If you experience digestive problems after eating bread, pasta, or muesli, there's a chance you don't tolerate gluten well, or even have celiac disease. But how do you tell the difference between gluten sensitivity and celiac disease?
Both gluten intolerances can exhibit similar symptoms, including diarrhea, nausea, vomiting, bloating, fatigue, headaches, joint pain, and stomach aches, but they are fundamentally different. So, how do you know which one you have?
Symptoms occur after consuming gluten, a protein found in wheat, barley, rye, and related grains. Foods made from these, such as bread, pasta, sauces, and muesli, as well as treats like cakes, biscuits, and pizzas, also contain a lot of gluten.
The only way to find out if you suffer from celiac disease or gluten sensitivity (also known as non-celiac gluten sensitivity (NCGS)) is to visit a doctor. Remember, it's always best to speak to a professional rather than self-diagnosing, as you may need tests to rule out other conditions. If you have celiac disease, it's important to get the right treatment and advice. In the meantime, here are seven pointers to help you understand the differences between gluten sensitivity and celiac disease.
1) Gluten intolerance is much more common
About one in 100 people in Germany has celiac disease, but only just under 20% of them have been diagnosed with a full clinical picture of celiac disease – meaning more than half a million Germans don't know they have it.
While celiac disease affects only about 1% of the German population, or just under 800,000 people, it is believed that up to 7% of Germans suffer from gluten sensitivity. This means a good 5.7 million people in Germany alone are affected and often experience a reduced quality of life. So, almost everyone knows at least one person who doesn't tolerate gluten well.
2) Celiac disease is an autoimmune disease
Celiac disease is a serious condition in which the body's immune system attacks itself when gluten is consumed, damaging the lining of the small intestine.
In gluten sensitivity, it is still unclear how the immune system is involved, but similar symptoms can occur as in someone with celiac disease. In gluten sensitivity, an inflammatory reaction is also assumed. Fortunately, there is currently little evidence that this causes long-term damage to the intestinal lining.
3) Celiac patients are very likely to have other autoimmune diseases as well
These include autoimmune diseases such as type 1 diabetes, rheumatoid arthritis, and thyroid disorders.
The likelihood of developing other autoimmune diseases can be significantly increased if the diagnosis of celiac disease is delayed or if the gluten-free diet is not followed.
4) Celiac disease is genetic
While the exact cause of celiac 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 celiac disease are more likely to have these genes and have a higher risk of developing celiac disease themselves during their lifetime.
Actress Caroline Quentin, who was diagnosed with celiac disease years ago after suffering from symptoms such as fatigue, diarrhea, vomiting, and mouth ulcers for years, tested positive for the genes associated with the condition.
She believes her late mother had celiac disease because, although she was never diagnosed, she had very severe digestive problems throughout her life and eventually suffered from anemia and osteoporosis, both of which are closely linked to untreated celiac disease.
Approximately 98% of celiac patients carry one of the two genes, but so do some people in the general population who do not have celiac disease. Therefore, the mere presence of the two genes is not sufficient to establish a diagnosis.
5) Celiac disease can be definitively diagnosed
Celiac disease is diagnosed through a blood test. This tests for specific tissue transglutaminase IgA antibody (tTG-Ab), sometimes endomysial (EmA-IgA-Ab) and total IgA. A biopsy of the intestinal villi, which line the small intestine, is performed when tTG-Ab levels are elevated. The reason is that gluten consumed by people with celiac disease causes the immune system to attack the intestinal lining. The villi absorb nutrients, and the attacking immune system destroys and flattens them, so fewer nutrients are absorbed. This can lead to 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 presented. 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 intestine.
6) Celiac disease can lead to severe complications
The intestinal damage caused by celiac 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 types of cancer.
People with gluten sensitivity do not have an increased risk of these complications.
7) Celiac patients must not eat gluten
Even the slightest trace of gluten has consequences for people with celiac disease. Scientists agree that even a few milligrams of gluten damage the intestinal lining. In very sensitive individuals, just one milligram a day is enough to cause chronic inflammation and damage.
A strict gluten-free diet helps control symptoms so that the damaged intestine can heal. Re-consuming any small amount of gluten causes further damage. Therefore, celiac patients should do everything possible to avoid gluten intake. However, gluten is often consumed 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 be 150 mg to 400 mg per day. Products like GluteoStop® can help by functionally supporting the breakdown of trace gluten in a gluten-free diet.
People with gluten sensitivity can often tolerate small amounts of gluten without developing symptoms. The goal here is to find the personal tolerance limit so that no symptoms occur. This is often a long journey and requires a lot of patience. GluteoStop® can also be a valuable tool for these people to raise their personal tolerance threshold.
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