Title
Subscribe to the Magazine for free
Subscribe for free to keep reading! If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.

5 Lab Tests You Need To Know About if You Want to Test for Gluten Sensitivity

Why This Was Updated?

Our specialists regularly review advancements in health and wellness, ensuring our articles are updated with the newest information as it becomes accessible.
Medically Reviewed by

Gluten sensitivity is the most common gluten-related ailment, affecting up to 13% of the general population. Symptoms of gluten sensitivity are very similar to irritable bowel syndrome, celiac disease, and wheat allergy; however, it is its own distinct medical diagnosis. The lack of conventional diagnostic markers makes diagnosis difficult, leaving many without a diagnosis or solution to their symptoms. (2)

This article will discuss gluten sensitivity, a functional medicine approach to evaluation and diagnosis, and commonly implemented, evidence-based natural modalities that can be used for its treatment.

[signup]

What is Gluten?

Gluten proteins are stored in the endosperm of wheat and related grains. The three main naturally gluten-containing grains are wheat, barley, and rye. Other gluten-containing wheat derivates include wheatberries, spelt, and farro. 

Wheat gluten is composed of gliadin and glutenin. Gliadin is the protein fraction responsible for most adverse health effects associated with gluten. 

Although some grains do not contain gluten, they have proteins that appear and act very similarly to gluten in the body (referred to as "cross-reactivity"). The avenin protein found in oats is the most notorious of these; it is the reason some people with gluten-related disorders cannot tolerate oats in their diet.

What is Gluten Sensitivity?

Gluten sensitivity, non-celiac gluten sensitivity (NCGS), and gluten intolerance all refer to the same digestive disorder. Gluten sensitivity is the presence of intestinal and/or extraintestinal symptoms after consuming gluten. These individuals do not have celiac disease or wheat allergy but experience symptomatic improvement when gluten is eliminated from their diet. (1, 2)

NCGS is recognized as less severe than celiac disease because it does not induce the same extent of small intestinal erosion and inflammation, leading to malabsorption and malnutrition, as celiac disease. However, there is research to support that gluten exposure does cause small intestinal morphological changes, immune activation, and increased intestinal permeability in patients with NCGS (5, 6).

Gluten sensitivity is a clinically distinct medical diagnosis from celiac disease and wheat allergy. For NCGS to be diagnosed, celiac disease and wheat allergy must be ruled out. Celiac disease is an autoimmune disease that results in inflammation and damage to the small intestine after consuming gluten. Celiac disease is diagnosed by key cellular morphological changes on small intestinal biopsy, and serological testing usually confirms the presence of celiac-associated autoantibodies. Wheat allergy is an immune-mediated allergic response by which the consumption of wheat results in allergic symptoms, including hives, rash, swelling of the skin, shortness of breath, wheezing, and swelling of the airways. Wheat allergy is confirmed by measuring IgE antibodies specific to wheat by skin prick or blood testing. (3, 4)

Gluten Sensitivity Symptoms

Gluten sensitivity most commonly triggers gastrointestinal (GI) symptoms after consuming gluten-containing foods. Symptoms related to gluten sensitivity can occur hours to days after consumption of the trigger food. Bloating, abdominal pain, diarrhea, nausea, and reflux are reported to be the most common GI symptoms. (7)

Gluten sensitivity can cause non-digestive symptoms, as well. Extraintestinal symptoms can vary widely, including headache, fatigue, brain fog, muscle and joint pain, skin rash, and depression. (7)

Top 5 Functional Medicine Tests for Gluten Sensitivity

While there are a multitude of tests available, here are the top 5 tests that functional medicine providers order for gluten sensitivity:

Celiac Disease

Celiac disease must be ruled out before making a diagnosis of gluten sensitivity. The gold standard for celiac disease diagnosis is a small intestinal biopsy for visual confirmation of small intestinal damage and inflammation. Histological villous atrophy is the characteristic diagnostic feature of celiac disease. (8)

Given this procedure's invasiveness, serological testing while the patient is consuming a gluten-containing diet is often recommended. The American College of Gastroenterology recommends using immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody as first-line screening (8). Functional medicine doctors often order a more comprehensive antibody panel, which includes IgA and immunoglobulin G (IgG) antibodies to TTG, endomysium, and deamidated gliadin peptide.

