Gluten has become a hot topic in recent years, with a growing number of people eliminating it from their diets. However, many remain unclear about the distinctions between gluten intolerance and coeliac disease, and even use the two terms interchangeably.
While both conditions involve a reaction to gluten, a protein found in grains like wheat, barley, and rye, they differ significantly in their causes, symptoms, and management. Understanding these differences is crucial for effective diagnosis and management. To do the same, we at OnlyMyHealth interacted with Dr. Piyush Ranjan, Vice-Chairperson, Institute Of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, New Delhi.
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What is Gluten?
Dr Ranjan explains that gluten is a type of protein found in the outer layers of grains such as wheat, barley, and rye. It is responsible for giving dough its elasticity and helping baked goods maintain their shape. However, in some individuals, gluten can cause adverse reactions ranging from mild discomfort to severe autoimmune responses.
What is Coeliac Disease?
“Coeliac disease is an autoimmune disorder that affects at least 1% of the global population. When individuals with this condition consume gluten, their immune system mistakenly attacks the lining of the small intestine”, says our expert. Over time, this immune response damages the villi, the tiny, finger-like projections in the intestine responsible for nutrient absorption. This damage leads to malabsorption of essential nutrients.
What is Gluten Intolerance?
“Gluten intolerance, also known as non-coeliac gluten sensitivity (NCGS), is less severe than coeliac disease. People with gluten intolerance may experience symptoms like bloating, gas, diarrhoea, and abdominal pain after consuming gluten”, says Dr Ranjan. However, unlike coeliac disease, gluten intolerance does not involve an autoimmune reaction or intestinal damage.
The symptoms of gluten intolerance typically subside when gluten is removed from the diet and return when it is reintroduced. Importantly, while gluten intolerance can cause significant discomfort, it does not have the long-term health risks associated with coeliac disease.
Expert Tips To Differentiate Between The Two
One can simply use this as a guide to map out the difference between the two by comparing the causes, genetic basis, and symptoms of each, according to our expert.
1. CAUSE
Coeliac disease is triggered by an autoimmune reaction to gluten. The immune system mistakenly attacks the small intestine.
Gluten intolerance is caused by a sensitivity to gluten but without an autoimmune or allergic response.
2. GENETIC PREDISPOSITION
Coeliac disease commonly has a genetic link and often runs in families. Specific genes like HLA-DQ2 or HLA-DQ8 are involved.
Gluten intolerance has no genetic connection.
3. DAMAGE TO INTESTINE
Coeliac disease causes significant damage to the villi in the small intestine, leading to malabsorption of nutrients.
Gluten intolerance does not cause any physical damage to the intestine.
4. SYMPTOMS
Coeliac disease manifests as chronic and severe symptoms, such as,
- Chronic diarrhoea
- Anaemia
- Weight loss
- Fatigue
- Bloating
- Abdominal pain
While gluten intolerance manifests as temporary and milder symptoms, such as,
- Bloating
- Abdominal discomfort
- Gas
- Diarrhoea
How is Coeliac Disease Diagnosed?
Dr Ranjan says that diagnosing coeliac disease typically involves,
- Screening for specific antibodies, such as IgA anti-tissue transglutaminase (anti-TTG) or IgA anti-endomysial antibodies (EMA).
- Looking for HLA-DQ2 or HLA-DQ8 genes, which are present in most people with coeliac disease.
- Confirming damage to the villi in the small intestine through a biopsy.
How is Gluten Intolerance Diagnosed?
There is no definitive test for gluten intolerance. Diagnosis is often made by exclusion, ruling out coeliac disease and wheat allergy through blood tests and food elimination trials. Symptoms typically improve when gluten is removed from the diet.
Specific Management Of These Gluten-Induced Issues
For those diagnosed with coeliac disease, the only treatment is a strict, lifelong gluten-free diet, as per Dr Ranjan. Even small amounts of gluten can cause damage to the intestines and lead to severe complications. Foods containing wheat, barley, and rye must be completely avoided, and cross-contamination with gluten-containing foods should be carefully managed.
In contrast, gluten intolerance does not require such strict adherence to a gluten-free diet. Many people with gluten intolerance can reintroduce gluten after a period of elimination, depending on their tolerance levels.
When Should You Seek Medical Advice?
If you experience gastrointestinal discomfort, persistent fatigue, or unexplained weight loss after consuming gluten, seek medical advice. A specialist can help differentiate between coeliac disease, gluten intolerance, and other potential conditions, such as irritable bowel syndrome (IBS) or wheat allergy.
Takeaway
Misdiagnosing gluten intolerance as coeliac disease can lead to unnecessary dietary restrictions, while overlooking coeliac disease can have serious health implications. If you suspect you have a gluten-related condition, consult a gastroenterologist who can recommend appropriate testing and dietary guidance.