Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
5 Sep

How Common is Gluten Sensitivity?

I’ve long suspected that everyone has some degree of sensitivity to gluten, even if they’ve never been formally diagnosed and even if they don’t notice any overt symptoms after eating it. Now we have concrete evidence that non-celiac gluten sensitivity actually exists. My own story was that of a lifetime grain-eater who defended my “right” to eat grains until I was 47 – until the evidence was just too overwhelming to ignore. Once I gave them up as part of a 30-day experiment, lo and behold, my arthritis cleared up, my lifelong IBS went away, and my occasional GERD disappeared. Ditching grains, especially wheat, changed my life for forever and made me understand how easy it is for so many people to overlook this possible problem. A recent study, which I highlighted in Weekend Link Love, confirmed the existence of non-celiac wheat sensitivity. Subjects without the atrophied villi (tiny projects that line the intestines and help absorb nutrients) characteristic of celiac and without positive tests for various markers that indicate celiac experienced gluten-related symptoms after a blinded wheat challenge. It doesn’t give us much of a clue as to the prevalence of sensitivity, but it establishes that such a thing might exist among the general population.

It’s not even the only study. It’s just the latest of many to establish and/or hint that non-celiac gluten sensitivity exists:

But how prevalent is it? We know that celiac disease is on the rise; what about gluten sensitivity?

First, before we get into numbers, let’s go over the difference between celiac and gluten sensitivity:

Celiacs have persistent and profound perforation of the intestinal lining (at least as long as they’re eating gluten) as well as atrophy of the villi, thereby allowing foreign proteins – including, but not limited to, gluten – constant access into the bloodstream and impairing nutrient absorption. Folks with “mere” gluten sensitivity have transient and milder intestinal permeability, or sometimes none at all.

Celiac is an autoimmune disease that inspires the immune system to attack the body’s own tissues, while in gluten sensitivity, the immune attacks are directed solely against components of the diet (gliadin).

Celiac disease seems to involve the “adaptive immune system,” while gluten sensitivity involves activation of the “innate immune system.”

In celiac, the inflammatory cytokine IL-17 is elevated. In gluten sensitivity, it is not.

So gluten sensitivity and celiac disease are two distinct “clinical entities” with the same environmental trigger – gluten – and many of the same symptoms:

  • Diarrhea
  • Bloating
  • Abdominal pain
  • Eczema
  • Headache
  • Foggy brain
  • Fatigue
  • Depression
  • Joint pain
  • Numbness in the extremities

And sometimes the symptoms aren’t obviously connected to gluten (or anything you did or ate). It’s tough to ignore persistent diarrhea that precipitates (pun intended) upon gluten ingestion. That’s an obvious symptom that may clue you in, especially if you’re aware of the potential problems with gluten, you’ve just eaten something containing it, and you’re pondering all this while filling the toilet. But gastrointestinal symptoms don’t always present themselves in gluten sensitivity, as in this study, where 13% of subjects with gluten ataxia (a kind of neuropathy) had no GI symptoms. I mean, who hasn’t felt brain fog from time to time, or been tired in the middle of the day, or had some itchy rashy red skin, or had sore joints before? Most people would never think to link these to the bagel they just ate (ok; you guys might).

Testing for gluten sensitivity is tough because there’s no real standard yet. You’ll notice that the recent study didn’t determine gluten sensitivity solely by running patients’ labs and looking for a certain figure; they had to painstakingly and laboriously eliminate confounding variables (like celiac) through extensive lab testing, and then run a double blind wheat challenge to see if symptoms still arose. That grand, single overarching lab test doesn’t exist, not yet anyway.

Well, that’s not exactly true. There are tests that measure the presence of anti-gliadin IgA (a gliadin antibody) in the blood and in the stool. Antibodies in the blood mean that gliadin made it through the intestinal lining into the blood, where the body mounted a defense against it; antibodies in the stool indicate the presence of antibodies in the gut, where the body has mounted a defense. Gut antibodies, however, come before blood antibodies. For that reason, fecal antibody tests are regarded as more accurate for testing gluten sensitivity, because blood antibodies only show up after significant intestinal damage has allowed gliadin to pass through. You could test positive for fecal antibodies and negative for blood antibodies if your intestinal lining remained fairly intact.

