Gluten free is without a doubt, one of the newest “fad diets”, and the issue is being hotly debated in the blogosphere and medical communities alike [1,2]. Gluten free is being criticized as trendy, and as an option for individuals who “just want to lose weight,” or believe that a gluten free diet will make them feel better. “Self-diagnosis” of a gluten sensitivity is common and shunned upon by most of the medical community, even though a diagnosis by exclusion is still the best and only way to diagnose non-celiac gluten sensitivities. The reaction by some when you chose not to eat a particular food group is shock and concern for your health, as if not eating bread will cause you more harm and this concept that you could end up with “severe nutritional deficiencies“. Let’s be clear, so long as you replace the gluten in your diet with healthy alternatives, you are likely not going to “miss out” on any nutrients, which are usually artificially added to wheat, anyway. Check out The Paleo Mom for a great article on the subject here.
When I first became gluten free, you either had biopsy-confirmed celiac disease or it was all in your head. I had the good fortune of having a doctor trained in Greece, who was more a fan of “if it made you feel better, then do it.” I did a rotation diet under his guidance, and discovered a severe sensitivity to wheat, although I was never diagnosed with “celiac disease,” (nor do I have the most commonly recognized susceptibility genes for it).
Initially in the literature, many scientists and practitioners argued if “non-celiac gluten sensitivity” was even a real thing. Apparently, many doctors had experienced people insisting they were sensitive to gluten, without any trace of official celiac disease on their medical records or diagnostic exams. For the last 3-5 years, the health community at large did, and still does to a considerable degree, consider non-celiac gluten sensitivity a fad-diet. Even still, perception and opinion persists among the medical and scientific communities, that if people don’t have “markers” for celiac disease, “there’s no evidence that the protein can do any lasting harm,” and only individuals with biopsy-confirmed celiac disease can benefit from a gluten free diet. There are even some with biopsy-confirmed celiac disease who have grown resentful of the “gluten free craze” and can’t wait for it to end.
Fortunately, very recent literature has done two things for us. In the first case, a study was conducted to determine that individuals with non-celiac gluten sensitivity weren’t just a bunch of liars with personality problems — whew, what a relief!
Secondly, current literature has refuted the fad-hypothesis and identifies non-celiac wheat sensitivity as a distinct clinical condition, which may present as a spectrum of related complications — from migrane to skin rashes to psychosis or depression. What’s more is that wheat/gluten sensitivity looks different in different individuals. Moreover, you’re talking about a patient population of 18 million Americans (compare that to only 100,000 American narcoleptics)
That’s not to say that there are probably people adopting a gluten free diet that don’t necessarily need to. These people are otherwise healthy, are completely gluten tolerant, get no (obvious) positive benefits from removing gluten from their diets and are really getting ripped off by a lot of companies trying to make a buck.
However, there are many ways that gluten can cause ill-effects outside of classical celiac disease. Indeed, gluten sensitivity often lies outside of intestinal pathology, per se, and rather manifests with extra-intestinal symptoms, including neurological issues. Take the case of celiac and non-celiac gluten sensitivity in schizophrenia, for example.
Sleep architecture has also been shown to be impaired in those with celiac disease, but whether these same disturbances occur in “non-celiac” sensitivities are not yet fully reported. Anecdotal evidence would suggest yes. Reports of hypnagogic hallucinations, sleep paralysis, and nightmares are common in people who have discovered an underlying gluten intolerance.
So, how could this be?
Firstly, you can’t find what you aren’t looking for.
It is apparent that non-celiac disease gluten sensitivity is not celiac disease. In that way, if you go looking for classical diagnostic markers of celiac disease, they won’t be there. Does this mean that you aren’t still gluten intolerant or wheat-sensitive? Absolutely not.
At the end of the day, elimination diets are still the clinically best way to determine if you have a non-celiac gluten sensitivity. After you have determined with your doctor that you do not have celiac disease, remove gluten for three weeks. If you feel better after removing it, you are likely sensitive.