Coeliac Disease and gluten sensitivity – what’s the difference?

Coeliac Disease and gluten sensitivity – what’s the difference?

What is the difference between Coeliac Disease and gluten sensitivity? Well, both Coeliac Disease and gluten sensitivity may cause unpleasant symptoms when gluten is consumed however; the answer to this is a little more complex.

What is gluten?

In order to understand the difference between gluten sensitivity and Coeliac Disease, we first need to understand what gluten is.

Gluten is a protein that is found in grains such as wheat, rye, barely, and oats where it acts as a glue-like substance binding the grains together.
Gluten may be confused for fructans which are a type of carbohydrate. Fructans are long chains of fructose, specifically, oligosaccharides and polysaccharides. These are FODMAPs and are also found in wheat and many other foods such as garlic, onion, and other vegetables. If you are on a low FODMAP diet, you may be minimising your intake of fructans.

In summary gluten is a protein that may cause symptoms in people with gluten intolerance or sensitivity and fructans are carbohydrates which may trigger symptoms in people with IBS. There are many foods that contain both gluten and fructans however, that is not always the case. Not all gluten free foods are low FODMAP and not all low FODMAP foods are gluten free.

To make a gluten-containing food ‘gluten free’, the gluten needs to be removed. Often, when gluten is removed from a food, some of the fructans (FODMAP) are also removed. This process of making a food product ‘gluten free’ may also lower the FODMAP content in a food. So when many people start eating gluten free and feel symptom improvement, it is quite often related to the reduction of FODMAPs, as opposed to the gluten. This is not the case for those with Coeliac Disease though. Step 1 if you are having symptoms is to see a doctor before making any dietary changes to rule out Coeliac Disease or any other red flags. Your doctor will run tests and may send you to a gastroenterologist for a diagnosis. Once you have this, you should work with a Gut Health Dietitian to help you reduce your symptoms and support you in meeting your nutrient requirements.

Coeliac Disease

This an autoimmune disease which means that your immune system accidently attacks your body. Consequently, when people with Coeliac Disease consume gluten, their immune cells, specifically T-cells, attack themselves. When this happens, it damages the villi in the intestines and therefore, can cause further complications such as malabsorption of nutrients. This means that when there is continuous intestinal damage caused from consuming gluten over a long period of time, nutrients from other foods (even ones that don’t contain gluten) may not be absorbed well. This is as the intestines may be too damaged to work properly and absorb the nutrients they should normally be absorbing. This may lead to other symptoms occurring such as fatigue. Anaemia is another possible symptom, if iron isn’t well absorbed; or joint and bone pain if calcium isn’t well absorbed.
Even when gluten is removed from the diet, the intestines can take months to completely heal.

Not only does gluten cause intestinal damage, but it can also cause very painful symptoms when consumed. Even the smallest particle of gluten such as a crumb in the toaster can cause a serious reaction. If you have Coeliac Disease, you need to completely cut out gluten to zero traces of gluten. It is important to see your doctor to get a definitive diagnosis. Your doctor can test for Coeliac Disease using a coeliac serology which is a blood test that measures the levels of an antibody called transglutaminase. A positive blood test must be coupled with a small bowel biopsy, which looks for the bowel damage associated with undiagnosed Coeliac Disease.

Gluten sensitivity

Non-coeliac gluten sensitivity or gluten intolerance is a functional sensitivity only. This means that a gluten sensitivity or intolerance does not cause any long-term intestinal damage unlike Coeliac Disease. However, if you are gluten sensitive or intolerant, gluten can cause symptoms which can be uncomfortable or painful. Often these symptoms can overlap with IBS symptoms, so again, it is best to see your doctor in order to get a diagnosis.
Although with Non-coeliac gluten sensitivity/gluten intolerance, eating gluten will not have the serious consequences and internal damage as associated with Coeliac Disease. So, there is no need to be as strict with gluten restriction. For example, if you have Coeliac Disease, you should not share a toaster with people who eat gluten due to cross-contamination. However with gluten intolerance, you do no need to worry about cross-contamination that may occur in a toaster, as a crumb of gluten containing bread will not cause damage.

In summary

If you feel sensitive or intolerant to gluten, it is important to get a definitive diagnosis from your doctor prior to limiting your gluten intake.
You can work with your Doctor, Gastroenterologist and Accredited Practising Dietitian to navigate your Coeliac Disease or gluten intolerance/sensitivity.
As always, see a Dietitian for more personalised support for your diet.

Written by: Ijmeet Maan, Accredited Practising Dietitian
Reviewed by: Kiarra Martindale, Accredited Practising Dietitian