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In recent years, the term “gluten-free” has become ubiquitous in the world of nutrition and dietary choices.

Many individuals opt for gluten-free products, whether due to a diagnosed condition or perceived health benefits.

Among those with genuine medical reasons to avoid gluten, a condition called gluten intolerance, or non-celiac gluten sensitivity (NCGS), has gained recognition.

In this comprehensive guide, we will dive deep into the realm of gluten intolerance, exploring its symptoms, causes, diagnosis, and management.


Understanding Gluten: The Culprit Behind Gluten Intolerance


Gluten is a complex protein composite found in wheat, barley, rye, and their derivatives.

It plays a vital role in the texture and structure of many foods, making it a common ingredient in various products like bread, pasta, cereal, and baked goods.

For the majority of people, gluten is harmless and a regular part of their diet.

However, for those with gluten intolerance, consuming gluten can trigger a range of unpleasant symptoms and health issues.

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Symptoms of Gluten Intolerance

Gluten intolerance manifests with a variety of symptoms, primarily affecting the digestive system, although it can extend to other areas of health.

These symptoms often appear after the consumption of gluten-containing foods and may include:

  1. Digestive Distress: Abdominal pain, bloating, gas, and discomfort are common complaints. Diarrhea or constipation may also occur.
  2. Fatigue: Many individuals with gluten intolerance experience unexplained fatigue or lethargy.
  3. Headaches: Recurrent headaches, including migraines, are a frequent symptom.
  4. Joint and Muscle Pain: Some people report joint and muscle pain, which may improve with a gluten-free diet.
  5. Brain Fog: Cognitive symptoms like brain fog, difficulty concentrating, and memory problems may arise.
  6. Mood Disturbances: Mood swings, anxiety, and depression have been reported in some individuals.
  7. Skin Issues: Skin problems such as eczema or a persistent rash called dermatitis herpetiformis can be associated with gluten intolerance.
  8. Nerve and Neurological Symptoms: In rare cases, gluten intolerance can lead to nerve-related symptoms, like tingling or numbness in the extremities.

It’s important to note that these symptoms can vary in severity and may overlap with those of other conditions, making the diagnosis of gluten intolerance a complex process.

Additionally, the onset of symptoms can be delayed, occurring hours or even days after consuming gluten.

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Causes of Gluten Intolerance

The exact cause of gluten intolerance is not fully understood, but several factors may contribute to its development:

  1. Immune System Response: Although it’s not an autoimmune condition like celiac disease, gluten intolerance involves an abnormal immune response to gluten. This response can trigger inflammation and symptoms.
  2. Genetics: There is evidence to suggest a genetic component to gluten intolerance. Some individuals may be genetically predisposed to develop NCGS.
  3. Gut Microbiota: Alterations in the gut microbiota, the community of microorganisms residing in the digestive tract, may play a role in gluten intolerance.
  4. FODMAPs: Some experts speculate that certain carbohydrates known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) found in wheat may contribute to symptoms in some individuals.
  5. Leaky Gut: Some theories propose that gluten intolerance may be associated with increased intestinal permeability, often referred to as “leaky gut.”

Diagnosis: The Challenge of Identifying Gluten Intolerance

Diagnosing gluten intolerance can be complex, as it requires ruling out other conditions that may share similar symptoms.

The process often involves the following steps:

  1. Medical Evaluation: A thorough medical evaluation is the starting point, where the healthcare provider collects information about the patient’s symptoms, medical history, and family history of related conditions.
  2. Exclusion of Celiac Disease: Celiac disease, an autoimmune disorder triggered by gluten consumption, shares some symptoms with gluten intolerance. Healthcare providers often begin by testing for celiac disease, which typically includes blood tests to detect specific antibodies (such as anti-tissue transglutaminase antibodies) and, if indicated, an upper endoscopy with biopsy to assess for small intestine damage.
  3. Exclusion of Wheat Allergy: Wheat allergy, a distinct condition involving an allergic reaction to proteins in wheat, is ruled out through specific allergy testing.
  4. Gluten Challenge: In some cases, individuals may be asked to undergo a “gluten challenge.” This involves a period of consuming gluten-containing foods under medical supervision to see if symptoms develop or worsen.
  5. Resolution of Symptoms on a Gluten-Free Diet: The most convincing confirmation of gluten intolerance often comes from symptom resolution on a gluten-free diet. If symptoms improve while avoiding gluten and return when gluten is reintroduced, gluten intolerance is considered likely.

It requires careful consideration of the patient’s medical history, symptoms, and response to dietary changes.