One study found that around 12% of healthy people’s blood samples tested positive for antibodies to IgG. Fecal tests, however, indicate that around 29% of healthy people test positive. If the fecal antibody tests are accurate and reflective of gluten sensitivity, that’s nearly a third of Americans!

There’s also a genetic component to gluten sensitivity and celiac, the HLA-DQ gene. According to some reports, almost every permutation of the HLA-DQ gene is associated with some manner of gluten sensitivity, particularly the haplotypes HLA-DQ2 and HLA-DQ8. Only HLA-DQ4 has never been linked to any form of gluten sensitivity, and less than 1% of the American population possesses a homozygous HLA-DQ4/4. If that holds true, then the vast majority of Americans have the genetic potential toward gluten sensitivity.

Of course, when you consider that everyone – regardless of genetic proclivity toward autoimmunity – releases zonulin, the regulator of intestinal permeability, when our intestinal lining is exposed to gliadin (a component of gluten), a universal response to gluten looks likelier. Sure, we all know plenty of people who can eat a sandwich without complaining, or that guy who claims he could never live without wheat. Gluten and related fragments may be getting through the intestinal lining in these people, but their immune systems mop them up pretty handily before they can do much damage. But what happens if their immune system is impaired, maybe because of a period of chronic stress or overtraining? What happens if their microbiomes are ravaged by antibiotics and poor diet and thereby absent the bacterial species necessary to fully degrade gluten? There’s no clinical trial tracking the effects of usually healthy people undergoing chronic stress or antibiotics on their sensitivity to gluten, but people are stressed, people are overworked, and their guts are messed up. It’s hurting our health in many different ways, and I wouldn’t be surprised if there is a lot more undiagnosed gluten sensitivity out there because of it.

It’s conceivable that gluten could be doing damage and causing constant, low-grade inflammation without you even knowing it. This is why folks who go Primal and give up wheat and other gluten-containing grains become more “sensitive” to wheat upon reintroduction. It’s not that going Primal has suddenly made them intolerant of gluten; it’s likelier that going Primal has made them more sensitive to their gluten sensitivity. It was probably always there, but they never knew what they were feeling until they removed it and then tried to reintroduce it.

As for figuring out if you’re gluten sensitive, I suppose you could go for one of the stool or blood tests provided by EnteroLab or Cyrex Labs (although not everyone is enamored with EnteroLab). But honestly? The gold standard is to just not eat gluten for a few weeks to a month and then reintroduce it and see how you feel. If any strange symptoms pop up (see list above), you’re probably sensitive to gluten. If you want further clarification at this point, then go for the tests. Just try the diet first. It’s gonna be your best (and probably the only necessary) lens.

We don’t have any real solid answers, sadly, just hints. But isn’t that how questions of human physiology tend to play out? It might be 12%, or maybe 30%, or perhaps even a higher (or lower) percentage of the population. Whatever the number, I know that grains don’t serve me well, and they probably aren’t doing you any favors either. So try giving them up for 30 days and seeing how you feel. After all, you aren’t missing out on anything nutritionally by avoiding gluten, except for some potential nasty health issues down the line.

That’s what I’ve got, folks. What do you think? Are you gluten sensitive? Let me know in the comments, and thanks for reading!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I have been eating Primal and GF for over a year now and have experienced so many benefits from the change in diet.

    Just last week my wife and I met our daughter and her husband at a pizza place and as we arrived Joe said that he had ordered me a beer. When it arrived I thought, “Oh, what the hell, it won’t kill me”. It tasted so good I ordered another one. Big mistake. In addition to the bloated feeling I had trouble sleeping that night and for the next couple days I had a continual urgent need to pee, and then when I got to the bathroom, had very little flow. There were a couple times when I almost wet my pants. I recalled that before going Primal I had had intermittent urinary annoyances, but that they had completely cleared up since I had stopped eating grains and started eating Primal. So it only took a couple bottles of beer to trigger it again. It makes me wonder how many people are taking unnecessary drugs for urinary problems that could be cleared up by not eating grains.

