Tricia Thompson, MS, RD is a nutrition consultant, author and speaker specializing in celiac disease and the gluten-free diet. She is the author of The Gluten-Free Nutrition Guide and has a MS degree in nutrition from Tufts University in Boston, Massachusetts and a BA degree in English Literature from Middlebury College in Vermont.

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Living Gluten-Free

by Tricia Thompson, MS, RD, The Gluten-Free Dietitian

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When I first started working in this field, the term gluten sensitivity was used interchangeably with the term celiac disease â€" they basically meant the same thing.

Times have changed. We are now learning that there is a group of people who do not have celiac disease and do not have an allergy to wheat but nonetheless can not tolerate gluten. This condition is being called “gluten sensitivity.”

Very little research has been conducted on gluten sensitivity. However, a study abstract on this condition was recently presented at a medical conference known as Digestive Disease Week. One of the study authors was Alessio Fasano, M.D., Medical Director of The University of Maryland Center for Celiac Research.

Dr. Fasano was gracious enough to answer some questions about gluten sensitivity.

The term non-celiac gluten sensitivity is being used with more frequency. Can you please define what it is and how it differs from celiac disease?

Gluten sensitivity is a non-allergic, non-autoimmune reaction to gluten that can cause symptoms similar to those experienced by people with celiac disease.

In your medical practice, how do you determine if a patient has non-celiac gluten sensitivity?

Because gluten sensitivity is not a food allergy (like wheat allergy), or an autoimmune process secondary to exposure to gluten (like celiac disease), the diagnosis is based on exclusion criteria. In other words, people that experience symptoms that are suspected as being related to gluten exposure will be tested for wheat allergy and celiac disease. If they are negative for both, gluten sensitivity is considered. The diagnosis will be confirmed if symptoms resolve following the embracement of a gluten free diet.

An abstract was presented at Digestive Disease Week that you co-authored entitled, "Role of the innate immune system in the pathogenesis of gluten sensitivity: Preliminary study." The abstract suggests that celiac disease and gluten sensitivity may be two separate diseases. Can you please explain?

As mentioned above, celiac disease is a true autoimmune disease (like type 1 diabetes and multiple sclerosis) in which both innate and adaptive immunity are involved. Conversely, gluten sensitivity is a non-autoimmune reaction to gluten in which only the innate immune system is involved.

In an article you wrote about Digestive Disease Week for Medscape Gastroenterology you state that gluten sensitivity "may be related to activation of the innate immune system without the involvement of the adaptive immune system." Can you please explain further, including what is meant by innate immune system and adaptive immune system?

The innate immune system is the most ancestral form of defense we have against "invaders," while the adaptive immune system is a more recent branch of our immune system. Once our body comes in contact with a substance from the environment that may represent a signal of danger, the innate immune system reacts immediately to try to eliminate the "attacker."

At the same time, the adaptive immune system will intervene with a more sophisticated, long process, during which the attacker is studied, its conformation evaluated, and a "customized response" to that particular molecule is engineered (i.e. specific antibodies). Further, the adaptive immune system will save this information as immune response memory, so that at the next encounter there is no need to re-do the job.

In autoimmune diseases, like celiac disease, there is a coordinate response between innate and adaptive immune system, a response that ends up in the wrong direction (i.e.; attacking its own body rather than the "invader"). In gluten sensitivity, there is only an innate immune response, since the adaptive immune system seems not involved.

Thank you Dr. Fasano!

It is important to remember that regardless of whether you have celiac disease or non-celiac gluten sensitivity the treatment is the same â€" a strict gluten-free diet.

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@ 2:38pm ET on October 19, 2008
hi everyone!

our next newsletter is going to be on Gluten sensitivity - an emerging epidemic - how to test for it and why it's important to know if your symptoms are caused by gluten. With Integrative Manual Therapy we are using myofascial mapping to test whether or not the cecum is showing signs of patho-physiology. When we find this we treat it and the effects of gluten sensitivity and have seen promising results. I am compiling the science and clinical findings as well as the Integrative Manual Therapy perspective on it. We have been able to solve many chronic auto-immune problems with a gluten free diet and integrative manual therapy to the colon, specifically the cecum as it relates to gluten sensitivity and allergic reactions.

I am looking for people's experiences as well. We are looking through our success stories of our patients and I would like other people's experiences of their illness and issues and how gluten free diet helped them. Their personal path toward health using the gluten free diet would be great to see.

Please, if you have a story about your own history with gluten sensitivity could you forward that to me at


In my practice, I've found this to be an emerging problem over the past 3 years and I want to get the information and help out to the people who need it.

thanks in advance for all your help with this.

my best to you all

Ralph Havens PT OCS IMTC


@ 6:06pm ET on October 29, 2008
I'm new at the Celiac thing. I have been eating gluten free, I am still getting very sick once a week or once every third week. Help! What am I doing wrong?