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Management of Gluten Intolerance: Embracing a Gluten-Free Lifestyle

Once diagnosed, the primary and most effective means of managing gluten intolerance is adopting a gluten-free lifestyle.

This involves eliminating gluten-containing foods from the diet and making informed choices to prevent inadvertent exposure.

Here are key considerations and strategies for successfully living gluten-free:

1. Eliminating Gluten from Your Diet

The foundation of managing gluten intolerance is to avoid foods that contain gluten. This includes:

  • Wheat-Based Products: This encompasses bread, pasta, cereal, and many baked goods.
  • Barley and Rye: These grains and their derivatives are also sources of gluten.
  • Processed Foods: Gluten can hide in many processed foods and sauces, so it’s crucial to read labels carefully.
  • Cross-Contamination: Be aware of cross-contamination, which can occur in shared kitchen equipment and utensils. Use separate cooking utensils, cutting boards, and cooking surfaces to prevent cross-contact.

2. Embracing Gluten-Free Alternatives

Fortunately, there is a wide array of gluten-free alternatives available for those with gluten intolerance. These include:

  • Gluten-Free Grains: Rice, quinoa, corn, and oats (labeled as gluten-free) can be used as substitutes for gluten-containing grains.
  • Gluten-Free Flours: Almond flour, coconut flour, and various gluten-free flour blends can be used in baking.
  • Gluten-Free Products: Many stores offer a wide range of gluten-free bread, pasta, and snacks.
  • Fruits and Vegetables: Fresh fruits and vegetables are naturally gluten-free and should be a central part of your diet.

3. Dining Out and Social Situations

Eating out can be challenging for individuals with gluten intolerance, but it’s possible with some precautions:

  • Check Menus: Look for restaurants that offer gluten-free options or have staff knowledgeable about accommodating dietary restrictions.
  • Communicate Clearly: When dining out, communicate your dietary needs clearly to the waitstaff and ask questions about food preparation.
  • Be Cautious with Cross-Contamination: Cross-contamination can occur in restaurant kitchens. Consider dining at dedicated gluten-free restaurants or those with a strong understanding of gluten-free practices.

4. Educating Yourself and Others

Education is a crucial aspect of managing gluten intolerance. It’s important to:

  • Learn to Read Labels: Familiarize yourself with ingredients that contain gluten and learn how to read food labels effectively.
  • Inform Friends and Family: Help your friends and family understand your dietary needs to ensure they can accommodate your requirements when cooking or hosting gatherings.

5. Monitoring Your Health

Regularly monitoring your health and discussing any concerns with your healthcare provider is essential. This includes addressing any nutrient deficiencies that may develop due to dietary restrictions.

6. Seek Support and Resources

Joining support groups and seeking resources related to gluten intolerance can be immensely helpful. These communities often provide valuable advice, recipes, and emotional support.

The Gluten-Free Journey: A Personal Experience

Adopting a gluten-free lifestyle can be challenging, especially in the beginning, but it’s important to remember that it’s a journey toward better health and well-being.

With time and experience, managing gluten intolerance becomes more intuitive, and you’ll discover a wide array of delicious gluten-free foods and recipes to enjoy.

Living gluten-free is not just about eliminating gluten from your diet; it’s about embracing a healthier way of eating and taking charge of your well-being.

By understanding your body’s needs and making informed dietary choices, you can lead a fulfilling and symptom-free life with gluten intolerance.

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In the world of dietary restrictions, gluten intolerance is a condition that requires careful attention and management. It may not be as widely understood as celiac disease or wheat allergy, but for those who experience its symptoms, it’s a very real and often life-altering condition.

Recognizing the symptoms of gluten intolerance, understanding its potential causes, and navigating the diagnostic process are essential steps toward effective management.

Once diagnosed, adopting a gluten-free lifestyle becomes the cornerstone of managing this condition.

The gluten-free journey is a personal one, and it may take time to adapt fully. However, with patience, perseverance, and the right resources, individuals with gluten intolerance can lead fulfilling lives while effectively managing their condition.

Understanding gluten intolerance empowers individuals to make informed choices about their health and nutrition, ultimately leading to a healthier and more symptom-free life.

Dr. Schneider is located at the Mill Park Hospital, Parktown, Johannesburg.

Services offered include consultation, and endoscopy procedures, including gastroscopy, colonoscopy and video capsule endoscopy.

For more information on the diagnosis and treatment of gluten intolerance in Johannesburg, contact Dr. Schneider or book your consultation today.


The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a Gastroenterologist or medical doctor regarding ANY and ALL symptoms or signs including, but not limited to: abdominal pain, haemorrhoids or anal / rectal bleeding as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today and schedule a consultation.