Celiac disease, non-celiac gluten sensitivity, and wheat allergy - what’s the difference?
Working in hospitality for a large portion of my early working life I saw the rapid growth of ‘gluten-free’ requests. Often people would say ‘a little bit is fine…’ and the chefs would roll their eyes assuming people were just following a new diet trend, but celiac disease is not the only reason people avoid gluten.
Celiac disease (CD) occurs in 1 in 100 people and is often left undiagnosed until very late in life. CD is a genetic autoimmune condition and consists of an immune reaction to gluten and gluten containing products. The immune-mediated response causes damage to the intestinal mucosa and atrophy of the intestinal villi which results in the inability to digest and assimilate nutrients. Treatment of CD requires a strict life-long gluten-free diet. 25% of those who suffer with CD will have other autoimmune conditions present in their lifetime.
Non-celiac gluten sensitivity (NCGS) is a growing concern among the general population, and especially in young females. NCGS is a symptomatic presentation caused from consumption of gluten products, be it as gastrointestinal distress, skin presentations, immune responses, or reduced cognitive performance. NCGS does not present with the same immune reaction as CD however has shown to produce increased intestinal lymphocytes and an inflammatory response. Gluten exposure in sensitive individuals alters the intestinal barrier and leads to an increase in intestinal permeability, which can lead to a myriad of conditions including autoimmune disease. NCGS currently has no definitive diagnosis and is commonly identified through process of elimination. While a gluten-free diet is highly recommended for those suffering with NCGS to prevent further damage, depending on the severity of the condition not everyone will observe symptoms from mild consumption.
Wheat allergy (WA), one a little more foreign but very serious. Wheat allergy most commonly presents in children who outgrow it by school age, however in those who do not outgrow it, it may present as a life-long risk of anaphylaxis like any other food allergy. WA occurs in 0.4% of children and 65% of those have outgrown the allergy by the age of 12. WA is an IgE mediated response which means an immune-reaction occurs immediately - unlike non-IgE reactions such as in NCGS which can occur up to 48 hours later. Treatment of WA in a strict wheat-free diet like the treatment of any other food allergy.
With gluten-related conditions becoming more prevalent, a sustained gluten-free diet is appropriate in many people including those who do not suffer WA or CD.
