Demystifying Coeliac Disease, Non-Coeliac Gluten Sensitivity + Wheat Allergy - some ‘digestible’ facts!

In this post, I aim to demystify and disentangle three conditions; Coeliac Disease, Non-Coeliac Gluten Sensitivity + Wheat Allergy. I want to give you a brief overview of all three, with my goal being to differentiate them in simple terms.

1.     Coeliac Disease

·      According to Coeliac UK, - ‘Coeliac disease is common and affects one in 100 people. However only 30% who have the condition have been diagnosed which means there are currently nearly half a million people who have coeliac disease but don’t yet know.’

·      If a close relative, such as a mother, father, sister or brother has the condition then the chances of having the disease increases to 1 in 10. So, sadly that means that you need to get everyone who is a first-degree blood relative tested as well if you have a positive diagnosis for coeliac disease.

What is it?

In essence, it is when the body’s own immune system attacks its tissues when you eat gluten. This process damages the lining of the gut – and in particular the villi in the small intestine, resulting in the body not being able to absorb nutrients from the food you eat. (see the diagrams below to visually explain this better)

Coeliac disease is not an allergy or a food intolerance.

Symptoms

So, how do you know if you have Coeliac disease?

There are so many symptoms, and they are far reaching, making diagnosis hard. However, they can be split into the following categories:

Gastro-Intestinal Symptoms (GI) – this is the most common category

Chronic Diarrhoea

Malabsorption

Severe constipation

Vomiting

Abdominal bloating

Burning stomach

Abdominal pain

Nausea

Weakness

Anaemia

Acid reflux

Failure to grow + thrive in children

Weight loss

Note: because of the way that coeliac disease can affect the gut, it is sadly frequently mis-diagnosed as IBS.

Shared symptoms of Coeliac Disease + IBS

Bloating

Constipation

Diarrhoea

Flatulence

Muscle cramps

IBS specific symptom

Mucus in the stool

Nervous system symptoms of Coeliac Disease

Depression

Neuropathy (numbness + weakness of the nerves)

Anxiety

Ataxia (jerky movements, uncoordinated)

Panic attacks

Palsy (especially weakness + drooping of facial muscles)

Mood disorders

There are now links to:

Schizophrenia

Autism

Bipolar Disorder

ADHD

Psychosis

Dementia

Other conditions not normally linked to Coeliac Disease

Infertility

Mouth sores

Ulcers

Skin rashes – dermatitis herpetiformis

Alopecia

Other auto-immune diseases

Elevated liver enzymes

Diagnosis

There are a few ways that doctors can diagnose coeliac disease:

·     A biopsy of the small intestine

·     An endoscopy to view images of the villi

·   A blood test to measure amounts of certain antibodies that are commonly elevated when reacting to gluten

·      Those with a first-degree relative with the condition may be more likely to also have it; therefore, genetic testing can be used to diagnose coeliac disease. *It is however not the case that if you have the gene you have coeliac disease. It has been estimated that 30-40% of the population has one or both of the genes (HLA-DQ2 and HLA-DQ8) but only 1-3% of the population actually gets the disease. Therefore, having 1 or both of the genes just means you are at a higher likelihood of getting the disease. So, what causes these genes to get ‘switched on’? I will explore this question in a later blog, as this refers to epigenetics.

·      The genetic testing route is popular for children, as it is less invasive and incorporates a saliva swab from the mouth.

2.   Non-Coeliac Gluten Sensitivity (NCGS)

·     Whilst the symptoms of non-coeliac gluten sensitivity and coeliac disease can often be similar – they are two different conditions.

·     It is currently not clear how the immune system might be affected, but there does not appear to be damage to the lining of the gut.

·    NCGS is a condition that is being recognised as a problem in many countries across the world. This is a relatively new area and there needs to be more research done to understand the risks better.

Key facts:

·     There are no specific diagnostic tests for NCGS

·    The removal of gluten from the diet and the improvement in NCGS symptoms is an indicator that there is a sensitivity. It is therefore considered a ‘diagnosis of exclusion.’

·     According to a recent general population study – 13% reported symptoms attributed to gluten. Whilst the actual number is unconfirmed, the prevalence of NCGS is considerably higher than that of Coeliac Disease, and it is on the rise.

·    Please do refer to my first blog post on the subject – ‘Making sense of Non-Coeliac Gluten Sensitivity’ – in which I share my own personal journey with testing for gluten sensitivity.

·     Make sure that you first get tested for Coeliac Disease – this is a simple blood test from your GP. Make sure you do this before you start to eliminate gluten from your diet. This is very important as you need to have been ingesting gluten regularly for at least 6 weeks (12 is optimal) for the test to be accurate. *I must add in here, with regards to my personal journey with testing – that I had not been regularly ingesting gluten prior to the blood test for Coeliac Disease. I had only managed 2 weeks of regular consumption of gluten containing products. My symptoms were so elevated and unbearable, that I refused to consume gluten for any longer. I therefore made the personal choice to accept that the test was negative, but that it may not have been accurate. I therefore strictly do not consume gluten products, and avoid them as far as I am able. On the very rare occasion that I accidentally do consume a tiny amount, sometimes referred to as ‘being glutened’ – the reaction is strong and unpleasant. Therefore, the personal choice to avoid gluten comes with no remorse! I will write more on this in a further post.

Symptoms of Non-Coeliac Gluten Sensitivity

Abdominal pain

Eczema

Itchy skin

Anaemia

Fatigue

Depression

Headache

Diarrhoea

Joint pain

If NCGS is a diagnosis that you have been given – then I am here to help guide you and make the transition to gluten free living easier and hopefully just as delicious!

3.    Wheat Allergy

·     Individuals with a wheat allergy have an allergic reaction to wheat.

·     Unlike coeliac disease and NCGS – adverse reactions occur almost immediately (within less than 2 hours)

·     Unlike coeliac disease and NCGS, people with a wheat allergy do not necessarily have to follow a strict gluten-free diet. All wheat should be avoided, but products using rye and barley may be acceptable. *Always check the packet though to understand if the product could have been handled by equipment that could have processed wheat.

·    Diagnosis – wheat allergy is more likely to occur in children – however some children can outgrow it. A skin prick test may be used to diagnose, but blood tests are considered more accurate.

Symptoms of a Wheat Allergy

Sneezing

Rashes

Swelling of the throat

Hives

Nausea/vomiting

Anaphylaxis (in extreme cases)

Diarrhoea

Please do ask questions in the comments below and I will of course endeavour to answer them from an integrative nutrition stance point. Thank you for taking the time to read this, and I do hope that it has been in some way useful.

                                                                                                                        Love Sammy X