    I’d also like to mention that I had been having to take antibiotics several times a year for chronic sinus infections. They seem to have completely gone away.

    And people that I haven’t seen for a while say “Oh, you look so healthy!” (BTW, I’m 64)

    David Bowers wrote on September 6th, 2012
  2. I know for a fact that non celiac gluten intolerance exists. about 3 years ago, on the advice of a CRNP friend I had the ALCAT test done, I was shocked at what I shouldnt be eating. Up till 2 weeks prior to the test I was on thyroid meds, anti depressants, anti acids and daily doses of NSAIDS. I quit cold turkey to do the tests. When I got the results and eliminated my intolerances from my life for 6 months, my eczema disappeared, I no longer needed thyroid meds, anti depressants, anti gas or antiacids. No suprise, a couple of my major intolerances were wheat, grains and CORN. I laugh now when I remember my doctor feeling my gut and telling me it was likely diverticulitis back then. Cut out the grains and everything changed on my insides.

    Kat wrote on September 6th, 2012
  3. Quote search: Wheat doesn’t like humans eating it, so why would it grant us opiate pleasure every time we eat it?

    Read more:

    I’ve heard similar about mushrooms. They try their best to make you all “on Lakeshore Drive” But humans are one of the few species that will actually seek something out because of a novel defense mechanism.

    Kelekona wrote on September 6th, 2012
  4. I haven’t read the pages & pages of comments, & congrats to anyone who reads all the way to mine. :-) But I just want to mention that the amount of gluten sensitivity in the USA has skyrocketed since the introduction of genetically engineered wheat flooding the market in the 1980s here. If you have ANY extra time or money, no matter where you live, you can volunteer to help or donate agains the millions Monsanto, Dow, etc. are spending to defeat a GMO labeling law in California in November. Remember, what goes in Cali WILL affect~maybe even determine~what Monsanto et all can get away with in the rest of the country. PLEASE support Yes on 37! This is SUPER meaningful to Primal eaters! Here is the website.

    Elizabeth wrote on September 6th, 2012
  5. I’ve taken a celiac test and its come back negative, but I know I have issues with wheat. After 30 minutes of ingestion, it feels like someone has sucker punched my stomach, intense gas begins and almost exactly 24 hours later after consuming, I get a sickening migrane. Going primal has been much easier on my grocery bill (I can’t afford the $6 gluten free breads) and much easier on my stomach.

    Primal Buddhette wrote on September 6th, 2012
  6. I just read this article and I am amazed. I did not know that everyone might have some sensitivity to gluten. I personally believe that I rely too much on gluten based products and I am willing to try this diet. I will definitely link my results to this amazing blog! Again thanks for a great article!

    Sid wrote on September 6th, 2012
  7. Hello,
    I had dandruff for the last 3 years before going paleo. When I started the diet, after 3 days with no gluten, it was gone. On a paleo diet for the last 8 months (went from almost narcoleptic to full of energy in 3 weeks), each time I have dandruff coming back, I can relate it to a accidental exposure to gluten and need 3 to 4 days to get rid of it.
    Is dandruff a known sign of gluten sensitivity ? Is there anyone else having this symptome when exposed to gluten ?

    Arzur wrote on September 6th, 2012
    • Me too. It´s the wierdest thing. I never would have connected the dots before getting off wheat.
      But there you have it. Along with no knee pain, down over 50 pounds, no more depression, no more dry skin, vastly improved sleep and on it goes.
      To me wheat is a bloody posion.