Wheat Allergy

A blood test negative for wheat IgE antibodies can rule out wheat allergy before diagnosing gluten sensitivity (4). 

Gluten Sensitivity

There are no conventional biomarkers for NCGS, allowing many cases to go undiagnosed in the allopathic setting (2). Specialty blood panels measuring antibodies and the immune response to various wheat- and gluten-related proteins help to measure the exact level of gluten reactivity and allow for better recognition of gluten sensitivity.

Gluten Cross-Reactivity

The Cyrex Array 4 panel identifies food sensitivities to foods that frequently cross-react with gluten-containing foods. This panel can be helpful for patients beginning to implement dietary modifications or who continue to experience NCGS-like symptoms despite eating a gluten-free diet.

Comprehensive Stool Testing

NCGS has been documented to trigger dysbiosis within the gut microbiome. Dysbiosis can further exacerbate intestinal inflammation and GI symptoms, increasing the severity of NCGS. A comprehensive stool test assesses the gut microbiome, along with measuring other markers of digestion and inflammation, for an extensive gut-health evaluation.

Other Lab Tests to Check 

Due to a phenomenon called molecular mimicry, gluten sensitivity and autoimmune thyroid disease are highly correlated. A comprehensive thyroid panel, measuring multiple markers of thyroid function and autoimmunity, can screen for thyroid autoimmunity and hypothyroidism caused by gluten sensitivity.

Integrative Medicine Treatment for Gluten Sensitivity

Functional medicine practitioners utilize the information they gain from the lab tests and create thorough treatment plans that may consist of the following:

Nutrition for Gluten Sensitivity

First-line therapy with patients with gluten sensitivity is to remove food sensitivities: gluten-containing foods and any identified cross-reactive foods. Strict adherence to a gluten-free diet (GFD) is recommended for at least one year for patients with gluten sensitivity. It is debated whether patients with NCGS require a life-long GFD. While some continue to have wheat triggers after up to eight years of dietary restrictions, evidence suggests many patients have gluten-tolerance thresholds and can reintroduce gluten into the diet in small amounts. (1, 7

Additionally, some patients with gluten sensitivity may benefit from reducing the consumption of high-FODMAP foods. A low FODMAP diet aims to reduce certain types of carbohydrates (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) from the diet. Research suggests a low FODMAP diet can further reduce GI symptoms in patients with NCGS and wheat-sensitive irritable bowel syndrome.

Supplements & Herbs for Gluten Sensitivity 

Endopeptidases, digestive enzymes specific to breaking down gluten proteins, effectively support the digestion of gluten and reduce its immunotoxic effects in sensitive patients. These digestive enzymes are effective at digesting small amounts of gluten in cases of accidental exposure but should not replace a GFD. (9)

Supporting a healthy gut microbiome and correcting dysbiosis is essential in treating NCGS and maintaining overall gut health. The gut microbiota can contribute to NCGS by controlling the digestion of gluten proteins, modulating intestinal permeability, and regulating pro-inflammatory immune responses. Probiotics containing Lactobacillus spp., Bifidobacterium spp., and Saccharomyces boulardii have been shown to reduce intestinal inflammation and promote the digestion of gluten in gluten-sensitive patients. (9)

Utilizing nutritional supplements and herbs to repair the small intestinal barrier once gluten has been eliminated from the diet can speed up the healing of a leaky gut caused by gluten exposure. L-glutamine, zinc carnosine, and demulcent herbs (e.g., aloe, deglycyrrhizinated licorice, and marshmallow) are routinely recommended by functional providers for gut-healing protocols.

Summary

Gluten sensitivity is a type of adverse food reaction to gluten-containing foods, distinct from celiac disease and wheat allergy. Because conventional biomarkers are unavailable to diagnose gluten sensitivity, it often goes undiagnosed, causing many debilitating digestive and extraintestinal symptoms similar to celiac disease. Functional lab panels can assist in the diagnosis of gluten sensitivity and the identification of cross-reactive foods causing symptoms. A gluten-free diet and nutritional supplements to improve gluten tolerance and heal leaky gut are often recommended by functional medicine doctors to treat gluten sensitivity. 

