Seven differences between coeliac disease and gluten intolerance

If you think you may have gluten intolerance or coeliac disease, go to your doctor.

Coeliac disease and gluten intolerance are different things, writes Lisa Salmon

IF you have digestive problems after eating things like bread, pasta or cereal, there’s a chance you might be intolerant to gluten, or have coeliac disease. But how do you tell the difference?

The only way to find out whether you’ve got coeliac disease or gluten intolerance (sometimes called non-coeliac gluten sensitivity) is to see a doctor. You may need to have tests to rule out other things. Plus, if you do have coeliac disease, it’s vital you get the right treatment and advice. But in the meantime, here are some pointers to explain the differences between the two.

1. While coeliac disease affects just 1% of the population, up to 13% are thought to have gluten intolerance. Indeed, a 2015 survey found 10% of households contain someone who believes gluten is bad for them.

“Part of this comes down to a greater awareness of conditions like coeliac disease and gluten intolerance,” says GP Dr Seth Rankin. “However, it’s important to stress that the two conditions are very different.”

2. Coeliac disease is a serious illness where the body’s immune system attacks itself when gluten is eaten, damaging the gut lining. In gluten intolerance, however, it’s unclear how the immune system is involved, but Dr Rankin says: “If you’re gluten intolerant, you may experience similar symptoms to someone who has coeliac disease. But importantly, there’s no evidence to suggest this affects the lining of the gut.”

3. Coeliacs are more likely to have other autoimmune disorders, such as type 1 diabetes and autoimmune thyroid disease. The chance of developing other autoimmune disorders may be increased when diagnosis of coeliac disease is delayed.

4. While the exact cause of coeliac disease isn’t known, having certain genes increases the risk, so those with a first-degree relative (parents, siblings) who has coeliac disease are more likely to have these genes, and are at higher risk of developing it themselves.

It’s not yet known whether gluten intolerance is related to genetics.

5. Coeliac disease can be diagnosed by blood tests which pick up specific antibodies signalling the condition.

There are no reliable blood biomarkers for gluten intolerance, so it’s diagnosed based on the symptoms being experienced, though tests should be carried out to rule out coeliac disease.

6. The gut damage caused by coeliac disease means nutrients from food can’t be absorbed properly and, if left untreated, it can lead to other conditions, including osteoporosis, infertility and anaemia. It’s linked with a higher risk of certain cancers too. People with gluten intolerance aren’t at higher risk of these complications.

7. The tiniest trace of gluten should be off-limits for people with coeliac disease. Following a strict gluten-free diet should help control symptoms, allowing the damaged gut to heal. Eating any amount of gluten will cause further damage. People with gluten intolerance can often eat small amounts of gluten without symptoms. It’s often a question of discovering what’s comfortable for you, and finding ways to manage symptoms so they don’t cause distress.

However, it’s important to note, coeliac disease and gluten intolerance aside, gluten is not a ‘bad’ food. Dr Rankin adds: “The issue for me is the proliferation of the gluten-free fad and the rise in the belief that gluten is the enemy of health — it’s not.”


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