffer from chronic symptoms lasting longer than four weeks, it could be a sign of something more sinister. 

In one study, more than 75% of adults with celiac disease, and around 50% of individuals with gluten sensitivity experience diarrhea after eating gluten-containing foods.[6]

Constipation is more commonly seen among children with celiac disease and is often accompanied by malabsorption and failure to thrive. In adults, constipation can be subtler and instead present itself as nutritional deficiencies, most commonly a lack of iron.

Abdominal Pain 

Abdominal pain is a common complaint among people with gluten intolerance. Often experienced shortly after eating, the pain is described as cramping and intermittent, and less commonly sharp. It can be attributed to the inflammation and damage caused by the body’s immune-mediated response to gluten.

One study of 215 Americans with celiac disease reported that, although diarrhea was the most frequent symptom, abdominal pain was the most common. Interestingly, 79% of participants reported significant, recurrent abdominal pain before treatment, while just 4% reported symptoms after 6 months on a gluten elimination diet.[7]. 

When it comes to the biggest benefits of gluten free living, a reduction in abdominal pain is definitely one of them! 

Abdominal Bloating 

You may have experienced bloating after a festive meal or a big weekend. Your stomach feels uncomfortably full and puffy due to a build-up of gases. However, if abdominal bloating becomes more than an occasional inconvenience, it could be a sign of celiac disease, gluten sensitivity, or other food intolerance. 

One survey of 1,032 adults with celiac disease found that bloating was the most prevalent symptom reported. In fact, 73% of participants reported bloating prior to treatment. [8] 

Another study showed reduced abdominal bloating among individuals with non-celiac gluten sensitivity after adhering to a strict gluten-free diet for six weeks. The same study also reported worsening of symptoms within one week of reintroducing gluten.[9]

Posts related to eating gluten free:

Unexplained Weight Loss

Sudden, unintended weight loss can occur after a stressful event, although it can also be a sign of serious underlying illness. In fact, unexplained weight loss is a common side effect of undiagnosed celiac disease.[10] One study of adults with celiac disease in Minnesota found one-quarter of patients presented with unexplained weight loss before diagnosis.[11]

Weight loss, muscle wasting, and impaired growth are also typical signs of celiac disease in children.[12] A study that scanned Brazilian children with a short stature for celiac disease found a high prevalence of 4%. After adhering to a gluten-free diet for 1.5 years, each child in the study showed an improvement in growth velocity.[13] 

Chronic diarrhea and malabsorption of nutrients are often blamed for weight loss and impaired growth.

Iron Deficiency 

Iron is a mineral needed for the formation of healthy red blood cells. If you don’t absorb enough iron from your diet, Anemia can develop, a condition where you don’t have enough healthy red blood cells to transport oxygen around your body.

Anemia can cause a range of symptoms including low blood pressure, shortness of breath, fatigue, dizziness, pale skin and noticeable heart palpitation. 

In celiac disease, malabsorption of nutrients in the large intestine can reduce the amount of iron absorbed from food. Studies indicate that between up to 63% of adults with celiac disease and 14.6% with gluten sensitivity suffer from iron-deficiency anemia.[14,15] Iron-deficiency anemia is also significant among children with celiac disease.[16] 

Extra-intestinal Symptoms

While celiac disease is primarily considered an intestinal disorder, there’s increasing evidence to support a broader concept of a systemic inflammatory disease. These are a wide array of symptoms that occur outside the gut (extra-intestinal) such as neurological, dermatological, osteological, and endocrine symptoms.

Fatigue

Everyone feels tired from time to time. And this is usually no cause for concern.

However, if you constantly feel exhausted (even after plenty of sleep) then its worth investigating the underlying cause.

