There has been a lot of discussion in the medical world about whether gluten intolerance, outside of Coeliac’s disease is really a thing. Before we launch into that, I first wanted to clarify the difference between Coeliac disease, and gluten intolerance.
Coeliac disease is a genetic autoimmune disease, triggered by the sufferer eating gluten. In fact we know the two genes responsible - HLA-DQ2 and HLA-DQ8. Now with any genetic condition, just because you have a mutation in the gene, doesn’t mean you display the disease. However it does increase your risk of having it at some stage in your life.
Non-Coeliac gluten sensitivity is entirely different. It was actually first identified in the 1970s in the case study of a woman who had the symptoms of Coeliac disease without being able to be diagnosed by any of the regular methods.
However it wasn’t until the last decade that non-coeliac disease gluten sensitivity really become popularised.
So what really is gluten...and why is it in our food?
Gluten is a type of storage protein found in wheat, rye, and barley. These storage proteins contain amino acids which are hard for the body to digest. In people with Coeliac’s disease, these undigested amino acids pass through the gut wall and trigger an immune response.
What are the symptoms of a gluten sensitivity?
This depends a little bit on whether the issues is Coeliac disease, or a gluten intolerance.
The shared symptoms include;
Loose bowels or constipation
Poor concentration / foggy brain
Symptoms specific to Coeliac disease include;
Presence of other conditions such as diabetes, thyroid disease, or infertility (when Coeliacs is left untreated)
Rash / skin issues
Nausea and vomiting
Bone and joint pain
Is there a reliable testing method for gluten problems?
The first test is to look for mutations in the two genes responsible for Coeliac disease. This is done via a blood or saliva test.
If the patient does show a mutation in one or both of the genes, the next step is to test their blood for Anti-IgA antibodies. This essentially shows if the body is producing an immune response. The other test which usually occurs at the same time is to check for damage to the gut wall.
If either of these tests come back positive, alongside the positive genetic test, it is most likely that the patient has Coeliac disease.
If any of the tests come back negative, particularly the genetic test, however the patient is showing symptoms similar to coeliac disease, it could be that they have a gluten sensitivity.
“Could”...Does that mean it could also be something else?
Yes. Many of the shared symptoms could also indicate any number of conditions not at all related to gluten.
Irritable bowel syndrome with FODMAPs, for example, being a trigger, is also possible. Other triggers could be lactose intolerance, or some other food sensitivity.
What can you do if you have these symptoms but don’t test positive for Coeliac disease?
There are currently no reliable tests for gluten sensitivity. Whilst there are many companies which claim to be able to test, none of these tests have been scientifically validated.
The most reliable method for diagnosis of a non-coeliac gluten sensitivity is through an elimination diet with a qualified nutritionist or dietitian.
With an elimination diet you have major trigger foods removed from your diet, and reintroduced to monitor for symptoms. This is the best way of figuring out which foods are causing your sensitivities outside of medically diagnosable Coeliac disease.