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Gluten Intolerance: Complete Guide (2024)

  • Post category:Lifestyle

Gluten intolerance – an affliction for the modern age. If you’re here, you may already be living a gluten-free lifestyle, or perhaps you’re only just starting on this journey. Stay with us, we’ll tell you everything there is to know. 

In this article we discuss the following:

  • What is Gluten Intolerance?
    • How Common is Gluten Intolerance?
      • Why is there Such an Increase in Gluten Intolerance?
    • Is Gluten Intolerance Real?
    • Is Gluten Intolerance Genetic?
    • Can You Develop Gluten Intolerance?
    • Is Keratosis Pilaris Related to Gluten Intolerance?
  • What Causes Gluten Intolerance?
    • Gluten Intolerance and Pregnancy
  • Gluten Intolerance Symptoms
    • How do You Know If You Have a Gluten Intolerance?
    • Symptoms of Gluten Intolerance
      • Signs of Gluten Intolerance on Skin
        • Gluten Intolerance Rash
        • Gluten Intolerance Skin Bumps
      • Gluten Intolerance and Weight Gain
      • Does Gluten Intolerance Cause Gas?
      • Water Retention Due to Gluten Intolerance
      • Gluten Intolerance and Joint Pain
      • Effects of Gluten Intolerance on the Brain
      • Can Gluten Intolerance Cause Hives?
      • Hidden Symptoms of Gluten Intolerance
      • Gluten Intolerance and Weight Loss
      • Gluten Intolerance Symptoms and Headache
      • Gluten Intolerance Symptoms in Children
      • Signs of Gluten Intolerance in Women
      • Gluten Intolerance and Stomach Pain
  • Types of Gluten Intolerance
    • Gluten Intolerance vs Celiac Disease
      • Difference Between Celiac and Gluten Intolerance
    • Wheat Intolerance vs Gluten Intolerance
    • Non-Celiac Gluten Intolerance
  • Gluten Intolerance Test
    • How to Test for Gluten Intolerance
      • Gluten Intolerance Blood Test
      • Gluten Intolerance Test Kit
    • Where Can I Get a Gluten Intolerance Test
    • Gluten Intolerance Test Online
    • Gluten Intolerance Test Cost
  • Gluten Intolerance Treatment
    • Gluten Intolerance Pills
      • Best Pills for Gluten Intolerance
    • Gluten Intolerance Diet
      • Gluten Intolerance Foods to Avoid
      • Gluten Intolerance Recipes
  • Gluten Allergy

What is Gluten Intolerance?

The most basic gluten intolerance definition involves the inability to properly process gluten through the digestive system. That said, the condition is usually a lot more nuanced and complex than just that, and the most common gluten intolerance meaning is usually along the lines of “an immune-mediated reaction to the ingestion of gluten proteins found in wheat, barley and rye,” or at least those are the words of Florida-based optometrist, Besty Jacob.

How Common is Gluten Intolerance?

Not to be confused with celiac disease, general cases of gluten intolerance are becoming increasingly common, particularly in countries where gluten-rich foods are staples. It is estimated that around 6% of the general population will suffer from gluten intolerance, though this number is likely significantly higher due to the fact that a lot of people go their entire lives never acknowledging their sensitivity to this protein and the problems it could be causing. 

Why is there Such an Increase in Gluten Intolerance?

A great question! The global increase in gluten intolerance is due to a combination of factors. Firstly, the widespread nature of gluten-containing foods has grown significantly in recent years, meaning more people are exposed to it. Secondly, there is now the added layer of an increased awareness and knowledge surrounding gluten-related issues, so more people are aware of the way their body is actually reacting when this protein is consumed.

In addition to this, modern wheat is higher in gluten than in the past, so those who are prone to gluten intolerance will be more affected today than they might have been decades ago. Finally, the overuse of antibiotics in Western culture has weakened our gut microbiomes, making the general population more vulnerable to gluten and other gut intolerances.

Is Gluten Intolerance Real?

To answer this touchy question with regards to gluten intolerance disease, we turned to author of the book Celiac Mom, Ann Campanella, for whom gluten has been a very real, and endless pain point in her adult life. 

“When my daughter was five years old, she was diagnosed with celiac disease. I set about learning everything I could to help support her through her transition to a gluten-free life. In the process, my husband and I both discovered through blood tests that we were gluten intolerant,” explains Ann.  