      Elena wrote on September 7th, 2012
  8. Last October, I stopped all grains. Since then, I wake up without “fog brain”. I am alert and ready to go. I had severe osteo arthritis since my late twenties and it was crippling in my feet. I made myself walk despite the pain. Since that time, I am pain free in my hips, knees,ankles and feet.I also have no more irritable bowel syndrome or diarhea. I don’t know why this seems to be related, but it would be worth further study. I also limit dairy and legumes. I am a fifty something. I’ve never had more energy than this. I eat a specific ratio of protein, good fats, veggies, and carb. With such good health benefits, why not try it and see how your body feels as Mark suggests.

    vmpenny1 wrote on September 6th, 2012
  9. I started becoming more gluten sensitive when I was pregnant last year (it’s apparently not uncommon). Hence I really cleaned up my act to about 75% Primal, having gluten maybe twice a week – any more than that and I started to really feel it. After I gave birth, though, the gluten started slowly creeping back in. Well, until last week. A bout of food poisoning (homemade applesauce was growing fuzz) seems to have rendered me both lactose and gluten sensitive, literally overnight. I’m not 100% whether it’s one or both, since I stopped them both as soon as I realised they were the cause of my continued lurgy. Tonight’s dinner of chicken soup with barley should help answer that question.

    I asked Dr Google what was going on there (I didn’t have cancer! Bonus!) and discovered that a sudden onset of gluten sensitivity and lactose intolerance after food poisoning is much more common than most people realise. Hopefully once I’ve been off the gluten for a few months I can slowly reintroduce dairy – I’ll be a very unhappy chappy without the option of raw cream on my blueberries. :-(

    Phoenix wrote on September 7th, 2012
  10. I want to say how pleased I am that I tried gluten free Paleo diet. My husband has tried to get me to try it for a few years now & I resisted. But, since I started this journey in June my migraines are almost gone. I still have a few but, I was starting have them almost everyday. My migraine medicine is very expensive. (my insurance doesn’t cover my medicine) I have also lost 22 pounds so far. My son thinks I am crazy he thinks gluten free is for people with Celiac Disease & I have told him I don’t care it must be working for me if I am not having migraines. All I know is I am happy to be gluten free!

    Tanya wrote on September 7th, 2012
  11. Great article, but test for celiac before trying the gluten elimination.

    NoGlutenEver wrote on September 7th, 2012
  12. I had a stool test done and it indicated to avoid all gluten etc. so went and had a upper and lower GI done and it didn’t show Celiac, and unfortunately that’s all the doctor was concerned about. But I do find when I avoid wheat/gluten I perform and feel much better, less brainfog! but I thik if the doc would of “diagnosed” me celiac I’d be more diligent, It’s a mental thing!

    Maria wrote on September 7th, 2012
  13. There is another symptom caused by eating wheat….itchy butt! I had itchy butt so bad I went to the doctor. How embarrasing! He couldnt find anything wrong and then later, after about a week of grain free itchy butt went away. I seem to have a threshold of how much grain I can eat before IB returns. I know a couple of people who have confided to me about itchy butt and I tell them to 86 the grains.


    Bobbie wrote on September 7th, 2012
  14. The one thing I’m sure of is that no one diet is right for everyone. EveryBODY is different.

    I’ve been off gluten (as well as soy, dairy, oil, sugar and raw) for a year, trying to address a long-time problem: urgent diarrhea first thing in the morning (I generally feel fine the rest of the day and have no other symptoms.) Doctors suspect gluten sensitivity leading to a weakened ability to digest fats. But all sorts of other things trigger episodes too, and I’m never exactly sure what’s to blame. Anyone else in the same boat?

    Laura wrote on September 7th, 2012
  15. I just read Wheat Belly too…so this is perfect timing. I grew up with asthma for no real known reason. Played sports and “outgrew” the asthma as doctors said I would. What came next? Eczema…the skin related cousin of asthma (genetic). So I dealt with ugly and often embarrassing eczema on the hands and feet for many many years. Only treatable by cortisone based creams I was told. Tired of the itching and flare ups, I tried alternative methods and that worked okay. Pulled myself off wheat 45 days ago (had a rare slice of pizza and still enjoy a beer)..,Amazing how the symptoms have cleared, my energy level has vastly improved, and I feel way better. #nowheat

    Patrick wrote on September 7th, 2012
  16. Great stuff as usual Mark! Thanks!