Note- If you’re someone who “can’t function” or live without coffee, this is not normal.  No one should ever need coffee to function.  If you need coffee to function, you’re simply covering up a symptom.  Covering up symptoms without getting to the root cause of the problem often leads to a slow snowball effect of problems building over many years all while being masked with temporary fixes.  We encourage you to try and drink coffee only intermittently (as long as you metabolize it well) and if you struggler without it, investigate why.  If you’re interested in a great alternative to coffee so you can have energy and focus without harming your health or blowing out your adrenal glands check out our post on The Ultimate Bulletproof Coffee Alternative. 

Individuals with gluten-related disorders frequented report fatigue and tiredness, especially after eating foods that contain gluten. A recent study involving 1,032 adults with celiac disease found 82% of participants experienced persistent fatigue before diagnosis.[17]

Another study found that those with gluten-related disorders were more likely to experience sleep disorders as well as nutritional deficiencies, particularly iron, vitamin B12, and folate, which could contribute to fatigue by depriving the body of essential nourishment.

Due to potential malabsorption and nutritional deficiencies, athletes with undiagnosed gluten-related disorders are at particular risk of overtraining, fatigue, and recurrent injury. A recent study of 1,443 endurance athletes with self-diagnosed non-celiac gluten sensitivity, found that 84% of participants reported a reduction in fatigue after adhering to a gluten-free diet.[18] 

Headaches 

Up to 20% of adults in the United States experience a severe headache or migraine from time to time.[19]  Interestingly, studies have shown that gluten-sensitive individuals might be more prone to headaches and migraines than others.[20,21] In fact, chronic headaches are reported by 30% of people with celiac disease and 56% of people with non-celiac gluten sensitivity.[22] 

Another study found that 100% of celiac patients with migraines experienced significant improvement in frequency, duration, and intensity of migraines within six months of a starting on a gluten-free diet.[23]

If you experience persistent headaches or migraines, it may be worth considering that you might have a gluten intolerance.  Still not sure what the difference is between a food allergy, sensitivity and intolerance?  Check out our post which explains the difference.

Limb Numbness, Impaired Coordination & Loss of Balance

Neurological manifestations occur in 10% to 30% of people with celiac disease.[24,25] Do you regularly experience any of the following?

  • Numbness, tingling or loss of sensation in your hands or feet
  • Loss of balance, coordination, or difficulty walking
  • Muscle weakness, particularly in the feet

Neurological disorders are prevalent among those who don’t comply with a gluten-free diet and the late-diagnosed elderly.[26] The two most common neurological manifestations are:

Cerebellar ataxia: a serious disorder of the central nervous system characterized by damage and inflammation to the cerebellum, a part of the brain responsible for fine motor control and muscle coordination. The condition is seen in 2% to 17% of celiac patients and has since been termed “gluten ataxia”.[27] In fact, studies show that gluten is responsible for up to 45% of idiopathic sporadic ataxia (e.g. cases of ataxia that were previously thought to have no underlying disease).[28,29] 

Peripheral Neuropathy: seen in 49-59% of people with celiac disease.[30] It is believed systemic inflammation triggered by gluten consumption damages peripheral nerves (e.g. nerves in the body’s extremities such as hands, feet, arms, and face). The peripheral nervous system is responsible for transmitting sensations (such as touch) to the brain as well as controlling muscle contractions. A study of 35 patients with peripheral neuropathy demonstrated that 100% of those who adhered to a gluten-free diet for one year experienced an improvement in symptoms.[31]

Seizures

Epilepsyis a slightly less common neurological manifestation, affecting between 0.8-6% people with celiac disease.[32] The condition affects the brain and causes frequent seizures.

Several studies have demonstrated successful treatment of epilepsy among celiac patients with adherence to a gluten-free diet, demonstrated by a reduction in the frequency of seizures.[33] If you suffer from unexplained seizures or cerebral calcifications, be sure to ask your doctor to rule out celiac disease as a possible origin.

“Brain Fog”

A milder form of neurological impairment often reported by individuals with a sensitivity to gluten is “brain fog.” Sufferers report impaired concentration, difficulty making decisions, short-term memory loss, and slow information processing.