“Most people don’t understand the enormous lifestyle change required to give up gluten. We suddenly found ourselves on the outside of every social event involving food. However, the health benefits were well worth it. Along with our daughter, my husband and I started to feel better. I had more energy, less digestive complaints, better sleep, less aches and pains, and no more brain fog, to name a few things. I wrote the book, Celiac Mom, to help other parents who find themselves having to leave gluten behind,” she adds. 

Is Gluten Intolerance Genetic?

While not hereditary, ongoing studies suggest that there may be an undeniable genetic component to gluten intolerance. Individuals born into a family with a lengthy history of gluten intolerance have shown to be far more likely to also experience intolerance. Additionally, certain, specific genes have been linked to a higher risk of developing gluten intolerance in some individuals.

Can You Develop Gluten Intolerance?

Absolutely! Not everyone is born with an intolerance to gluten; there are a lot of people who will develop their condition over time, and usually later on in life. This is because the condition is autoimmune related, and things like environment, genes or significant changes to diet or lifestyle can greatly affect the body’s ability to process the gluten protein. 

Is Keratosis Pilaris Related to Gluten Intolerance?

Ever catch yourself noticing those small red bumps some people have on the back of their arms? It’s called keratosis pilaris, and it is a common skin condition that can occur on the upper arms, thighs and even buttocks, and is often mistaken for acne or eczema. Though there is much speculation, this condition is actually not directly related to gluten intolerance at all. But while gluten intolerance is not a direct cause of keratosis pilaris, it is possible for those with gluten intolerance to experience symptoms of the condition due to the inflammation associated with the intolerance.

What Causes Gluten Intolerance?

There really is no single gluten intolerance cause, which is what makes this such a complex condition to diagnose, treat and manage. Numerous things can onset the immune response to gluten proteins, which then lead to a range of digestive symptoms. Possible causes of gluten intolerance include a genetic predisposition, sensitivity to gluten proteins, damage to the small intestine, or a progressing autoimmune condition. 

Nutritionist Paul Claybrook says that while the exact cause of gluten intolerance is unknown, researchers believe that it may be due to a combination of genetic and environmental factors. “In some cases, gluten intolerance may be triggered by a viral infection or surgery. There is also evidence that dysbiosis, an imbalance of gut bacteria, can contribute to gluten intolerance,” explains Paul. 

Gluten Intolerance and Pregnancy

Pregnancy can actually lead to sudden gluten intolerance, even if the pregnant person has digested gluten just fine throughout their lives prior. People with existing gluten intolerance can also have a particularly tough time during pregnancy, as the body undergoes many changes which can make it difficult for women with gluten intolerance to cope.

Pregnancy already involves significant levels of stomach pain, bloating, constipation, and fatigue; Now add these symptoms in double, as they are also associated with gluten response. It is important for pregnant women with gluten intolerance to follow a strict gluten-free diet to maintain their health and the health of their baby. Additionally, pregnant women with gluten intolerance should consult with their doctor to ensure that their dietary needs are being met and that their baby is receiving the necessary nutrients. 

Gluten Intolerance Symptoms

We’ve hinted at some of the symptoms of gluten intolerance, but the list is truly vast. We’d like to note that when it comes to this condition, symptoms versus signs of gluten intolerance can be vastly different. A gluten intolerance symptoms checklist can help immensely in this regard, especially if this is something you’d like to stay on top of. 

woman wearing black underwear

How do You Know If You Have a Gluten Intolerance?

So, what are the first signs of gluten intolerance? The first thing you want to be sensitive to is how you feel physically after consuming gluten-rich foods. Take note of your energy levels, how your body feels and what’s going on in your gut. Try to notice differences compared to when you eat gluten-free foods. 

Next, you want to take note of any symptoms that are prevalent when your body is digesting gluten, and these can be broad & varied… so take note!

Symptoms of Gluten Intolerance

Paul Claybrook, who we heard from earlier, offered us his perspective on gluten intolerance symptoms. “The symptoms of gluten intolerance can vary widely, and many of them overlap with symptoms of other conditions, making it difficult to diagnose. Some common symptoms of gluten intolerance include bloating, gas, abdominal pain, diarrhea, constipation, fatigue, headache, brain fog, and skin problems like eczema or rashes. Some people with gluten intolerance also experience joint pain or swelling, depression, and anxiety.”

