In American today many people are having difficulty eating food containing gluten, which is a protein found in the grains Barely, Rye and Wheat. Some of those have Celiac Disease and others have what is termed Non-Celiac Gluten Sensitivity (NCGS) or Gluten Intolerance. The “Gluten Free Diet” is helping many people and has taken over as the most popular diet in the US. Let’s look at the differences between Celiac and NCGS.
Celiac is an autoimmune disease which requires three components to be activated:
- The physiological reaction to gluten and damage to the lining of the small intestine.
- The genetic component of the gene HLA DQ2 or HLA DQ8.
- Some type of assault that brings on the disease whether by a physical injury, negative psychological strain or stress, infection, another autoimmune disease, etc.
Checking for Celiac requires a blood test for tTG (anti-tissue transglutaminase) IgA + EMA and total IgA. If these blood tests show positive results, a biopsy is usually recommended to confirm the diagnosis. A biopsy allows for a visual examination of the small intestine and will capture tissue samples in order to check the villi for damage.
Non-Celiac Gluten Sensitivity has many of the same physical and medical symptoms as Celiac. It does NOT, however, have an autoimmune mechanism resulting in damaged tissue. At this time there are no specific biomarkers available to diagnose NCGS. The first step is to rule out the diagnosis of Celiac Disease or a Wheat Allergy. Currently, it seems as if NCGS mainly affects adults. After eating gluten-containing foods, people may complain of abdominal pain, diarrhea, bloating or extra-intestinal issues with mental confusion (foggy brain), headaches and even muscular aches. NCGS reactions usually happen within hours or days of eating gluten, where Celiac can take weeks or years of exposure to react with recognizable symptoms.
Wheat Allergy has an immediate anaphylactic response, similar in nature to that of a peanut allergy. A Wheat Allergy can be diagnosed with a skin prick test, a blood test for wheat specific antigens (IgE) and a gluten challenge.
NCGS is determined by assessing the symptoms and complaints after Celiac has been determined to not be a factor. When removal of gluten from the diet provides relief from the complaints, NCGS can be the problem. Then a gluten challenge, a time of adding gluten-containing food back to the diet, should be tried. If the symptoms return, NCGS again can be reasoned to be the problem. The person can begin following a strict Gluten Free Diet to alleviate the issues.
(*Note: DO NOT Start a Gluten Free Diet before getting the tTG test which evaluates the body’s reaction to gluten. Remove the gluten, remove the reaction, there is no immune antigen produced and a false negative test will result).
If the Gluten Free Diet is not helpful, other things should be considered like assessing for Candida (overgrowth of GI fungus), SIBO (small intestinal bacteria overgrowth) or possibly a trail of a FODMAP or other diet. A Registered Dietitian can help walk you through this process.