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Coeliac disease is just a gluten intolerance… isn’t it?

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Coeliac disease and gluten intolerances often get bundled into the same basket, but there’s a very real difference between them says dietician Claire Wylde

Nowadays, there is such a high demand for gluten free food. It’s really easy to find gluten free recipe books. The free-from aisle is bigger than ever and more and more restaurants offer a gluten free option or are simply built around the free-from concept.

So what’s driving the demand?

I think it’s a combination of factors. Following a gluten-free diet is certainly still a ‘trendy’ and in vogue diet. Perhaps more importantly, the awareness of coeliac disease is much better too. It also helps that testing is more affordable and accessible these days as well. That being said, there I would like to clear up some misconceptions that have been highlighted in the press. You may have seen them mentioned by TOWIE star Megan Mckenna, which is a shame.

Firstly coeliac disease is not associated with anaphylactic shock.  Secondly, having alcohol (beer, lagers, stouts and ales excluded) shouldn’t affect those that have coeliac disease any more than if you don’t have coeliac disease. Thirdly, whilst there are associations of bowel cancer in untreated cases, it’s a very rare complication and the risk is much less than previously thought. From what I have seen, once a patient has got their head around the concept of what the diet involves, life goes back to normal. Granted it is a new normal but is one where their life is not ruled by their diet.

So what’s the difference between coeliac disease and gluten intolerance? Is there any such thing as a gluten intolerance?

Coeliac disease is an autoimmune response to the protein gluten. This is found in oats, rye, barley and wheat. When gluten is ingested in those with coeliac disease an immune response is triggered. This response causes their own body to damage their gut. In the small intestine we all have ‘finger-like’ structures (called villi) which ‘grab’ hold of nutrients as they flow past. In coeliac disease, these structures are blunted and as a result the gut can’t work properly. The fantastic news is that once gluten is removed from the diet any damage caused previously is usually reversible. It does mean though that following a strict gluten free diet is for life not just until you start to feel better.

With regards to gluten intolerance none of the above need apply. Of course, the cramps, bloating, diarrhoea or constipation can still feel truly awful to the individual when they expose their gut to wheat. Crucially though, they will not be damaging it as someone with coeliac disease would do if they were exposed to even just a crumb. Coeliac disease and gluten intolerance certainly both exist and both can have really profound impacts on someone’s quality of life before being diagnosed.

From my experience however, a gluten intolerance is usually wrapped up in a pretty bow called Irritable Bowel Syndrome (IBS) and it often doesn’t come by itself. Whilst it can, I rarely see a patient who just has a gluten intolerance.

In fact, patients can even find their symptoms weren’t attributable to gluten as they thought after they see a dietitian. It could be fructans (a fermentable sugar) for example that was troubling them. However, by taking gluten out (the most talked about food offender) it also meant some of those fructan foods happened to be excluded too without realising it. Immediately the situation gets complicated because the true cause is masked.

If you feel you have a gluten intolerance just bear in mind that there are usually other food groups that are poorly tolerated. It isn’t really until all of them have been eliminated and re-introduced that thresholds are established. Then the full extent of intolerance is revealed. I would always advise that you see a dietitian to do this. It’s really easy to make mistakes or miss things and can potentially have a real impact on your health and even cause deficiencies if not done properly.

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