Coeliac Disease vs. Gluten Intolerance. What is the difference?

Gluten is a protein found in wheat, barley and rye. To people with coeliac disease, it triggers an autoimmune reaction in the small intestine causing damage to the cells lining the small intestine. As well as causing symptoms such as diarrhoea, bloating, fatigue and weight loss, it can cause nutritional deficiencies and other serious complications. If you suspect you or a member of your family has coeliac disease you must seek a proper medical diagnosis. A blood test is usually the first treatment option, to test for specific antibody levels and genetic markers, but a small bowel biopsy is usually needed for a definitive diagnosis. Once diagnosed, people with coeliac disease need to remove ALL GLUTEN from the diet FOR LIFE

Non-coeliac gluten sensitivity (NCGS)

Many people without coeliac disease report symptoms and discomfort from eating gluten containing foods. NCGS is difficult to diagnose, and for many years has been disregarded by health professionals as a real thing. It is now being more widely studied and recognised as a disabling clinical condition.

One of the things that sets gluten sensitivity apart from coeliac disease or wheat allergy it that it causes both intestinal and whole-body symptoms such as fatigue, headache, anxiety and depression, fibromyalgia-like joint and muscle pain and brain fog. These symptoms may last for several days after eating gluten-containing foods. While some people may have a dose response and can tolerate tiny amounts of gluten, others find they have to remove it completely from their diet.

Wheat allergy

This is an allergic reaction to foods containing wheat. While it is sometimes confused with coeliac disease, these conditions differ. Wheat allergy occurs when your body produces antibodies in response to proteins found in wheat. It does not cause the damage to the lining of the small intestine like coeliac disease does. Avoidance or minimalisation of wheat however, is still the treatment

Fructan sensitivity

People who report gluten sensitivity may genuinely be intolerant to wheat and other gluten-containing foods, however it is not gluten that is the problem here but rather Fructan sensitivity.

Fructans are a type of FODMAP*, falling under the oligosaccharides group ie the ‘O’ in ‘FODMAP’. They are simply a type of carbohydrate made by a chain of fructose molecules strung together. Because humans don’t have the fructan digestive enzyme, fructans are poorly broken down in the small intestine so pass through into the large intestine (colon) where they are fermented by our natural gut bacteria to produce gas. This causes gastrointestinal symptoms such as bloating, nausea, flatulence and diarrhoea. Gluten is not a fructan, but many fructans are found in gluten-rich foods, hence the confusion.

Fructans are found in abundance throughout the food supply, both naturally occurring and added into processed foods. They are especially concentrated in grains and wheat products but also found in many types of fruits, vegetables and legumes. A FODMAP elimination diet is often the only way a fructan intolerance is detected. With fructan intolerance, dose is the key. You may be able to tolerate small amounts depending on what else you are eating. Elimination is the first response, followed by a reintroduction phase to test your tolerance.

Foods high in fructans include

Breads and grains especially barley, rye, wheat and spelt

Certain vegetables - artichokes, Brussels sprouts, cabbage, fennel, garlic, leeks, onions and peas

Certain fruits - grapefruit, nectarines, persimmon, ripe banans, watermelon and white peaches

Nuts and seeds especially almonds, cashews and pistachios

Legumes – chickpeas, lentils, soy beans, other dried beans

Other – instant coffee, chamomile tea, fibre-enriched foods or foods containing inulin

*FODMAPS

The acronym FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. It’s a type of carbohydrate that can resist digestion. Some people with digestive issues can benefit by reducing these in their diet.

FODMAPs are types of carbohydrates found in certain foods, including wheat and beans. Studies have shown strong links between FODMAPs and digestive symptoms like gas, bloating, stomach pain, diarrhoea, and constipation.

Low FODMAP diets can provide remarkable benefits for many people with common digestive disorders.