Diagnosing Gluten Intolerance

femaly patient talking with her doctor

While Celiac disease and wheat allergies are relatively easy to diagnose, many doctors still struggle to identify patients suffering from gluten intolerance accurately. Some patients experience gastrointestinal symptoms and other complaints when they consume foods containing gluten, one of the proteins found in wheat and some other grains, but they don't have the signs of Celiac or allergies. This tricky disorder is emerging as a legitimate diagnosis in the medical community, but eliminating the placebo effect, or the patient's perceived improvement, can be challenging.

A New Algorithm for Diagnosing Gluten Intolerance

In 2012, the journal BMC Medicine published a new algorithm for diagnosing gluten sensitivity as a separate disorder from Celiac disease and wheat allergy. The new algorithm is based on the consensus of 15 experts in the field of immunology and gastroenterology. If you are experiencing the symptoms of gluten intolerance, which include gastrointestinal discomfort, headaches, joint aches, and other complaints, your doctor may use the algorithm to diagnose you.

According to the BMC Medicine article, this is the procedure for diagnosing gluten sensitivity.

Examine Patient and Take a History

First, your doctor will give you a physical examination and listen to your symptoms. He or she will ask about your current and previous health conditions. Specifically, your doctor will be trying to determine whether your symptoms come on suddenly after you've eaten a wheat product or if they are more gradual and happen hours or days after your meal.

Rule Out Wheat Allergy

Next, your doctor will rule out a wheat allergy. If your symptoms happen soon after eating gluten, this can signal a histamine reaction. Your doctor may use allergy skin prick testing to see if your react to wheat. He or she may also draw blood to check for certain substances that can indicate a wheat allergy.

Rule Out Celiac Disease

After your doctor has determined that you don't have a wheat allergy, he or she will need to rule out Celiac disease. To do this, your doctor will draw blood and check for serum levels that signal Celiac. If those levels are present, you'll undergo further testing to check the condition of your intestines.

Perform a Double-Blind Gluten Challenge

If you don't have Celiac or a wheat allergy, your doctor will check to see if you are sensitive to gluten. To do this, you'll be asked to eliminate all gluten from your diet for a while. Then your doctor will have you eat certain foods. Neither you nor your doctor will know whether these foods contain gluten. You'll record any symptoms you experience after eating the test foods. Then you and your doctor will meet to examine the results. If you reacted to the gluten, you'll be diagnosed with gluten intolerance. If you didn't, your doctor will continue working with you to find the source of your symptoms.

Does Your Doctor Use this Approach?

There's a great deal of controversy about the existence of gluten sensitivity. In fact, the BMC Medicine article is one of the first to state unequivocally that this disorder exists. If your doctor does not believe in the existence of gluten intolerance or does not agree with this approach, he or she may try a different process to diagnose you. It's important to keep an open mind and listen to your doctor's reasoning about this.

However, if you feel certain that you have a gluten intolerance and your doctor does not believe this condition exists, you can get a second opinion from a doctor who might use a different diagnostic approach.

Self-Diagnosing Gluten Sensitivity

Always talk to your doctor if you feel you're reacting to gluten. Wheat allergies are potentially life threatening, and Celiac disease can cause serious damage to your intestines. You'll need a doctor to rule out both of these conditions before you attempt to diagnose a gluten sensitivity.

If, after ruling out Celiac and wheat intolerance, you can't find a doctor who will take your concerns seriously, you can try a gluten elimination diet at home to see if it helps to improve your symptoms. It's important to remember that this is not an official diagnosis; you'll need to work with a health professional to obtain that. However, this process can help you get answers about your condition. Here's how to do it:

  1. Eliminate all gluten from your diet, while still ensuring that your meals are balanced and healthy. Remain gluten-free for at least a month.
  2. Eat a food that contains a large amount of gluten. If possible, have someone else feed you something with gluten when you don't expect it so you can avoid a placebo effect. Record your symptoms in a food journal.
  3. Repeat this process with a number of different foods.
  4. Review your food journal to see if there is a trend that indicates gluten intolerance.

Change Your Diet

Once your gluten intolerance is diagnosed, you can change your diet to avoid this protein. In many cases, symptoms improve dramatically, and with all the tasty gluten-free foods available, you'll hardly miss the wheat protein that's been causing you trouble.

Diagnosing Gluten Intolerance