Celiac disease vs. gluten sensitivity

I have a cousin who has had a gluten “allergy” for as long as I can remember. When I was growing up I didn’t know it had an actual name — celiac disease — and wasn’t truly an allergy. I just knew when my parents were hosting the family for dinner, our lasagna required rice noodles rather than “regular” noodles.

As I learned later in life, celiac disease is an autoimmune disorder induced by gluten proteins in wheat, barley and rye. The ingestion of gluten gives rise to antibodies that attack the small intestine. Celiac disease affects fewer than 1 percent of the U.S. population. For those with the autoimmune disorder, there is only one treatment — a strict, gluten-free diet.

Today, gluten intolerance, or gluten sensitivity, seems to be common terminology and has sparked the rise of gluten-free diets and the diagnosis of non-celiac gluten sensitivity. According to the National Foundation for Celiac Awareness, as many as 18 million Americans may have non-celiac gluten sensitivity. However, rather than being properly diagnosed, many are choosing to eat gluten-free by choice. 

In May, researcher Jessica Biesiekierski, Ph.D., with Monash University in Australia, released the results of a clinical trial focusing on the effects of gluten on those who self-diagnosed as having non-celiac gluten sensitivity. During her clinical trial, she discovered an alternative explanation for perceived gluten sensitivity — sensitivity to fermentable, poorly absorbed, short-chain carbohydrates (FODMAPs). Most gluten-containing products also contain FODMAPs, which are known to cause gastrointestinal issues. Biesiekierski wanted to see if FODMAPs, rather than gluten, were causing the gastrointestinal problems of those in the clinical trial. The trial found that in patients with a diet low in FODMAPs, gluten did not produce a negative effect. “Indeed, patients who believe they have non-celiac gluten sensitivity are likely to benefit from lowering their dietary intake of FODMAPs,” Biesiekierski said.

Based on Biesiekierski’s research, it is possible that non-celiac gluten sensitivity may not technically exist, but rather it is the FODMAPs causing the gastrointestinal issues. However, because the underlying causes of gluten sensitivity aren’t yet fully understood, more research is necessary to prove that gluten intolerance may not exist.

If you are experiencing symptoms that lead you to believe you may be gluten-intolerant, speak with your physician and get tested for celiac disease. For each diagnosed celiac patient, there are at least seven who go undiagnosed. If you test negative for celiac disease and are still experiencing symptoms, consider reducing your intake of FODMAPs. An diet unnecessarily devoid of gluten can be deficient in fiber and other vitamins and minerals. Reducing your intake of FODMAPs, however, can be healthier and less restrictive.

Before making any dietary changes, speak with your physician to ensure you are making healthy decisions for your lifestyle.