Written by Shaynie Ashkenazi, Nutritionist & Founding Director.

In the community, there is a lot of confusion between what Coeliac Disease (CD) and Non-Coeliac Gluten Hypersensitivity (NCGH) are.

Today we're breaking down the key differences between these 2 different phenomena, and in order to understand the differences, let's first go back to basics!

What is Coeliac Disease?

Coeliac Disease (CD) is an autoimmune disease, whereby the body rejects consumption of gluten. Gluten is a protein found in wheat, barley, oats and rye, and when consumed, causes inflammation and damage to the small intestine. (1).

The small intestine is lined with minuscule, finger-like projections called 'villi', which help to digest and absorb nutrients in food. (1) Without complete avoidance of gluten, villous atrophy occurs, which is when the villi become inflamed and flatten, reducing the intestinal surface area available for nutrient absorption. This is the major cause for nutritional deficiencies in patients with CD. (1)

Without treatment, individuals with CD can experience severe symptoms and various health concerns. Tap here to learn more.

What is NCGH?

This is a condition whereby symptoms of gluten ingestion i.e. bloating, pain, and alternating bowel habits, and also symptoms outside of the gut, are triggered in the absence of CD and wheat allergy. (2).

The symptoms often reported by individuals with NCGH include:

• Head ache
• Brain fog
• Fatigue
• Fibromyalgia-like muscle or joint pain
• Skin rash
• Anemia
• Leg or arm numbness

• Depression and/or anxiety

Many also report IBS-type symptoms, making it difficult to ascertain if the condition present is truly CD, IBS or NCGH.

How are CD and NCGH Diagnosed?

Coeliac Disease

Serology testing detects antibodies in the blood. Elevated levels of certain antibodies indicate an immune response to gluten ingestion.

Genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-DQ8) can be used to rule out CD. 

Intestinal biopsy and gluten challenge testing are effective diagnostic procedures.

A gluten challenge test is when when a person intentionally consumes gluten i.e. via wheat bread, to ascertain if the body produces antibodies, indicating that they have CD.

How are CD and NCGH Managed?

Coeliac Disease

The only known treatment is a lifelong, strict gluten-free diet. Eliminating all sources of gluten, including products containing trace amounts, will assist a person in managing their gut symptoms, while also promoting intestinal healing.

Non-Coeliac Gluten Hypersensitivity

If a person has tested negative for CD, it is recommended to undergo dietary gluten exclusion, with re-challenging, in order to determine a threshold of tolerance, and/or to rule out other dietary triggers (see below section about FODMAPs).

Generally, it is not necessary to adhere to a gluten-free diet as strictly, or for as long, as in the case of CD. The consequences of doing this include nutrient deficiency, and low dietary fibre intake, both of which may confer adverse health outcomes.

What About the Low FODMAP Diet?

FODMAP elimination can be useful in order to assist whether or not an individual is in fact reacting to gluten, and/or short-chain fermentable carbohydrates.

When consumed in either food or drink, FODMAPs can be poorly absorbed in the small intestine, causing gut symptoms like bloating, diarrhoea, and abdominal pain; similar symptoms to those experienced in untreated CD and NCGH.

However, FODMAPs are carbohydrates, not proteins, as is gluten. They are different molecules with different effects on the body in those affected by their consumption. Tap here to learn more about the differences between FODMAPs and gluten.

Where-to From Here

If you are experience ongoing gut, skin, mental health, and physical symptoms, it's time to book in to see your doctor to receive the correct diagnosis, followed by a visit to a gut health expert Accredited Practising Dietitian (APD) or Registered Dietitian (RD).

These 2 health professionals can put you on the right track to ensure you are meeting all your nutrition requirements for good health and wellbeing, and will equip you with the tools you need to take care of your gut health.

In the mean time, browse the below range of gluten free and low FODMAP food products, all of which are suitable for Coeliacs, NCGH's and people with IBS.

References

1. Coeliac.org.au. 2022. Coeliac Australia. [online] Available at: <https://www.coeliac.org.au/s/article/Coeliac-disease> [Accessed 3 August 2022].

2. Biesiekierski, J. & Iven, J.(2015). Non-coeliac gluten sensitivity: piecing the puzzle together. United European Gastroenterol J. 2015 Apr; 3(2): 160–165. doi: 10.1177/2050640615578388.

Gluten Free Products to Try