    Chris wrote on September 7th, 2012
  17. Add myself and my wife to the list of vastly improved health and well-being since going gluten-free.

    Matthew Hampton wrote on September 7th, 2012
  18. Going gluten free did alleviate my symptoms for sure. Back then, to me, that was proof that gluten is inherently evil.

    However, as I researched more about health and different ways you can become reactive to foods (other than the usual “it’s all in your gut health!”), I started to correct those imbalances (which was much simpler than removing all gluten forever or doing crazy things to heal my gut)

    I looked more into raising my metabolism (i.e. body temperature) which has made life so much easier for me. All the things I attributed to bad gut health and wheat were pretty much eradicated.

    I don’t recommend eating wheat at all, but I don’t go out of my way to avoid wheat and gluten. Going out and eating whatever ONCE IN A WHILE is something I love doing, though. It’s nice to know that it won’t destroy me anymore, either.

    My 2 cents.

    Kamran wrote on September 9th, 2012
  19. I had severe Rheumatoid Arthritis, esp. in my hands and hips/knees. MRI’s confirmed degenerative changes in my gnarled hands. Was barely walking with a cane. Was taking Methotrexate (chemo) & narcotic pain pills daily. Went gluten-free and within a few days was walking easily & w/out pain – 1 mile walk around the park…NO PROBLEM. Hands didn’t hurt any more. After many months gluten-free & off all pills for RA, my Rheumatologist redid the MRI’s of my hands and found HEALING of my joints (according to Dr, this just does NOT happen). Was discharged from the Rheumatologist and haven’t looked back since. Okay, well, I’ve had an accidental exposure to wheat/gluten here and there, resulting in pain in my hands and joints, sometimes for 3-4 weeks after. Boy, am I more vigilant now about checking EVERYTHING that goes in my body! If you suffer from any kind of auto-immune symptoms, I highly encourage you try going gluten-free. It requires diligence, but gets easier & easier the longer you adhere.

    Sil wrote on September 9th, 2012
    • That is very encouraging seeing I have rhuematoid arthritis. I have noticed I feel so much better when I ditch the stuff. Awesome!!!

      Kevin wrote on October 16th, 2012
  20. Growing up in a province, in Canada, whose licence plates proclaimed, “Wheat Province” quite proudly, makes it difficult to now leave the stuff alone. It is ingrained very deeply, despite the symptoms I have lived with my entire life. My mother told me I was born covered in exzema, I underwent allergy skin tests at a young age, suffer from asthma, and even had an operation called “draining the antrums” when I was 5. The doctors said I would have to repeat this procedure every five years. (This was in 1948) Never had it again.
    I had stomach cramps and bloating constantly, but never seriously considered wheat until I read “Wheatbelly.” Even though I feel much better when I avoid the grain, I frequently find myself in the bakery department, often taking home something from the day-old discount table. (I’m also a cheapskate) Dr. Davis talked about wheat’s ability to hit the same receptors in the brain as opium, and I believe that is why I can’t resist. I’m not trying to make excuses, but the foods look, smell and taste (for the first few bites) great, but within a few minutes, the negative reactions begin.

    Barrie Templeton wrote on September 9th, 2012
  21. When you’re advocating going off wheat for a month, or indeed giving it up altogether if reintroducing it brings symptoms, how hard-core are we talking? I lived for five years with a coeliac who was sensitive to the smallest crumb. It looks like a hard life to live. Do you think that people who suspect a gluten sensitivity should go to the same lengths?

    saoili wrote on September 10th, 2012
  22. About 15 years ago a chiropractor put me on a cleansing fast for 3 weeks to “cure” my allergies and asthma. List of foods allowed were mostly fruits and veggies (but no citrus fruits or nightshade veggies). No meats, processed foods, grains, dairy. After 2 days on the fast, my allergies, asthma, excema and intestinal troubles all cleared up.