Signs of Gluten Intolerance on Skin

The skin is our biggest organ, so one can rest assured that if there is an intolerance to something, it will likely make itself known via our external body as well as internal. Bear with us, this is a long list: 

Eczema, psoriasis, seborrheic dermatitis, hives, contact dermatitis, red spots, itchy skin, flaky skin, dry skin, dark circles under the eyes, acanthosis nigricans, swollen lips, canker sores, vesicles, blisters, cracking and peeling at the corners of the mouth, rosacea, hyperpigmentation, mouth ulcers, alopecia areata, perioral dermatitis, keratosis pilaris, folliculitis, and vitiligo are all possible signs of gluten intolerance on the skin. Consult with a physician to confirm this potential diagnosis, and always take photos of your skin when it is at its most reactive, so that your doctor can piece everything together. 

Gluten Intolerance Rash

Rashes are the most common of the skin-based symptoms when it comes to gluten intolerance, as most of the other severe symptoms occur inside of the body. A gluten intolerance rash is technically an allergic reaction. Symptoms of these rashes can range from itching and redness of the skin, to more severe reactions such as hives and even blistering. 

Gluten Intolerance Skin Bumps

Earlier we touched on keratosis pilaris; also known as “those skin bumps on the back of people’s arms”. Though a fairly common skin condition that can occur on the upper arms, thighs and even buttocks, we can conclude that this condition is actually not directly related to gluten intolerance at all. That said, while gluten intolerance is not a direct cause of keratosis pilaris, it is possible for those with gluten intolerance to experience symptoms of the condition due to the inflammation associated with the intolerance itself.

Gluten Intolerance and Weight Gain

Gluten intolerance can lead to weight gain if left untreated. Long-term untreated gluten intolerance can lead to malabsorption of vital nutrients, thus causing weight gain. Weight gain can also occur due to increased intake of gluten-containing foods as individuals (ironically) seek to reduce their symptoms. A gluten-free diet is the only effective way to manage gluten intolerance and prevent associated weight gain, should this be your body’s response to the allergy. 

Does Gluten Intolerance Cause Gas?

Oh yes indeed. Gluten intolerance causes gas due to the body’s inability to properly digest and absorb the gluten proteins. When gluten proteins are not broken down, they remain in the digestive system and ferment, producing excessive gas. The gas production can be further increased due to the presence of other factors such as the presence of bacteria in the intestines, the inability to absorb nutrients, and the effects of the body’s immune system in reaction to the gluten proteins. As a result, individuals with gluten intolerance often suffer from excessive gas and bloating, which is almost always extremely painful.

Water Retention Due to Gluten Intolerance

When gluten is not properly or easily digested, it can cause inflammation and leaky gut, leading to an accumulation of water in the body. This water retention can cause abdominal bloating and swelling, as well as other symptoms. Additionally, gluten intolerance can also lead to malabsorption of certain nutrients, which can further contribute to water retention.

Gluten Intolerance and Joint Pain

As if there weren’t already enough symptoms due to gluten intolerance, joint pain joins the long list. Joint pain from gluten intolerance is caused by inflammation of the small intestine, which can affect the entire body, including joints. Additionally, the antibodies that the body produces to fight the gluten can cross-react and attack the joints, causing inflammation and pain. 

Effects of Gluten Intolerance on the Brain

Suffering every time one eats gluten comes with its own spell of depression and anxiety, but gluten does also have a direct effect on the brain in terms of physical symptomatic response. Namely, this involves cognitive dysfunction, fatigue, brain fog, headaches, and in severe cases, seizures. In addition to this, gluten intolerance can also lead to nutrient deficiencies that can impact brain health, such as a deficiency in vitamin B12, zinc, and magnesium. More so, it can lead to an imbalance of hormones in the body, which can affect the brain’s ability to produce neurotransmitters. Since this condition also causes inflammation throughout the body, the brain is not exempt and this area can eventually see signs of cognitive impairment.

Can Gluten Intolerance Cause Hives?

Yes, sadly gluten can cause hives in people who are even mildly intolerant. Hives, also known as urticaria, is an itchy skin rash that can be very uncomfortable. Hives are indicated by raised, red, itchy bumps that can appear absolutely anywhere on the body.

