Gluten – Gluten: coeliac disease, gluten sensitivity or wheat allergy?

In short: Gluten is a protein found in grains. Coeliac disease is an autoimmune condition that needs a medical diagnosis; gluten sensitivity and wheat allergy are different reactions. Knowing the differences helps you choose the right tests.

What is gluten?

Gluten is the main storage protein in several grains. It is found in wheat, barley, rye, spelt, triticale, emmer, kamut and green spelt. Oats and buckwheat are naturally gluten-free but can come into contact with gluten-containing grains during processing.

Coeliac disease

Coeliac disease is an autoimmune condition: contact with gluten inflames the lining of the small intestine. Over time the intestinal villi can be damaged. This can lead to nutrient deficiencies and symptoms such as digestive problems, weight loss, tiredness or bone and joint pain.

If coeliac disease is suspected, a blood test for specific antibodies comes first. Important: don't cut out gluten before the test – otherwise the result isn't reliable. People with coeliac disease must avoid gluten strictly.

Wheat allergy

A wheat allergy can be triggered by gluten but also by other proteins in wheat. Typical symptoms are diarrhoea, vomiting, abdominal pain or allergic reactions similar to hay fever.

Gluten sensitivity

Gluten (or wheat) sensitivity is a relatively new diagnosis. Its symptoms resemble coeliac disease: diarrhoea, abdominal pain, tiredness, headaches or muscle pain. As there are no specific markers, it is usually identified by ruling out coeliac disease and wheat allergy.

Gluten is then left out for a while. If symptoms improve, it is reintroduced in a controlled way to see how much you tolerate. A lifelong strict gluten-free diet, as in coeliac disease, is usually not necessary. Ancient grains such as einkorn or emmer are often better tolerated.

Why do many people tolerate wheat less well than before?

Wheat is a staple food and gluten has good baking properties – that's why it's in many processed foods. In the past, grain was fermented longer before eating, which can improve tolerance. Many modern breads are made very quickly. A long-fermented sourdough bread is often a good choice.

When should I see a doctor first?

If coeliac disease is suspected, or with unintended weight loss or blood in the stool, please have it checked by a doctor first.

Want to find out what you tolerate well? More here: Nutritional advice.

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