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What is the difference - Gluten Sensitivity and Coeliac Disease?



So firstly lets categorise the three conditions which involves the digestion of wheat and gluten:-


Celiac disease (CD), a genetic autoimmune disorder in which the person developed through an inherited genetic predisposition, by consuming gluten, and/or have the disease activated through a trigger such as stress, trauma or a viral infection. The consequence of ingesting gluten therefore causes damage to the cells within the small intestine shown below in picture B. Some conditions that may manifest are anaemia, behavioural changes, stunted growth, infertility and dermatitis herpetiformis a celiac disease that manifests as a skin rash.



Non-Celiac Gluten Sensitivity (NCGS), is not an immune nor autoimmune reaction. Unfortunately there are no test to identify NCGS and therefore not clear if other components of gluten-containing grains may be involved in causing symptoms. Other conditions are ruled out a diagnosis stage, after following a Gluten free diet which then improves symptoms, NCGS can then be diagnosed.


Wheat allergy however involves an immune reaction to the ingestion of wheat. After ingestion white blood cells (B-cells) signal antibodies (IgE) to attack the ingested wheat, whilst the surrounding tissues send out natural chemical messengers to alert the body there is a problem within minutes resulting in a range of symptoms such as nausea, abdominal pain, itching, swelling of the lips and tongue, to trouble breathing, or anaphylaxis (a life-threatening reaction). Avoidance of wheat is a must however the typical person can tolerate gluten from non-wheat sources.


Although these three have been categorised, it is possible that a person can be both allergic to wheat and have CD or NCGS. Children have been seen to outgrow the allergy however this does not seem to be the case for adults, where following a wheat free diet is the only recommended management.



So what is the difference between sensitivity and Coeliac disease ?


As stated as CD is a well researched illness where the immune system attacks and damages itself and surrounding tissues causing damage to the lining of the gut resulting in the nutrient absorption efficiency. This confirms that CD is an autoimmune disease, its not a food allergy or intolerance. A Wheat allergy has a clue in the name, it's an allergy that occurs when proteins within the wheat triggers the immune system within seconds causing a range of symptoms. NCGS is a sensitivity to gluten and not a autoimmune disease however manifests similar symptoms as CD without the associated antibodies and damage to the lining of the gut.


An article reports three different cases: the first, an elderly patient with celiac disease which was diagnosed based on signs and symptoms of malabsorption and by a proper lab test; second, a case of NCGS which was initially misdiagnosed as lupus; third, a patient with NCGS overlapping with Crohn's disease. The symptoms of all three patients

improved significantly after 12 months of following a gluten-free diet plus other modalities.


Do not self diagnose if in suspicion please contact either myself or a registered dietitian before following a gluten free diet.

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