Hidden Symptoms of Gluten Intolerance

Other than the skin-based symptoms listed above, sadly most gluten response symptoms are hidden and occur deep inside the body where only the person experiencing them is aware of their existence. This includes all of the listed digestive issues, with bloating being the only one that may not be so hidden all the time. 

Other hidden symptoms include fatigue, joint pain, headaches and even brain fog. Some individuals experience anemia, thyroid issues, depression, anxiety, and autoimmune diseases — all of which are obviously not physically visible to the outside world. We also know now that gluten intolerance can also cause a wide range of neurological issues, such as difficulty concentrating, irritability, and an inability to focus. Nutrient deficiencies, hormone imbalances, and an increased susceptibility to infections are other hidden threats.  

Gluten Intolerance and Weight Loss

As a testament to just how subjective this condition can be for different people, gluten intolerance can cause both weight gain and weight loss, depending on the individual in question. Funny enough, the causes of both of these symptoms are the exact same: the body being unable to absorb the nutrients it needs from food. 

Gluten Intolerance Symptoms and Headache

Headaches are very common when it comes to gluten. When gluten is consumed, it irritates the digestive system, resulting in inflammation and the release of chemicals that can cause headaches. Additionally, we know that gluten can cause inflammation in the brain, leading to an increase in blood flow, which in turn can cause a headache. Then one needs to factor in the  malabsorption of nutrients, leading to deficiencies and nutrient imbalance that can also cause headaches.

Gluten Intolerance Symptoms in Children

Gluten intolerance will present itself in children via most of the same symptoms it does in adults. That said, there are many cases of children who report a mysterious tingling sensation in their arms and legs, and this has since been associated with a negative gluten response. If gluten intolerance is suspected, a doctor can easily order tests for your little one to confirm the diagnosis.

artisan hand made gluten free text
Signs of Gluten Intolerance in Women

Due to the way their bodies metabolize the proteins found in wheat, rye, and barley, women typically tend to display more signs of gluten intolerance than men. The most common symptoms in women include bloating, nausea, headaches, fatigue, skin rash, and depression. Men, on the other hand, tend to experience more targeted digestive issues such as diarrhea, abdominal pain, and constipation.

Gluten Intolerance and Stomach Pain

The most common symptom of them all would be abdominal pain due to gluten intolerance. This, of course, is a broad phrase used to encompass all of the various things that can go wrong in the stomach area to cause said discomfort. Stomach pain causes from gluten are associated with excessive bloating, inflammation of the intestines, cramping, constipation, leaky gut and diarrhea. 

Types of Gluten Intolerance

It’s crucial to note that gluten intolerance is an umbrella term for a range of conditions that arise when individuals have difficulty digesting gluten… like a spectrum. These conditions may range from mild to severe and include celiac disease, gluten sensitivity, wheat allergy, and non-celiac gluten sensitivity. 

Gluten Intolerance vs Celiac Disease

The most severe gluten intolerance comes in the form of something known as celiac disease. If left untreated, this condition can lead to fatalities and is not to be taken lightly in any instances. 

The symptoms of celiac disease involve largely the same range as that of mild to moderate intolerance, but long-term complications of untreated celiac disease can include an increased risk of certain types of cancer, osteoporosis, and other health issues.

Difference Between Celiac and Gluten Intolerance

Coach and athletic consultant, Jeremiah Shaw, helps us distinguish between being celiac, and simply being intolerant of gluten. “There are two types of reactions to gluten: one where the body has an immune response, and one where it doesn’t. The first type is called celiac disease; the second type is called non-celiac gluten sensitivity (NCGS).” 

He explains that both of these types of reactions can cause all sorts of symptoms, from diarrhea to bloating to headaches. “But only celiac disease causes damage to the lining of the small intestine, so if you’ve been diagnosed with celiac disease or NCGS but don’t have any signs of damage on your endoscopy (a procedure where they look at your small intestine), you don’t need to be avoiding gluten anymore—you just need to make sure you’re eating lots of fresh fruits and veggies!” he adds.

Wheat Intolerance vs Gluten Intolerance

Wheat intolerance and gluten intolerance are two separate conditions, though they are often confused or grouped together. Wheat intolerance is an adverse reaction to wheat proteins and is not actually related to the gluten found in wheat. As we know, gluten intolerance is a condition in which one cannot tolerate gluten, a protein found in some grains such as wheat, rye and barley. Understandably, this can become very confusing, especially since the symptoms for both sensitivities are pretty much the same (digestive related). 

