How to determine if you have coeliac disease or gluten sensitivity (or something else entirely!)
Gluten-free diets have become very popular in the last few years. In some people, gluten sets off a reaction in their gut that interferes with digestion, causing symptoms such as abdominal pain, gas, bloating, diarrhoea, constipation, lethargy, headaches, muscle and joint aches, mood swings or low mood and a reduced ability to absorb essential nutrients, particularly iron (resulting in anemia). In many cases eliminating gluten can alleviate these symptoms and increase energy and general well-being.
However, even though a gluten-free diet may make you feel better, it’s worth knowing whether you actually have a problem with gluten, because there may be another underlying problem that needs addressing. Other culprits can be irritable bowel syndrome (IBS), wheat intolerance, or inability to absorb certain types of sugar, all of which can cause similar symptoms to gluten sensitivity.
So, before you embark on your gluten-free journey, you need to do some detective work and make sure that it isn’t something else. “This is particularly the case with children, where unnecessary food restrictions should be avoided as much as possible,” says Coeliac NZ.
Coeliac disease or gluten sensitivity?
First, it’s important to recognise that coeliac disease is different to gluten intolerance. Both have similar symptoms, but “coeliac disease is a permanent, autoimmune disorder that causes a reaction to gluten which is found in wheat, barley, rye and oats,” according to Coeliac NZ. “In coeliac disease, the cells lining the small bowel (intestine) are damaged and inflamed. [The disease] is associated with positive coeliac antibodies on blood testing. Coeliac disease also requires a positive small bowel biopsy. Patients with non-coeliac gluten sensitivity (NCGS) will have normal coeliac antibody tests.”
Gluten intolerance (as opposed to coeliac disease) is hard to isolate, because there is no way to test for it. Both have similar symptoms, although diseases associated with coeliac disease, such as diabetes and thyroid disorders, are not associated with gluten sensitivity.
However, the symptoms may also be caused by something other than gluten. Eliminating gluten may coincidentally improve these symptoms even if it is not the root cause, so it is important to get properly diagnosed. A gluten-free diet may make you feel better simply because it has forced you to eliminate a lot of refined and processed foods, which put a strain on the digestive system and lead to inflammation.
If you think you may have coeliac disease, you should get tested for it before trying a gluten-free diet, as the diet could fool the test. At this point you should also consult your doctor to eliminate other possible health conditions such as IBS or other dietary issues.
If you don’t have coeliac disease but think you may be gluten intolerant, try eliminating just wheat first. You should try this for at least two to three weeks, as it can take a long time for the symptoms to subside. Wheat intolerance has similar symptoms but is much easier to manage, because you don’t have to rule out rye, oats and barley.
Unfortunately, it can be quite a lengthy process of trial-and-error to narrow down a food intolerance.
If eliminating wheat (but not other sources of gluten) doesn’t help, you can then try a gluten-free diet. You need to eliminate 100% of gluten for at least two or three weeks, then reintroduce it to see how your body reacts. The gut takes a while to repair itself, and to eliminate the gluten from your body completely, so you may not see an improvement in symptoms straight away.
When eliminating gluten (the same goes for wheat) you must eliminate it completely, because even the smallest amount can trigger the symptoms). This means checking the ingredients in everything!
Unless labelled as ‘gluten-free’ you can assume the following foods contain gluten: baked foods such as breads, biscuits, cakes, pastry, pizza bases. It is also in most breakfast cereals, pasta, battered or crumbed foods and stuffing.
In addition to the obvious sources, gluten is also often found in sauces, gravies and soups as a thickener; it is also in some medications and supplements, sausages, beer, soy sauce, and even lipstick!
If you genuinely suffer from coeliac disease or gluten intolerance, then following a gluten-free diet is well worth the effort. To start you off here is a gluten-free recipe!