Gluten intolerance versus an allergy

Posted on 20 September 2016

Gluten intolerance is on the rise. But how can you know for sure whether you’re allergic, sensitive or intolerant?

Dr Eduan Deetlefs, a gastroenterologist at Mediclinic Milnerton, explains that there’s a spectrum of gluten-related diseases. ‘The most severe and serious is celiac disease, an autoimmune condition in which your body’s immune system attacks the small bowel. This occurs if you have certain predisposing genetic abnormalities and when you eat gluten, which is found in wheat, barley and rye.’ Other gluten-related conditions include gluten allergy and non-celiac gluten sensitivity.

The usual symptoms of gluten intolerance

Dr Deetlefs says non-celiac gluten sensitivity mainly presents with intestinal symptoms, and although disabling in some it does not lead to serious long-term problems.

‘Symptoms of non-celiac gluten sensitivity are similar to irritable bowel syndrome, including bloating, abdominal pain, cramps, constipation and diarrhoea,’ he says, adding that although gluten sensitivity is a controversial condition, it is now mostly recognised as a medical condition.

A gluten or wheat allergy usually manifests with skin rashes or eczema, and can even cause breathing problems.

Diagnosing gluten intolerance or sensitivity

There is a blood test available to diagnose celiac disease, along with a biopsy taken from the small bowel during a gastroscopy, Dr Deetlefs explains.

For allergies there is a blood and skin test, but for non-celiac gluten sensitivities there is no test.

‘The usual way to diagnose gluten sensitivity is with an elimination diet,’ says Dr Deetlefs. ‘Not only gluten, but also other foods could have a similar effect and cause sensitivity. We think sensitivity could be related to substances in food called FODMAPS [short-chain carbohydrates that are poorly absorbed in the small intestine]. These cause your gut bacteria to produce gas, which then leads to bloating, gas and bowel hypersensitivity along with altered bowel habits. There is a big overlap between gluten sensitivity and IBS [irritable bowel syndrome], but the right diet will help both.’

Gluten issues, fact or fad?

‘Non-celiac gluten sensitivity is not a new condition,’ clarifies Dr Deetlefs. ‘I suspect that gluten or wheat sensitivity has been troubling some people for a while, but because of a greater awareness the condition is now more often diagnosed. I think to some extent the condition might also be promoted by fad diets. Some people are just more sensitive to carbohydrates, including wheat and gluten – and now the sensitivity has a name.’