One study of 120 individuals recruited through Celiac Australia found that 100% of participants had experienced symptoms of brain fog after the consumption of gluten.[34] Another recent study has shown that these subtle neurological impairments resolve in parallel with intestinal healing over the course of 12 months adhering to a gluten-free diet.[35]

The exact cause of brain fog among celiacs is still under investigation. However, the brain and spinal scans of patients with gluten sensitivity and brain fog have shown white matter abnormalities.[36,37]

Furthermore, a 2001 study reported white matter lesions on the brain of 20% of children with celiac disease.[38] Researchers believe the most likely explanation is the presence of elevated levels of circulating cytokines, which facilitate the movement of leukocytes into the brain promoting inflammation and in turn reduce the speed of neural messages. 

If you often have difficulty concentrating, remembering information, making decisions or generally feel “cloudy” after consuming gluten, you may be experiencing gluten-induced brain fog.

Joint and Muscle Pain

Gluten causes systemic inflammation in intolerant individuals, which can also manifest as joint and muscle pain. Researchers have known for many years that people with celiac disease are at greater risk of developing other autoimmune disorders, like rheumatoid arthritis and juvenile arthritis.[39,40] However, a growing body of research now supports the idea that there is a connection between gluten and non-pathologic join pain (e.g. not due to underlying disease). 

Around 11% of people with gluten sensitivity report joint and muscle pain.[41] If you experience painful joint pain and inflammation that impairs your day-to-day activities, you might consider eliminating gluten. 

Anxiety & Depression

Anxiety affects around 18% of Americans each year.[42] It’s a feeling of unease, worry, or fear that can range from mild to severe.

People with celiac disease tend to be more susceptible to anxiety and panic disorders when compared to healthy individuals.[43,44,45] A survey of 522 celiac patients found that women on the gluten-free diet were especially prone to anxiety, but not depression.[46] Furthermore, 39% of patients with suspected non-celiac gluten sensitivity reported that they regularly felt anxious.[47]

Skin Rashes

Gluten-related disorders can also manifest on your skin. Dermatitis herpetiformis is the most common skin condition associated with gluten, affecting around 17% of people with celiac disease.[48] The blistering rash is a telltale sign of ‘silent’ celiac disease, where damage to the small intestine is found in the absence of any digestive symptoms.

Psoriasis is another common skin condition among celiacs. It’s characterized by patches of red, dry, itchy, and scaly skin, typically on the elbows, knees, scalp, and upper back. One study of 25,341 Americans found that those with celiac disease were twice as likely to suffer from psoriasis.[49] 

Individuals with non-celiac gluten sensitivity seem to be more prone to ulcers, dermatitis, and eczema, while wheat allergies are more likely to manifest with allergic hives.[50]

Who Can Benefit from Gluten Free Living?

As you can see, gluten can wreak havoc on almost every system in the body from your digestive tract to your nervous system and even skin. However, keep in mind that most of the symptoms mentioned above have several possible explanations, and in many cases, do not indicate anything serious.

Nonetheless, if you frequently experience these issues for no obvious reason, then your body could be reacting negatively to gluten. In which case, removing gluten would alleviate or resolve your symptoms and make a vast improvement to your overall health.

Many people mistakenly think “well I don’t have celiac disease, so I can eat gluten”, but the fact is, gluten-based foods are manufactured so differently these days and as a result, a significant portion of the population can no longer safely digest gluten. 

I have literally witnessed miracles from the avoidance of gluten and firmly believe you don’t need to be diagnosed with celiac disease or non-celiac gluten sensitivity to reap the benefits of a gluten-free diet.

