If you have digestive problems after eating bread, pasta or cereal, there is a chance that you do not tolerate gluten well or even have coeliac disease. But how do you tell the difference between gluten sensitivity and coeliac disease?
Both gluten intolerances can have similar symptoms, including diarrhea, nausea, vomiting, bloating, fatigue, headaches, joint and stomach pain, but they are fundamentally different. So how do you know which one you have?
The symptoms occur after eating gluten, a protein found in wheat, barley, rye and related grains. Foods made from these grains, such as bread, pasta, sauces and cereals, as well as treats such as cakes, cookies and pizzas, also contain high levels of gluten.The only way to find out if you have celiac disease or gluten sensitivity (also known as non-celiac gluten sensitivity (NCGS)) is to see a doctor. Remember, it's always best to speak to a professional rather than self-diagnose, as you may need tests to rule out other conditions. If you have coeliac disease, it's important that you get the right treatment and advice. In the meantime, here are seven tips to help you understand the differences between gluten sensitivity and coeliac disease.
1) Gluten intolerance is much more common
Around one in 100 people in Germany have coeliac disease, but only just under 20% of them have been diagnosed with full-blown coeliac disease - which means that more than half a million Germans are unaware that they have it.
While coeliac disease only affects around 1% of the German population, or just under 800,000 people, it is thought that up to 7% of Germans suffer from gluten sensitivity. This means that a good 5.7 million people in Germany alone are affected and are often restricted in their quality of life. Almost everyone knows at least one person who does not tolerate gluten well.
2) Celiac disease is an autoimmune disease
Coeliac disease is a serious illness in which the body's immune system attacks itself when gluten is consumed and damages the intestinal mucosa.
In gluten sensitivity, it is still unclear how the immune system is involved, but symptoms can be similar to those of someone with coeliac disease. Gluten sensitivity is also thought to be caused by an inflammatory reaction. Fortunately, however, there is little evidence to date that this causes long-term damage to the intestinal mucosa.
3) People with coeliac disease are also very likely to have other autoimmune diseases
These include diseases such as type 1 diabetes and autoimmune thyroid disorders.
The likelihood of developing other autoimmune diseases can be significantly increased if the diagnosis of coeliac disease is delayed or the gluten-free diet is not adhered to.
4) Coeliac disease is genetic
While the exact cause of coeliac disease is still unknown, the presence of certain genes (HLA-DQ2 and HLA-DQ8) increases the risk, so people with a first-degree relative (parent or sibling) who has coeliac disease are more likely to have these genes and have a higher risk of developing coeliac disease themselves in their lifetime.
Actress Caroline Quentin, who was diagnosed with celiac disease two years ago after suffering from symptoms such as fatigue, diarrhea, vomiting and mouth ulcers for years, tested positive for genes linked to the disease.
She believes her late mother had celiac disease because although she was never diagnosed, she had very bad digestive problems throughout her life and eventually suffered from anemia and osteoporosis, both of which are closely linked to untreated celiac disease.
Almost 98% of coeliac disease patients carry one of the two genes, but so does a proportion of the population who do not have coeliac disease. Therefore, the presence of the two genes alone is not sufficient to make a diagnosis.
5) Celiac disease can be definitively diagnosed
Coeliac disease can be diagnosed by blood tests, such as the detection of the specific antibody transglutaminase (TG-Ak). A biopsy of the intestinal villi lining the small intestine is carried out if TG-Ak levels are too high. The background to this is that gluten consumed by people with coeliac disease triggers the immune system to attack the intestinal mucosa. The villi absorb nutrients and the attacking immune system destroys and smoothes them out so that fewer nutrients are absorbed. This can lead to a collective nutrient deficiency and trigger the aforementioned symptoms.
There are no reliable blood biomarkers for gluten sensitivity, so the diagnosis is made based on the symptoms experienced. However, tests should be performed to rule out celiac disease and wheat allergy. A biopsy would not be useful if a person only had gluten sensitivity as the condition does not damage the gut.
6) Celiac disease can lead to serious complications
The intestinal damage caused by coeliac disease means that nutrients from food cannot be properly absorbed. If left untreated, celiac disease can lead to other conditions, including osteoporosis, infertility and anemia. It is also associated with a higher risk of certain cancers.
People with gluten sensitivity do not have a higher risk of these complications.
7) Patients with coeliac disease must not eat gluten
Even the smallest trace of gluten has consequences for people with coeliac disease. Scientists agree that even a few milligrams of gluten can damage the intestinal mucosa. In very sensitive people, just one milligram a day is enough to cause chronic inflammation and damage.
A strict gluten-free diet helps to control the symptoms so that the damaged intestine can heal. Eating any small amount of gluten again will cause further damage. People with coeliac disease should therefore do everything they can to avoid ingesting gluten. However, gluten is often ingested unknowingly, for example through contamination or residual gluten in products labeled gluten-free (20 ppm rule). Studies show that even with a supposedly gluten-free diet, unintentional gluten intake can range from 150 mg to 400 mg per day. Products such as GluteoStop® can help by functionally supporting the breakdown of gluten traces in a gluten-free diet.
People with gluten sensitivity can often tolerate small amounts of gluten without developing symptoms. It is therefore a matter of finding the personal tolerance limit so that no symptoms occur. This is often a long process and requires a lot of patience. GluteoStop® can also be a valuable tool for these people to raise their personal tolerance threshold.