    I became a believer that what we eat drectly impacts the imflammation in our body and we can cure ourselves by changing what we eat.

    When I added foods in after the fast, my two biggest triggers were dairy and gluten.

    Since then I have been allergy and asthma free and a host of other ailments have righted themselves.

    Mary wrote on September 11th, 2012
  23. I started seeing a naturopath after irregular (but too frequent for my liking) severe abdominal cramps. Followed the recommendation of removing gluten and dairy. No cramps since…except that one time when I ate something that I wasn’t 100% positive was gluten-free.

    I initially wanted to re-introduce gluten (life is easier when you don’t have to think about what you can’t eat), but after accidentally eating a little and having the same pain immediately return, I’m now completely happy leaving gluten out of my life (but I do crave good bread).

    Lauren wrote on September 11th, 2012
  24. I just returned from Burning Man and while prior to that was more or less 85% primal, I was definitely 100% on the playa. Not only did I lose weight, and lots of water, I also lost my bloat. I was diagnosed with Cholera while in India 5 years ago and it’s been very difficult to lose weight and the bloat. Upon returning to the “real” world I reintroduced a croissant 3 mornings in a row with an americano, and a plate of pasta for lunch yesterday. Low and behold – this afternoon a brain fog hit so hard I thought I was going to pass out – and the bloat returned. For me, it takes a certain amount of gluton to build up in my system, and time, before I react. I really get my sensitivity now. p.s. Thank you, Mark, for your incredibly detailed informative blog – been reading it for about 8 months now and I’m finally starting to heal.

    Bryan Melillo wrote on September 11th, 2012
  25. You are right that people can develop a wheat sensitivity, even though they test negative for Celiac disease. I am a medical provider, and have experienced the same problem for several years, as well as all of the same symptoms. Except, I became sensitive to other foods as well (corn, milk, animals fed grains, etc). With much research, I learned about the problem of dysbiosis of the gut, and knew that my problem (wheat sensitivity, IBS, inflammatory symptoms, etc) originated from that. Based on my research, there is a reason why people develop wheat sensitivity; and our high carb, high sugar diets, have a lot to do with it. I sought treatment from my primary care physician and a gastroenterologist, but both were limited in their knowledge. After many expensive tests, they could not tell my why my problem existed nor how to resolve it. I ended up going to a physician, specializing in functional medicine, who was able to do tests which revealed I had a significant overgrowth of intestinal candida, as well as a very low level of healthy gut flora. The candida had taken over, and caused leaky gut syndrome. With aggressive treatment, and a strict candida diet, I am on my way to recovery. In a year or two, once my intestines heal, I hope to be able to include some wheat on my diet again. I recommend that you do some further research into your medical condition. Giving up wheat can help for a short time, but if your problem stems from an overgrowth of candida, then other grains and sugars will also become a problem, and your symptoms will flare up again despite removing wheat from your diet. Best wishes, Karen

    Karen wrote on September 12th, 2012
  26. I suffered from chronic sinus infections, blocked ears, post nasal drip, and coughing for YEARS. Even had surgery. Quit the gluten and it ALL cleared up in2 weeks. Hadnt breathed so well ever! Now if i have a small cheat, I’m stuffy and coughing within hours. Eat it all day and it takes several weeks to recover from the sinus infection.

    rebecca wrote on September 13th, 2012
  27. Grains make my skin break out, too, is there anyone experiencing the same? Maybe it could be added to the list of symptoms?

    Anna wrote on September 13th, 2012
  28. I went primal for one month – wow!!! My IBS is gone, the burping, gas, diarrhea, stomach pain, bloating – all gone! Since I’ve had my galbladder out in 2007, I’ve never felt right and now I do. Now I’m off the meds and feel great! Thanks for the enlightenment!!!

    Sandy wrote on September 13th, 2012

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