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July 15th, 2011
07:42 AM ET

Are there degrees of gluten sensitivity?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Friday, it's Dr. Melina Jampolis, a physician nutrition specialist.

Question asked by Sue R. of Oakland, California

I know that I'm sensitive to carbs but I wanted to know how sensitive I was to gluten. I had a test taken by a nutritionist, and it came out positive. So I wanted to get tested by an official M.D., which I did. He tested me for celiac disease, even though I told him I didn't have it. He didn't understand when I told him that gluten sensitivity has different degrees of impact. Was I misinformed? I always thought it was a spectrum.

Expert answer:

Hi Sue! Several people asked me about gluten sensitivity after I mentioned it in my response on celiac disease several weeks ago, so I thought this would be a good time to expand further on this less well-known and much less well-defined condition.

To get the most up to date and comprehensive information, I spoke with an expert in the field, Dr. Joseph Murray, professor of medicine and consultant in gastroenterology and immunology at the Mayo Clinic in Rochester Minnesota.

Murray explained that gluten sensitivity is a real entity and most likely represents more than one clinical condition.

The first is a condition that probably falls under the heading of gluten sensitivity Murray refers to as "celiac lite," meaning that a person may or may not have antibodies in the blood characteristic of celiac disease, does not have the intestinal damage seen in celiac disease (intestinal damage can be confirmed only by biopsy - taking a small piece of the lining of your intestine), but does have symptoms including abdominal pain, bloating, gas and diarrhea and does benefit in terms of symptoms from following a gluten free diet.

The second group of patients, categorized as having nonceliac gluten sensitivity, have the same symptoms of abdominal pain, bloating, gas and diarrhea, but do not have antibodies or the genetic predisposition for celiac disease.

[An earlier version of this post incorrectly said this group of patients do have antibodies or the genetic predisposition for celiac disease.]

They are often told they have irritable bowel syndrome, but their symptoms improve on a gluten free diet (generally within one month).

A recent double blind, placebo controlled Australian study published in the American Journal of Gastroenterology strongly suggested the presence of this form of nonceliac gluten sensitivity or intolerance, but was unable to determine the cause.

So assuming that celiac disease has been ruled out by your doctor (antibodies to the protein TTG are the most accurate, according to Murray) and depending on your symptoms, you may have gluten sensitivity. There is no reliable test to diagnose gluten sensitivity, according to Murray, so whatever your nutritionist ordered is not medically approved.

If your symptoms resolve after one month on a gluten free diet, and the diet does not stop working several months later, this is probably the case and you should do your best to follow a gluten free diet long-term.

One thing to consider is that many people feel better on a gluten free diet because they are eating less food overall (due to fewer choices) and cutting out most sources of refined grains, both of which are a good idea even if you don't have gluten issues.

Your "sensitivity" to carbs may also relate to blood sugar fluctuations and insulin resistance, both of which can improve by reducing total and particularly refined grain intake.

Follow Dr. Melina on Twitter.


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