This week on #AskADietitian live, I cover the differences about IBS, celiac, and non-celiac gluten sensitivity – there are IMPORTANT differences, and management varies!
Get the facts on the latest research!
The big takeaways:
What is celiac disease?
Celiac disease is an autoimmune condition, wherein your immune system responds to gluten exposure by destroying the lining of your small intestine. It is not curable, but rather can be managed by a life-long adherence to a gluten free diet. THIS is the disease where exposure matters. Even crumbs can make those with celiac disease unwell. Diagnosis typically in Canada requires a blood test and a biopsy.
IBS is a functional gut disorder. It is not harmful to your health in the way that celiac is (from a damaging perspective), however it can greatly impact quality of life! Read all about it here and here. The best evidence for management is the low FODMAP diet, but at Ignite, we do things a bit differently – encompassing our 4-pillar approach. Find out more about it here.
Non-celiac gluten sensitivity
We don’t know a lot about non-celiac gluten sensitivity yet. In fact, I think we can even say – we’re not sure it’s gluten that’s causing the symptoms. We know that those with non-celiac gluten sensitivity cannot tolerate gluten/wheat, but they do not experience intestinal damage, and do not develop antibodies. It is not considered an autoimmune condition.
We also know it’s not an IgE mediated allergy (think bee stings, peanuts etc.).
We think it may be a non-IgE mediated allergy, triggering other pathways of the immune system (maybe like my sulphite sensitivity!)
The fact is, there is still a lot we don’t know about how the immune system functions – however – a small scale study was recently done to begin to understand the mechanisms of this.
Non-Celiac Gluten Sensitivity in IBS
A recent SMALL scale study, with no control group took a look at how the GI tract/duodenum changes when exposed to a wheat suspension (read: not isolating various components, thereby not fully understanding the cause yet – but still an important first step). 13/36 IBS patients exposed to this wheat suspension had increased lymphocytes, epithelial shedding, and GI permeability. The remaining 23 did not.
This is the first studies directly looking at luminal changes in the gut when exposed to wheat in those who struggle with GI issues.
YES – it’s exciting. But the fact is – we need more information. We don’t know the mechanism yet. We don’t know rates of occurrence in a population without IBS. We don’t know what component of the wheat suspension may have triggered it, and if it occurs with other foods.
If you suspect you may have an intolerance to gluten – NEVER cut it out as your ‘first line defence’. Go to your doctor. Get the blood test. If you remove gluten from your diet, it will make proper diagnosis extremely difficult.
Your diagnosis then determines management.
Working with an RD to begin to tease out if your symptoms are solely IBS, or if you may have non-celiac gluten sensitivity is your next step. While we don’t have a test for this, with proper implementation of diets like the low FODMAP diet, we can help to guide you through managing your GI symptoms and living with a better quality of life!
At Ignite, we help people with coordination of care, and a holistic approach to health and wellness. Work with one of our dietitians today!