When you eat something with gluten do you get sick right a way..............or days later?????????
Let me know

@ 9:46am ET on October 30, 2008

If you have not already made an appointment with a dietitian knowledgeable in celiac disease, please do. She or he can go over with you what you are eating to make sure you are not unintentionally eating gluten. Ask your gastroenterologist for a referral.

In the meantime, please read the Living Gluten-Free post entitled, “How to tell if a food is gluten free.” Also, please visit my website www.glutenfreedietitian.com. Read the Gluten-Free Diet Basics page as well as the Newsletter page. There are several newsletter topics you will find helpful, including Help for the Newly Diagnosed.

This will get easier—promise!


@ 8:25pm ET on March 14, 2009
Hi Tricia. I am a registered outpatient dietitan at Hoag Memorial Hospital in Newport Beach, CA. I consult with celiacs in my practice and am responsible for writing the MNT guidelines for celiac disease. In my research I am having difficulty finding actual medical nutriton therapy guidelines for celiac disease. Much of the information I find is about the general diagnosis and treatment of CD and the gluten free diet. Can you you direct me to the appropriate resources? I need guidelines on the macro- and micro nutrients required by the celiac patient including fiber,calories,etc.
Thank you very much.
Miriam Matulich R.D.

@ 3:25pm ET on March 15, 2009
Hi Miriam,

Does your hospital subscribe to the American Dietetic Association's on-line Nutrition Care Manual? If so, there is an extensive section on celiac disease. Also, please go to ADA's Evidence Analysis Library topic on celiac disease--it is free to all ADA members. We are currently in the process of developing practice recommendations on celiac disease for dietitians. If you will be at FNCE in Denver, please make plans to attend the Pre-FNCE workshop on celiac disease. We will be discussing these recommendations in detail. Please let me know if I can be of any further assistance.


@ 3:02am ET on March 19, 2010
I am here to report on a scientific paradigm shift regarding early diagnosis of gluten sensitivity based on about 30 years of medical research by myself and others. My message is that earlier and more inclusive diagnosis of gluten sensitivity than has been allowed by blood tests and intestinal biopsies must be developed to prevent the nutritional and immune consequences of long-standing gluten sensitivity. Imagine going to a cardiologist because your blood pressure is high or you’re having chest pain, and the doctor says he is going to do a biopsy of your heart to see what is wrong. If it ‘looks’ O.K., you are told you have no problem and no treatment is prescribed because you have not yet had a heart attack showing on the biopsy. You would not think very highly of the doctor utilizing this approach because, after all, isn’t it damage to the heart that you would want to prevent? But for the intestine and gluten sensitivity, current practice embraces this fallacious idea that until an intestinal biopsy shows structural damage, no diagnosis or therapeutic intervention is offered. This has to change now because with newly developed diagnostic tests, we can diagnose the problem before the end stage tissue damage has occurred, that is “before the villi are gone,” with the idea of preventing all the nutritional and immune consequences that go with it.

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@ 1:08am ET on May 11, 2010
A unique kind of article, keep sharing with us

@ 8:17am ET on October 14, 2010
I am actuality to address on a 3COM certification accurate archetype about-face apropos aboriginal Adobe certification analysis of gluten acuteness based on about 30 years of medical analysis by Apple certification myself and others. My bulletin is that beforehand and added across-the-board analysis of gluten acuteness than has been accustomed by claretCheckpoint certification tests and abdominal biopsies accept to be developed to anticipate the comestible Cisco certification and allowed after-effects of abiding gluten sensitivity. Imagine traveling to a cardiologist because your claret burden is top or you’re accepting chest pain, and the doctor says he is traveling to do a biopsy of your affection to see what is wrong. If it ‘looks’ O.K., you are told you accept no botheration and no analysis is assigned because you accept not yet had a affection advance assuming on the biopsy. You would not anticipate actual awful of the doctor utilizing this access because, afterwards all, isn’t it accident to the affection that you would wish to prevent? But for the civil and gluten sensitivity, accepted convenance embraces this beguiling abstraction that until an abdominal biopsy shows structural damage, no analysis or ameliorative action is offered. This has to change now because with anew developed analytic tests, we can analyze the botheration afore the end date tissue accident has occurred, that is “before the villi are gone,” with the abstraction of preventing all the comestible and allowed after-effects that go with it.

@ 10:16pm ET on May 14, 2011

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@ 9:32pm ET on November 22, 2016
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@ 10:15pm ET on November 22, 2016
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