While both coeliac disease and gluten sensitivity are a cause of great discomfort and often pain because of the ingested protein called gluten, the two conditions differ significantly. People with coeliac disease damage their gut when they eat gluten. Gluten sensitive people do not.
Those who are gluten sensitive are also referred to as non-coeliac gluten sensitivity. They cannot tolerate gluten and experience symptoms similar to those with coeliac disease. However, they lack the same antibodies and intestinal damage seen in coeliac disease.
Gluten is a family of proteins found in grains like wheat, spelt, rye and barley. It can be found in many types of food because it helps food maintain its shape.
Dr Samuel Aquilina explains that coeliac disease an auto-immune condition. Ingesting gluten prompts the body to attack parts of its own digestive system causing several symptoms. This is distinct from gluten sensitivity where some similar symptoms are felt but no damage to the gut occurs.
He says that research studies show clear differences in the effects of coeliac disease on children and adults: "Children tend to show more classic signs of the condition. In adults, coeliac disease is not recognised as easily because it tends to present with non-typical symptoms and effects. This leads to a delay in diagnosis."
Symptoms in children typically include a bloated belly, poor appetite and diarrhoea. Weight loss or difficulty in gaining weight is usually an issue. "Older children may suffer from constipation rather than diarrhoea and the stools may be described as oily and floating," explains Dr Aquilina.
"A doctor will look out for signs of anaemia, changes in teeth and a particular skin rash." Meanwhile a child with vague abdominal pain and fatigue may also be tested for celiac disease.
"Gluten sensitivity has similar symptoms to coeliac disease," Dr Aquilina adds. "A person who is intolerant or sensitive to gluten will experience abdominal pain, bloating and diarrhoea.
"The key difference between the two conditions is that, while coeliac disease is an autoimmune disorder that develops in persons with a particular genetic make-up, gluten sensitivity is a form of intolerance.
"In an autoimmune disorder, the body attacks itself. In coeliac disease, the trigger is gluten and the body attacks the lining of the gut."»
Dr Aquilina said that awareness is rising. The latest statistics show a considerable rise in the number of persons diagnosed with coeliac disease, but a good number of cases still remain undiagnosed.
"This increase can be attributed, at least in part, to better tests and improved knowledge and awareness about the disorder among doctors and the general public. Others hypothesize that this could be due to increased gluten content in wheat."
Referring to the diagnosis of gluten sensitivity, Dr Aquilina said this condition is diagnosed only after excluding coeliac disease and wheat allergy. While it is included in the list of gluten-related disorders and a list of criteria for diagnosis exists, some experts still question the disorder's existence due to the lack of knowledge about how this intolerance exactly comes about.
According to the world's largest coeliac NGO, Coeliac UK, non-coeliac gluten sensitivity is something that is being recognised as a problem in many countries around the world.
"This is a new area and there is a need for more research to understand the condition and who is at risk. The exact role of the immune system in non-coeliac gluten sensitivity is unclear and further research is needed," Dr Aquilina says. There are no specific diagnostic tests for non-coeliac gluten sensitivity.
Coeliac UK states that, while some researchers define non-coeliac gluten sensitivity as an improvement in symptoms when following a gluten-free diet, it is difficult to rule out the possibility of a placebo effect.
If you are concerned about your health, seek medical advice and continue with your usual eating pattern to ensure the accuracy of any tests that will need to be carried out.
GLUTEN is a protein found in the cereals wheat, barley and rye.
GLUTEN SENSITIVITY symptoms may be similar to those experienced by many people with coeliac disease, but it is not clear how the immune system might be involved and there does not appear to be damage to the lining of the gut.
COELIAC DISEASE is a serious illness where the body’s immune system attacks itself when gluten is eaten. This causes damage to the lining of the gut and means that the body cannot properly absorb nutrients from food. Coeliac disease is not a food allergy or intolerance. It is an autoimmune disease.
WHEAT ALLERGY is a reaction to proteins found in wheat, triggered by the immune system and usually occurs within seconds or minutes of eating.
NON-COELIAC GLUTEN SENSITIVITY is when symptoms similar to coeliac disease are experienced, but there are no associated antibodies and no damage to the lining of the gut.
FOOD THAT CONTAINS GLUTEN
Wheat and its derivatives
• wheat starch
• wheat bran
• wheat germ
• couscous
• cracked wheat
• durum
• einkorn
• emmer
• farina
• faro
• fu (common in Asian foods)
• gliadin
• graham flour
• kamut
• matzo
• semolina
• spelt
Other grains which contain gluten include
• barley
• bulgur
• oats (if processed in places that produce gluten-containing grains)
• rye
• seitan
• triticale and Mir (a cross between wheat and rye)
Prepared foods which contain gluten
• Pasta
• Noodles made with buckwheat flour, and egg noodles (rice noodles are gluten-free).
• Breads and pastry
• Crackers
• Cakes, biscuits, pies
• Corn flakes and rice puffs often contain malt extract/flavoring
• Granola often made with regular oats, not gluten-free oats
• Pancakes, waffles, french toast, crepes
• Food coating mixes, stuffing and dressing made with breadcrumbs
• Sauces and gravies which use wheat flour as a thickener
• Soy sauce
• Tortillas and wraps
• Cream-based soups which use flour as a thickener
• Potato chips may contain wheat starch
• Energy bars and granola bars may contain wheat. Many contain oats which are not gluten-free if they are processed in a plant which processes wheat products.
• Salad dressing and marinades may contain malt vinegar, soy sauce or flour, all of which contain gluten.
BE WARY OF THE FOLLOWING
• Lipstick, lipgloss, and lip balm because they are unintentionally ingested
• Communion wafers
• Herbal or nutritional supplements
• Drugs and over-the-counter medications
• Vitamins and supplements
• Play-dough - make homemade play-dough with gluten-free flour.›‹