Врачи предупреждают: исключите глютен из рациона только после прохождения теста на целиакию

Joanna Mason spent years blaming her aching joints, brain fog, and exhaustion on getting older. The real culprit, it turned out, was hiding in her morning toast. “Gluten was the last thing I suspected,” she told The Epoch Times. Yet stories like Mason’s have become increasingly common. People describe years of chasing diagnoses before noticing an unexpected pattern: When they eliminated gluten from their diets, many of their symptoms disappeared. For decades, gluten was associated almost entirely with celiac disease, an autoimmune disorder in which eating gluten damages the lining of the small intestine. The condition affects about one percent of the population and requires strict lifelong avoidance of gluten to prevent ongoing intestinal injury and a myriad of symptoms. Yet many of the people reporting improvements after giving up gluten don’t have celiac disease, and before anyone follows their lead, doctors say there is a critical step that’s easy to skip. Don’t Go Gluten-Free Before You’re Tested Despite the growing interest in gluten-related illness, experts agree on one point above all others: Don’t eliminate gluten before being evaluated for celiac disease. “First and foremost, we must rule out celiac disease before they start a gluten-free diet,” Dr. Alyssa Parian, director of The Center for Inflammatory Bowel Disease at Hackensack University Medical Center, told The Epoch Times. “The tests for celiac disease are only accurate if the person is still consuming gluten.” That means cutting gluten early—even briefly, just to “see how you feel”—can permanently muddy the diagnostic waters. Once celiac disease and gluten allergy have been ruled out, a structured elimination and reintroduction process can help determine whether gluten is actually contributing to symptoms. So if gluten isn’t the simple answer to people’s symptoms it once seemed to be, what is really going on? A Condition Without a Test Researchers now recognize a condition known as non-celiac gluten sensitivity (NCGS). People with the condition experience symptoms that resemble celiac disease but test negative for its hallmark antibodies and show no evidence of the intestinal damage that defines the autoimmune disorder. Unlike celiac disease, there is no blood test or biopsy that confirms NCGS. Instead, physicians must carefully evaluate symptoms, rule out other conditions, and assess whether symptoms improve when foods with gluten are removed. Celiac disease is often the first condition people think of when gluten causes problems, but it is far from the only culprit. Wheat allergy is an allergic reaction specifically to proteins found in wheat. Irritable bowel syndrome, or IBS, is a gastrointestinal disorder that typically causes abdominal pain, bloating, diarrhea, constipation, or a combination of those symptoms. Non-celiac gluten sensitivity shares characteristics with both celiac disease and IBS. “In my practice, telling the difference between non-celiac gluten sensitivity and irritable bowel syndrome is a common challenge,” Parian said. “The symptoms can be nearly identical: bloating, abdominal pain, and changes in bowel habits.” “If both [IBS and wheat sensitivity] are negative, and a patient’s symptoms improve on a gluten-free diet, we may diagnose them with NCGS,” Parian said. Even after celiac disease, wheat allergy, and IBS have been considered, one question remains: What exactly are people reacting to? A Variety of Symptoms One reason non-celiac gluten sensitivity can be so difficult to recognize is that the symptoms don’t always point to the digestive system. Some people experience stomach issues, while others describe problems that seem entirely unrelated to food. - Brain Fog: Difficulty concentrating, memory lapses, and the feeling of thinking through a haze are among the most commonly reported symptoms of non-celiac gluten sensitivity, although researchers are still working to understand why they occur. - Fatigue: Persistent fatigue is a commonly reported symptom. Patients often describe feeling drained despite adequate sleep. - Joint and Muscle Pain: Ongoing aches can sometimes be part of the picture, too. A review published in Gastroenterology Clinics of North America found that joint pain and muscle aches were among the symptoms reported outside the digestive tract in people with non-celiac wheat sensitivity. - Skin Conditions: Dermatitis herpetiformis (Duhring’s disease) is the classic skin problem with celiac disease, but researchers have also described eczema-like rashes, itching, redness, and other dermatologic symptoms in some patients with non-celiac wheat sensitivity. - Difficulty Swallowing: Wheat is one of the six foods most commonly eliminated in people with eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus that can make swallowing difficult. Although EoE is a separate condition, it shows that wheat doesn’t affect everyone the same way. These symptoms don’t immediately point to diet. Someone experiencing headaches or brain fog may see a neurologist. Joint pain often leads to a visit to a rheumatologist. Persistent fatigue can prompt evaluations for thyroid disease, anemia, or hormonal changes. By the time diet is considered, many people have already spent years looking elsewhere for answers—much like Mason did. Looking Beyond Gluten Researchers then compared gluten with a placebo and found that gluten alone did not explain many of the participants’ symptoms. The findings suggested that other components of wheat, rather than gluten alone, might be contributing to their complaints. Beyond gluten, wheat contains hundreds of naturally occurring compounds. The 2013 study prompted researchers to examine wheat more closely, and they began investigating whether some of those other compounds could also contribute to symptoms. “When someone goes on a gluten-free diet, they are also naturally reducing their FODMAP intake, which could be the real reason they feel better,” Parian said. Because these carbohydrates aren’t absorbed well in the small intestine, bacteria in the colon ferment them, producing gas, bloating, abdominal pain, and changes in bowel habits. Rather than pointing to a single explanation, research suggests that the symptoms of NCGS may have more than one underlying cause. Why Some People Feel Better Eating Bread in Europe One of the most persistent questions surrounding gluten sensitivity has to do with travel. Many people report eating bread and pasta comfortably while visiting Europe, only to have symptoms return after coming home. Researchers have explored several possible explanations, though none have been confirmed. “A very common issue with gluten is the high amount of processing in most of the gluten consumed in this country,” Parian said. She has seen patients improve without eliminating wheat. “If patients change their diet to whole grains and non-processed gluten, that commonly works just as well as a gluten-free diet.” Traditional bread-making methods—including longer fermentation times that may alter the carbohydrates and proteins in wheat—also remain more common in parts of Europe. Travel also changes more than bread: smaller portions, more walking, less stress, and fewer ultra-processed foods could all play a role independent of wheat. What to Do If You Suspect Gluten Is Affecting You The path forward, doctors say, is methodical rather than instinctive. If reducing gluten appears to help, the next step is building a diet that remains nutritionally complete. Joy emphasized naturally gluten-free whole foods such as fruits, vegetables, legumes, nuts, seeds, quinoa, brown rice, and millet rather than relying heavily on processed gluten-free substitutes. Many packaged gluten-free products contain less fiber and more added starches, sugars, and fats than their gluten counterparts. A registered dietitian can help identify potential nutrient gaps and ensure adequate intake of fiber, B vitamins, and iron while determining whether gluten is truly the source of symptoms. For Mason, removing gluten didn’t explain why she had spent years feeling unwell. It simply helped her feel better. The answer may lie not in gluten alone, but in the complex relationship between wheat, the immune system, the gut microbiome and the people who eat it.