Gluten, a protein found in wheat, barley, and rye, has become a topic of increasing concern in recent years as more people report adverse reactions to gluten-containing foods. For some, consuming gluten triggers uncomfortable symptoms that can disrupt daily life, leading to the adoption of gluten-free diets. However, the reasons behind these reactions can vary, with the most common causes being gluten sensitivity and celiac disease. Although these conditions share some similarities, they are fundamentally different in terms of their causes, symptoms, and long-term health implications.
In this blog, we’ll explore the key differences between gluten sensitivity and celiac disease, with a focus on how these conditions affect individuals in India. We’ll also discuss how to recognize the symptoms, get a proper diagnosis, and manage each condition.
What Is Gluten?
Gluten is a group of proteins found in grains like wheat, barley, and rye. It gives dough its elasticity and helps it rise during baking. Gluten is present in many everyday foods such as bread, pasta, and cereals, as well as in processed foods like sauces and snacks. In India, gluten is a staple in many traditional dishes, especially in wheat-based foods like chapatis, parathas, and naan.
Understanding Celiac Disease
Celiac disease is an autoimmune disorder where the ingestion of gluten triggers an abnormal immune response in the small intestine. This response causes inflammation and damage to the lining of the small intestine, leading to malabsorption of nutrients. Over time, untreated celiac disease can lead to various health complications, including nutritional deficiencies, anaemia, osteoporosis, and an increased risk of certain cancers.
Symptoms of Celiac Disease
The symptoms of celiac disease can vary widely and may affect different parts of the body. Common symptoms include:
- Digestive Issues: Chronic diarrhoea, constipation, bloating, and abdominal pain.
- Weight Loss: Unintentional weight loss due to malabsorption of nutrients.
- Fatigue: Persistent tiredness and lack of energy.
- Anaemia: Iron-deficiency anaemia due to poor absorption of iron.
- Bone Health Issues: Osteoporosis or osteopenia due to calcium and vitamin D deficiencies.
- Skin Rash: Dermatitis herpetiformis, a blistering skin condition linked to celiac disease.
- Neurological Symptoms: Numbness, tingling in the hands and feet, or migraines.
In children, celiac disease can also cause delayed growth, behavioural issues, and dental enamel defects.
Understanding Gluten Sensitivity
Non-celiac gluten sensitivity (NCGS), also known simply as gluten sensitivity, is a condition where individuals experience symptoms similar to those of celiac disease after consuming gluten. However, unlike celiac disease, gluten sensitivity does not involve an autoimmune response or intestinal damage. The exact cause of gluten sensitivity is still not fully understood, and it’s considered a diagnosis of exclusion, meaning it’s diagnosed after ruling out celiac disease and wheat allergy.
Symptoms of Gluten Sensitivity
Symptoms of gluten sensitivity can overlap with those of celiac disease but are generally less severe. Common symptoms include:
- Digestive Issues: Bloating, gas, diarrhoea, or constipation.
- Fatigue: Feeling tired and lethargic after eating gluten.
- Headaches: Frequent headaches or migraines.
- Joint Pain: Unexplained joint or muscle pain.
- Mood Disorders: Anxiety, depression, or brain fog.
Unlike celiac disease, gluten sensitivity does not lead to long-term complications or damage to the small intestine. However, the symptoms can still significantly impact an individual’s quality of life.
Diagnosing Celiac Disease vs. Gluten Sensitivity
Accurate diagnosis is crucial for managing both celiac disease and gluten sensitivity. The diagnostic process for each condition differs significantly.
Diagnosing Celiac Disease
The diagnosis of celiac disease typically involves the following steps:
- Blood Tests: The first step is a blood test to check for specific antibodies, such as anti-tissue transglutaminase (tTG) antibodies. High levels of these antibodies suggest an immune reaction to gluten.
- Endoscopy and Biopsy: If the blood test is positive, a gastroenterologist will likely recommend an endoscopy, during which a small tissue sample (biopsy) is taken from the small intestine. The biopsy helps confirm the diagnosis by showing damage to the intestinal lining.
- Genetic Testing: In some cases, genetic testing for HLA-DQ2 and HLA-DQ8 genes may be conducted to determine the risk of celiac disease.
It’s important to note that these tests should be done while the patient is still consuming gluten. Going gluten-free before testing can lead to false-negative results.
Diagnosing Gluten Sensitivity
There is no specific test for gluten sensitivity, making it a diagnosis of exclusion. The diagnostic process typically involves:
- Ruling Out Celiac Disease and Wheat Allergy: A doctor will first perform tests to rule out celiac disease and wheat allergy.
- Gluten Challenge: If these conditions are ruled out, the patient may undergo a gluten challenge. This involves reintroducing gluten into the diet after a period of elimination and monitoring symptoms.
- Symptom Assessment: If symptoms reappear after reintroducing gluten and disappear when gluten is removed, gluten sensitivity may be diagnosed.
Managing Celiac Disease
For those diagnosed with celiac disease, the only effective treatment is a strict, lifelong gluten-free diet. This means completely avoiding all foods and products containing wheat, barley, rye, and their derivatives. Cross-contamination with gluten-containing foods must also be avoided.
Living gluten-free in India can be challenging due to the widespread use of wheat in Indian cuisine. However, awareness of gluten-free options is growing, and many traditional Indian foods, such as rice, lentils, and certain millet varieties, are naturally gluten-free.
- Gluten-Free Alternatives: Opt for gluten-free grains like rice, corn, millet, and buckwheat. Many gluten-free flours are also available, including rice flour, besan (gram flour), and tapioca flour.
- Read Labels Carefully: Be vigilant about reading food labels, as gluten can be hidden in sauces, soups, and processed foods.
- Dining Out: When eating out, communicate your dietary needs clearly and choose dishes that are naturally gluten-free, such as rice-based meals.
Regular follow-up with a healthcare provider is essential to monitor nutritional status and ensure adherence to the diet.
Managing Gluten Sensitivity
The management of gluten sensitivity also involves a gluten-free diet, but it may not need to be as strict as that for celiac disease. Some people with gluten sensitivity may be able to tolerate small amounts of gluten without severe symptoms. However, it’s important to listen to your body and adjust your diet accordingly.
- Gluten Reduction: Start by eliminating gluten entirely and then gradually reintroduce small amounts to see if symptoms reappear.
- Focus on Whole Foods: Emphasise a diet rich in fruits, vegetables, lean proteins, and naturally gluten-free grains.
Unlike celiac disease, gluten sensitivity does not require as stringent avoidance of gluten, but it’s important to identify and avoid the amount of gluten that triggers symptoms.
The Importance of Awareness and Education
In India, where wheat is a staple in many regions, understanding the differences between celiac disease and gluten sensitivity is crucial. Increased awareness can lead to earlier diagnosis, better management, and improved quality of life for those affected. Healthcare providers, educators, and the food industry all play a role in supporting individuals with these conditions.
For individuals experiencing symptoms that could be related to gluten, it’s important to seek medical advice rather than self-diagnose. A proper diagnosis ensures that you receive the appropriate care and dietary recommendations.
While gluten sensitivity and celiac disease share some common symptoms, they are distinct conditions that require different approaches to management. For those living with celiac disease, a strict gluten-free diet is essential to prevent long-term complications, while individuals with gluten sensitivity may have more flexibility in their diet.
At RPS Hospitals, we believe in preventative care and holistic healing. If you have any trouble processing gluten or any form of food, please reach out to us so we can guide on proper methods of care and diet.