Non-Celiac Gluten Intolerance

Non-celiac gluten intolerance is a condition in which a person experiences symptoms similar to those of full blown celiac disease, but without the presence of antibodies or intestinal damage. Symptoms may include bloating, abdominal pain, nausea, fatigue, joint pain, or any of the other signs listed earlier on in this article. While a gluten-free diet may help alleviate symptoms, the only definitive way to confirm a case of non-celiac gluten intolerance is via the elimination diet, which we will dive into in more detail below. 

Gluten Intolerance Test

In order to get an accurate diagnosis gluten intolerance, there are a number of hoops to jump through; many of which are time consuming. In the end, however, this is a worthwhile journey to embark upon, as it means long term relief and a more fulfilled life when it comes to health, food and dining options. 

According to Paul Claybrook, the nutritionist who we heard from earlier, there is no specific test for gluten intolerance, and it can be challenging to diagnose. “A doctor may perform blood tests to rule out celiac disease or other conditions that may cause similar symptoms. An elimination diet, where gluten-containing foods are removed from the diet for several weeks, followed by reintroduction to see if symptoms return, can also be used to diagnose gluten intolerance.”

How to Test for Gluten Intolerance

Testing to confirm gluten intolerance is a step by step process that one can start on any given day. If you’re ready to take the leap, here’s are a few things that you can do: 

  1. Start by keeping a food journal. Record what foods you eat and any symptoms you experience. 
  2. Talk to your doctor about testing for gluten intolerance, and discuss doing a blood test to look for antibodies against gliadin, a protein found in gluten. 
  3. Depending on the blood test results, consider an endoscopy to look for signs of damage to the small intestine.
  4. Request a breath test to measure levels of methane and hydrogen, which can also help to indicate a gluten intolerance. 
  5. Plan and start your own elimination diet to observe how your body reacts to the removal of gluten from different mealtimes. 
  6. Try an at-home gluten intolerance test, which is a self-administered saliva test.
Gluten Intolerance Blood Test

As mentioned above in point two, a blood test is a way of testing for gluten intolerance, however it is not always the most conclusive mode of testing. During the test, a sample of blood is taken from the patient and tested for the presence of certain antibodies that indicate an intolerance to gluten. The test also checks for IgA and IgG antibodies which may be elevated if the patient is intolerant to gluten. If the test comes back positive, further testing may still be required to confirm the diagnosis. In some cases, a biopsy may be necessary to rule out other conditions that could be triggering the blood markers. 

Gluten Intolerance Test Kit

One can purchase an at home test kit in order to self-monitor gluten levels at home. The test involves collecting a small sample of saliva, stool or blood, and will detect antibodies that the body produces when exposed to gluten. That said, this test is only worthwhile for the testing of full celiac disease, and will not be able to determine non-celiac gluten sensitivity.

Where Can I Get a Gluten Intolerance Test?

At home gluten test kits are available from most pharmacies and health stores. You should also be able to order them online in most countries. The cost of these tests can vary anywhere between $20 to $100, depending on the complexity of the variations. 

Gluten Intolerance Test Online

If you suspect you and gluten may not be compatible, there are many online quizzes that you can take in order to gain further clarity on your condition. These quizzes will guide you through a series of questions relating to your general bodily observances before and after eating gluten-containing foods.

Gluten Intolerance Test Cost

If you decide that it’s time to see a doctor and have some more formal tests conducted, then you need to be ready to pay blood test fees. These can vary depending on country and practice, but are typically in the range of a couple of hundred dollars.

Gluten Intolerance Treatment

While a tell-all guide on how to reverse gluten intolerance would be wonderful, it’s sadly not always realistic. Once this condition is present, it can’t necessarily be reversed… but it can be carefully managed and controlled. Essentially, there is no cure for gluten intolerance, only a very feasible and beneficial set of practices that can keep the condition in check. 

Gluten Intolerance Pills

Take note, there is no such thing as gluten intolerance medication. That’s right, there is currently no existing OTC pill or medication that can heal symptoms caused by gluten intolerance, and anything that claims to be able to, is likely a fraud. 