Screening & Testing Methods

With that said, if you suspect you might have a gluten sensitivity or intolerance, it’s well worth getting tested. Early diagnosis reduces the chances of complications and the development of other autoimmune diseases. Receiving an accurate diagnosis also tells you how strict you need to be, and can help you identify whether your family has a genetic predisposition. The current body of research recommends the following people undergo testing:

  • Children older than 3, and adults experiencing symptoms
  • First-degree relatives of a diagnosed celiac
  • Any individual with an associated autoimmune disorder, especially type II diabetes 

Different Tests For Celiac Disease

There are several tests available to diagnose celiac disease and wheat allergy. However, there are no current clinical tests available for non-celiac gluten sensitivity. It’s also important to realize that a test will never be 100% accurate. 

Serologic Testing: 

Serologic testing is the first step when screening symptomatic patients for celiac disease. It involves blood testing for the presence of certain antibodies. Currently, the recommended serologic tests include:

  • Anti-tissue transglutaminase antibodies (tTG-IgA)
  • Endomysial antibodies (EMA-IgA)
  • Total IgA (to exclude IgA deficiency)
  • Deamidated gliadin peptide antibodies (IgA-DGP) and anti-gliadin antibodies (IgG-AGA) can be used in young patients aged between 2 and 3 that may test negative to IgA-tTG and EMA antibodies. 

Keep in mind, those going gluten-free before being tested for celiac disease can make diagnosis difficult. To receive an accurate result, it is recommended that you regularly eat two slices of wheat bread for 6-8 weeks prior to serologic testing. Generally, after 6 to 12 months adhering to a gluten-free diet, you have an 80% chance of receiving a false negative.[51] 

Genetic Testing:

To develop celiac disease you must first have either the HLA-DQ8 or HLA-DQ2 gene. However, these genes don’t necessarily mean you will develop celiac disease. In fact, up to 40% of the population has celiac genes, but only 1% of the entire population develops celiac disease. 

Genetic testing is therefore only used to rule out celiac disease, not provide an accurate or concrete diagnosis. 

Intestinal Biopsy:

Depending on your serologic and genetic test results, your doctor may recommend an endoscopy to confirm your diagnosis. In this procedure, the physician eases a long, thin tube known as an endoscope down your throat and reaching your esophagus. The physician will then take two to three small tissue samples from different areas of your small intestine. 

The biopsies are examined for signs of inflammation, damage, and villous atrophy. Samples from different areas of the small intestine are necessary as damage can be patchy and vary in severity. Similar to blood testing, you must be on a gluten-containing diet for an accurate diagnosis. If your test results are negative you may still have non-celiac gluten sensitivity or wheat allergy. Unfortunately, there are no tests currently available to accurately diagnose non-celiac gluten sensitivity. However, you can undergo skin prick and skin patch testing to rule out wheat allergy. 

Gluten Elimination Diet

While clinical testing can help ease your mind, the gold standard for identifying any food intolerance or allergy is an elimination diet. It’s more accurate than any test money can buy! A gluten elimination diet involves removing all gluten-containing foods for a period of 2-6 weeks. 

During this elimination period, you need to closely monitor and continuously record your symptoms, paying close attention to both the intra-intestinal and extra-intestinal signs listed in this article. After a minimum of 2 weeks, you can begin reintroducing gluten-containing food one at a time and watching for a reaction every 24-48 hours. If your symptoms are severe, I suggest following an elimination diet for at least 4 weeks. 

Should you follow a Gluten-Free Diet?

While following a strict gluten-free diet is an absolute must for those with gluten sensitivity or celiac disease, it’s important to understand that you don’t have to be diagnosed to reap the benefits of gluten free eating.  However, I encourage anyone who suspects they have a gluten sensitivity to get screened and to do so before commencing a gluten-free diet to improve the chances of an accurate diagnosis.  Still think that a gluten free diet may just be a fad?  If so, check out our post discussing whether a gluten free diet is healthier than other diets.  Also, if you’ve got a story about going gluten-free, leave a post about it in the comments section, we’d love to hear it!

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