Gluten sensitivity is a common gluten-related condition, affecting a significant portion of the population. Symptoms of gluten sensitivity can be similar to those of irritable bowel syndrome, celiac disease, and wheat allergy; however, it is recognized as a distinct condition. The lack of conventional diagnostic markers makes diagnosis challenging, leaving many without a clear diagnosis or solution to their symptoms. (2)

This article will discuss gluten sensitivity, a functional medicine approach to evaluation and diagnosis, and commonly implemented, evidence-based natural strategies that may be used to support individuals with this condition.

[signup]

What is Gluten?

Gluten proteins are stored in the endosperm of wheat and related grains. The three main naturally gluten-containing grains are wheat, barley, and rye. Other gluten-containing wheat derivatives include wheatberries, spelt, and farro. 

Wheat gluten is composed of gliadin and glutenin. Gliadin is the protein fraction often associated with adverse reactions to gluten. 

Although some grains do not contain gluten, they have proteins that appear and act very similarly to gluten in the body (referred to as "cross-reactivity"). The avenin protein found in oats is one of these; it is the reason some people with gluten-related disorders may not tolerate oats in their diet.

What is Gluten Sensitivity?

Gluten sensitivity, non-celiac gluten sensitivity (NCGS), and gluten intolerance all refer to the same digestive condition. Gluten sensitivity involves the presence of intestinal and/or extraintestinal symptoms after consuming gluten. These individuals do not have celiac disease or wheat allergy but may experience symptomatic improvement when gluten is reduced or eliminated from their diet. (1, 2)

NCGS is considered less severe than celiac disease because it does not typically cause the same extent of small intestinal damage and inflammation. However, some research suggests that gluten exposure may lead to small intestinal changes and increased intestinal permeability in individuals with NCGS (5, 6).

Gluten sensitivity is a distinct condition from celiac disease and wheat allergy. For NCGS to be considered, celiac disease and wheat allergy must be ruled out. Celiac disease is an autoimmune condition that results in inflammation and damage to the small intestine after consuming gluten. Celiac disease is diagnosed by key cellular changes on small intestinal biopsy, and serological testing usually confirms the presence of celiac-associated autoantibodies. Wheat allergy is an immune-mediated allergic response by which the consumption of wheat results in allergic symptoms, including hives, rash, swelling of the skin, shortness of breath, wheezing, and swelling of the airways. Wheat allergy is confirmed by measuring IgE antibodies specific to wheat by skin prick or blood testing. (3, 4)

Gluten Sensitivity Symptoms

Gluten sensitivity may trigger gastrointestinal (GI) symptoms after consuming gluten-containing foods. Symptoms related to gluten sensitivity can occur hours to days after consumption of the trigger food. Bloating, abdominal pain, diarrhea, nausea, and reflux are reported to be common GI symptoms. (7)

Gluten sensitivity can also be associated with non-digestive symptoms. Extraintestinal symptoms can vary widely, including headache, fatigue, brain fog, muscle and joint pain, skin rash, and mood changes. (7)

Top 5 Functional Medicine Tests for Gluten Sensitivity

While there are many tests available, here are the top 5 tests that functional medicine providers may consider for gluten sensitivity:

Celiac Disease

Celiac disease must be ruled out before considering a diagnosis of gluten sensitivity. The gold standard for celiac disease diagnosis is a small intestinal biopsy for visual confirmation of small intestinal damage and inflammation. Histological villous atrophy is the characteristic diagnostic feature of celiac disease. (8)

Given this procedure's invasiveness, serological testing while the patient is consuming a gluten-containing diet is often recommended. The American College of Gastroenterology recommends using immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody as first-line screening (8). Functional medicine doctors may order a more comprehensive antibody panel, which includes IgA and immunoglobulin G (IgG) antibodies to TTG, endomysium, and deamidated gliadin peptide.

Wheat Allergy

A blood test negative for wheat IgE antibodies can help rule out wheat allergy before considering gluten sensitivity (4). 

Gluten Sensitivity

There are no conventional biomarkers for NCGS, allowing many cases to go undiagnosed in the allopathic setting (2). Specialty blood panels measuring antibodies and the immune response to various wheat- and gluten-related proteins may help to assess gluten reactivity and allow for better recognition of gluten sensitivity.