A lot of supplement brands have marketed their products as beneficial for gluten sufferers. These include things like probiotics or other gut-related supplements that are just generally good to have in your daily ritual. That said, they have little to no effect on the symptoms of gluten intolerance. 

Best Pills for Gluten Intolerance

There are a number of pills on the market that claim to be able to help the body digest gluten more easily. The truth is, however, that anyone with a real aversion to gluten will tell you that these tablets have absolutely zero effect on helping the gut process gluten, and one is still going to experience the same amount of pain, discomfort and symptoms as they would have without the pills. As far as healing gluten intolerance goes, pills are not the answer. 

Gluten Intolerance Diet

For real gluten intolerance relief, Paul Claybrook confirms that the only option is to avoid gluten-containing foods. “This can be challenging, as gluten is found in many foods, including bread, pasta, cereals, and baked goods. It is essential to read food labels carefully, as gluten can be hidden in sauces, dressings, and other processed foods. A gluten-free diet can be nutritionally balanced if done correctly, with a focus on whole, unprocessed foods like fruits, vegetables, lean protein, and gluten-free grains like rice, quinoa, and millet. Some people with gluten intolerance may also benefit from supplements like probiotics or digestive enzymes to help support gut health,” he explains. 

However, nutritional expert Elizabeth Quinn isn’t a fan of a lot of gluten-free alternatives. “Many people believe a gluten free diet is automatically a healthy diet. They load up on all the packaged and processed foods that are labeled “gluten free”. Packaged and processed foods are never a healthy way to eat, whether they contain gluten or are gluten free. Many of the gluten free products out there are made with low fiber grains like white rice flour. They can contain inflammatory additives and preservatives. They might even be loaded up with different forms of sugar to make them taste better.”

She adds that one can follow a gluten free diet and still eat whole foods like fresh meats, vegetables, fruits and gluten-free whole grains.

person holding diet quote
Gluten Intolerance Foods to Avoid

To answer this question, with alternative food options provided, we spoke with Barbara Kovalenko, RD and nutrition consultant at Lasta. “The treatment for gluten intolerance or sensitivity is also a gluten-free diet, but it may not need to be as strict as that required for celiac disease. I usually advise my patients to replace these popular gluten-containing products to their gluten-free replacements:

  • Bread: Gluten-free bread is widely available in grocery stores and online, and can be made from a variety of grains such as rice, quinoa, or sorghum.
  • Pasta: There are many gluten-free pasta options available made from grains like rice, corn, or quinoa.
  • Flour: Gluten-free flour blends can be used in place of wheat flour in most recipes. These blends are typically made from a combination of rice flour, potato starch, and tapioca flour.
  • Cereal: Many cereals contain gluten, but there are plenty of gluten-free options available made from rice, corn, or quinoa.
  • Snacks: Popular gluten-containing snacks like crackers and pretzels can be replaced with gluten-free versions made from alternative flours like rice or almond flour.
Gluten Intolerance Recipes

Something people tend to overlook when preparing gluten-free foods is that cross contamination is a very real risk. Kym Tolson is a traveling therapist and lives with celiac disease, and has mastered the art of traveling anywhere in the world in spite of her condition. 

“I prioritize meal planning and preparation. I pack gluten-free snacks, such as nuts, fruits, and protein bars to ensure I have safe options available when needed. Furthermore, I carry a travel-sized cutting board, utensils, and basic kitchen supplies to avoid cross-contamination in shared cooking spaces,” she explains. 

“Also, I educate myself on local cuisines and languages, enabling me to communicate my dietary needs effectively. By learning essential phrases and culinary customs, I can ensure my meals are prepared using recipes without gluten-containing ingredients, safeguarding my health and allowing me to continue my passion for helping others as a traveling therapist,” she adds.

Gluten Allergy

All conditions, symptoms and variations of gluten intolerance discussed in this article qualify under the umbrella term of ‘gluten allergy’. Maria Luci is the Director of Research Engagement at Beyond Celiac, and explained to us that over 3 million Americans are estimated to live with celiac disease: the serious autoimmune disease where the immune system attacks itself after ingesting gluten.

“Those without celiac disease that still react to gluten are said to have non-celiac gluten sensitivity (NCGS), which is often referred to as gluten intolerance. NCGS patients experience symptoms similar to those with celiac disease but without intestinal autoimmune damage,” she added. 

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