What is the difference between gluten intolerance and gluten sensitivity?

Gluten-free diets and products are becoming more popular as a result of increasing sensitivity or even intolerance to gluten or wheat-containing food. It is however important to determine whether you are intolerant or allergic to the wheat protein or if it’s a matter of sensitivity.

Gluten intolerance or celiac disease (gluten-sensitive enteropathy), sometimes called sprue or coeliac, is a genetic, immune reaction to eating gluten, a protein found in wheat, barley and rye. If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine’s lining and prevents absorption of some nutrients such as iron, calcium and many others (malabsorption). This condition is hereditary, and the symptoms are managed with a maintained gluten-free diet.

Gluten sensitivity, also known as non-celiac gluten sensitivity (NCGS), or non-celiac wheat sensitivity (NCWS), is not well defined as of yet. This condition may have an immune component but is still being investigated. The symptoms can be managed and even treated by initiating a gluten-free diet.

Wheat allergy can be defined as an adverse immunologic reaction to wheat proteins and shares symptoms with the other gluten-related disorders, but is usually characterised by skin conditions.

How do I know if I’m gluten intolerant?

Celiac disease and gluten or wheat allergy share many signs and symptoms. Below are the most common. Chronic IBS (irritable bowel syndrome) can very often be due to gluten intolerance or celiac disease and should always be considered as possible cause. Since a gluten elimination diet is both bothersome and expensive, a gluten intolerance test like GlutenCHECK® is of paramount importance to ascertain whether a person is truly gluten intolerant. The re-testing can be a valuable tool after following a gluten-free diet to determine true Celiac’s or a mere sensitivity.

The final diagnosis and initiation of treatment must always be done by a doctor.

7 Signs of gluten-related problems:

Diarrhoea. Loose, watery stool is one of the first symptoms that many people experience before being diagnosed with celiac disease. Constipation can also be prevalent.
Bloating, flatulence, cramping, indigestion, nausea, vomiting, lactose intolerance.
Weight Loss.
Headaches and fatigue
Iron-Deficiency Anaemia is often found as the cause of these.
Pain in abdomen, joints and/or muscles.
Depression and mood swings.
Skin conditions such as itching, hives or a rash.
Dermatitis herpetiformis is an itchy, blistering skin disease that stems from intestinal wheat allergy. The rash usually occurs on the elbows, knees, torso, scalp and buttocks. Dermatitis herpetiformis is often associated with changes to the lining of the small intestine identical to those of celiac disease, but the disease may not produce noticeable digestive symptoms. Doctors treat dermatitis herpetiformis with a gluten-free diet or medication, or both, to control the rash.

When to see a doctor/clinical nutritionist/dietician:

Consult your doctor if you have diarrhoea or digestive discomfort that lasts for more than two weeks. Consult your child’s doctor if your child is pale, irritable or failing to grow or has a potbelly and foul-smelling, bulky stools.
Caesarean babies have been linked to possible lactose intolerance and Celiac’s.
Be sure to consult your doctor or clinical nutritionist before trying a gluten-free diet. If you stop or even reduce the amount of gluten you eat before you’re tested for celiac disease, you may change the test results.

Celiac disease tends to run in families. If someone in your family has the condition, ask your doctor if you should be tested. Also ask your doctor about testing if you or someone in your family has a risk factor for celiac disease, such as type 1 diabetes.

References:

Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. Spectrum of gluten disorders: consensus on new nomenclature and classification. BMC Med 7(2012) 10-13. http://dx.doi.org/10.1186/1741-7015-10-13

Czaja-Bulsa, G. Non coeliac gluten sensitivity – A new disease with gluten intolerance. Clinical Nutrition 34(2015) 189-194.

Catassi C, Bai JC, Bonaz B, Bouma G, Calabro A, Carroccio A, et al. Non-celiac gluten sensitivity: the new frontier of gluten related disorders. Nutrients 5(2013) 3839-3853. http://dx.doi.org/10.3390/nu5103839