Gluten Cross-Reactivity

The Cyrex Array 4 panel identifies food sensitivities to foods that frequently cross-react with gluten-containing foods. This panel can be helpful for patients beginning to implement dietary modifications or who continue to experience NCGS-like symptoms despite eating a gluten-free diet.

Comprehensive Stool Testing

NCGS has been documented to be associated with dysbiosis within the gut microbiome. Dysbiosis can further exacerbate intestinal inflammation and GI symptoms, potentially increasing the severity of NCGS. A comprehensive stool test assesses the gut microbiome, along with measuring other markers of digestion and inflammation, for an extensive gut-health evaluation.

Other Lab Tests to Check 

Due to a phenomenon called molecular mimicry, gluten sensitivity and autoimmune thyroid disease are often discussed together. A comprehensive thyroid panel, measuring multiple markers of thyroid function and autoimmunity, can screen for thyroid autoimmunity and hypothyroidism in individuals with gluten sensitivity.

Integrative Medicine Approaches for Gluten Sensitivity

Functional medicine practitioners utilize the information they gain from the lab tests and create thorough plans that may consist of the following:

Nutrition for Gluten Sensitivity

First-line strategies for individuals with gluten sensitivity often involve reducing food sensitivities: gluten-containing foods and any identified cross-reactive foods. A gluten-free diet (GFD) is often suggested for a period of time for individuals with gluten sensitivity. It is debated whether individuals with NCGS require a life-long GFD. While some continue to have wheat triggers after several years of dietary changes, evidence suggests many individuals have gluten-tolerance thresholds and may reintroduce gluten into the diet in small amounts. (1, 7

Additionally, some individuals with gluten sensitivity may benefit from reducing the consumption of high-FODMAP foods. A low FODMAP diet aims to reduce certain types of carbohydrates (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) from the diet. Research suggests a low FODMAP diet may help reduce GI symptoms in individuals with NCGS and wheat-sensitive irritable bowel syndrome.

Supplements & Herbs for Gluten Sensitivity 

Endopeptidases, digestive enzymes specific to breaking down gluten proteins, may support the digestion of gluten and help reduce its effects in sensitive individuals. These digestive enzymes may assist in digesting small amounts of gluten in cases of accidental exposure but should not replace a GFD. (9)

Supporting a healthy gut microbiome and addressing dysbiosis may be beneficial in managing NCGS and maintaining overall gut health. The gut microbiota can influence the digestion of gluten proteins, modulate intestinal permeability, and regulate immune responses. Probiotics containing Lactobacillus spp., Bifidobacterium spp., and Saccharomyces boulardii have been shown to support intestinal health and may aid in the digestion of gluten in gluten-sensitive individuals. (9)

Utilizing nutritional supplements and herbs to support the small intestinal barrier once gluten has been reduced or eliminated from the diet may help in maintaining gut health. L-glutamine, zinc carnosine, and demulcent herbs (e.g., aloe, deglycyrrhizinated licorice, and marshmallow) are sometimes suggested by functional providers for gut-support protocols.

Summary

Gluten sensitivity is a type of adverse reaction to gluten-containing foods, distinct from celiac disease and wheat allergy. Because conventional biomarkers are unavailable to diagnose gluten sensitivity, it often goes undiagnosed, causing many challenging digestive and extraintestinal symptoms similar to celiac disease. Functional lab panels may assist in the recognition of gluten sensitivity and the identification of cross-reactive foods. A gluten-free diet and nutritional supplements to support gluten tolerance and gut health are often suggested by functional medicine practitioners to help manage gluten sensitivity. 

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
Learn More
No items found.

Lab Tests in This Article

1. Non-Celiac Gluten Sensitivity. (2022, May 12). Beyond Celiac. https://www.beyondceliac.org/celiac-disease/non-celiac-gluten-sensitivity/

2. Akhondi, H., & Ross, A.B. (2022). Gluten Associated Medical Problems. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538505/

3. Posner, E.B., & Haseeb, M. (2022). Celiac Disease. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441900/ 

4. Patel, N., & Samant, H. (2023). Wheat Allergy. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK536992 

5. Uhde, M., Ajamian, M., Caio, G., et al. (2016). Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut, 65(12), 1930–1937. https://doi.org/10.1136/gutjnl-2016-311964

6. Rostami, K., Ensari, A., Marsh, M., et al. (2022). Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study. Nutrients, 14(12), 2487. https://doi.org/10.3390/nu14122487

7. Cárdenas-Torres, F.I., Cabrera-Chávez, F., Figueroa-Salcido, O.G., et al. (2021). Non-Celiac Gluten Sensitivity: An Update. Medicina-Lithuania, 57(6), 526. https://doi.org/10.3390/medicina57060526

8. Rubio-Tapia, A., Hill, I.D., Kelly, C.P., et al. (2013). ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease. The American Journal of Gastroenterology, 108(5), 656–676. https://doi.org/10.1038/ajg.2013.79

9. Serena, G., D’Avino, P., & Fasano, A. (2020). Celiac Disease and Non-celiac Wheat Sensitivity: State of Art of Non-dietary Therapies. Frontiers in Nutrition, 7. https://doi.org/10.3389/fnut.2020.00152

Subscribe to the Magazine for free to keep reading!
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
See All Magazine Articles
Trusted Source
The Journal of Pediatrics
Peer Reviewed Journal
Visit Source
CDC
Government Authority
Visit Source
Office of Dietary Supplements
Government Authority
Visit Source
National Heart Lung and Blood Institute
Government Authority
Visit Source
National Institutes of Health
Government Authority
Visit Source
Clinical Infectious Diseases
Peer Reviewed Journal
Visit Source
Brain
Peer Reviewed Journal
Visit Source
The Journal of Rheumatology
Peer Reviewed Journal
Visit Source
Journal of the National Cancer Institute (JNCI)
Peer Reviewed Journal
Visit Source
Journal of Cardiovascular Magnetic Resonance
Peer Reviewed Journal
Visit Source
Hepatology
Peer Reviewed Journal
Visit Source
The American Journal of Clinical Nutrition
Peer Reviewed Journal
Visit Source
The Journal of Bone and Joint Surgery
Peer Reviewed Journal
Visit Source
Kidney International
Peer Reviewed Journal
Visit Source
The Journal of Allergy and Clinical Immunology
Peer Reviewed Journal
Visit Source
Annals of Surgery
Peer Reviewed Journal
Visit Source
Chest
Peer Reviewed Journal
Visit Source
The Journal of Neurology, Neurosurgery & Psychiatry
Peer Reviewed Journal
Visit Source
Blood
Peer Reviewed Journal
Visit Source
Gastroenterology
Peer Reviewed Journal
Visit Source
The American Journal of Respiratory and Critical Care Medicine
Peer Reviewed Journal
Visit Source
The American Journal of Psychiatry
Peer Reviewed Journal
Visit Source
Diabetes Care
Peer Reviewed Journal
Visit Source
The Journal of the American College of Cardiology (JACC)
Peer Reviewed Journal
Visit Source
The Journal of Clinical Oncology (JCO)
Peer Reviewed Journal
Visit Source
Journal of Clinical Investigation (JCI)
Peer Reviewed Journal
Visit Source
Circulation
Peer Reviewed Journal
Visit Source
JAMA Internal Medicine
Peer Reviewed Journal
Visit Source
PLOS Medicine
Peer Reviewed Journal
Visit Source
Annals of Internal Medicine
Peer Reviewed Journal
Visit Source
Nature Medicine
Peer Reviewed Journal
Visit Source
The BMJ (British Medical Journal)
Peer Reviewed Journal
Visit Source
The Lancet
Peer Reviewed Journal
Visit Source
Journal of the American Medical Association (JAMA)
Peer Reviewed Journal
Visit Source
Pubmed
Comprehensive biomedical database
Visit Source
Harvard
Educational/Medical Institution
Visit Source
Cleveland Clinic
Educational/Medical Institution
Visit Source
Mayo Clinic
Educational/Medical Institution
Visit Source
The New England Journal of Medicine (NEJM)
Peer Reviewed Journal
Visit Source
Johns Hopkins
Educational/Medical Institution
Visit Source