Gluten-free eating is on the rise. It has been suggested that around 8.5 million people in the UK are cutting out gluten from their diets (BBC, 2016), but why? This blog seeks to explain the difference between coeliac disease, wheat allergy and non-coeliac gluten sensitivity.
Coeliac disease
According to Coeliac UK, 1 in 100 Britons suffer from coeliac disease, although it is generally believed that many more suffer with milder, undiagnosed – or indeed misdiagnosed, e.g. as Irritable Bowel Syndrome – symptoms. Coeliac disease is not an allergy or an intolerance to gluten, but rather an autoimmune condition. When someone with coeliac disease eats gluten – a protein found in wheat, barley and rye, their immune system reacts by damaging the lining of the small intestine. As a multi system disorder, coeliac can affect most areas of the body, with symptoms including diarrhoea and/or constipation, nausea and vomiting, iron, vitamin B12 or folic acid deficiency, weight loss and neurological (nerve) problems such as ataxia (loss of coordination, poor balance). (Coeliac UK):
Undiagnosed and untreated coeliac disease may lead to developing osteoporosis (thin/brittle bones), infertility, lymphoma and certain bowel cancers. It is important to get the correct diagnosis and to follow a gluten free diet for life. Exposure to gluten, even in small doses, can damage the lining of the small intestine. It is therefore imperative that coeliac disease sufferers strictly avoid gluten in the diet. See the end of this blog for a list of gluten-containing and gluten-free ingredients.
Wheat allergy
Unlike coeliac disease, wheat allergy, as the name suggests, is an allergy. Wheat allergy sufferers react to various proteins found in wheat, with a reaction taking place immediately after wheat exposure. Exposure to these proteins (through consumption or, in some cases, as a contact allergy) triggers the production of allergy-causing antibodies (called IgE) and an overreaction of the immune system. The symptoms of a wheat allergy are more typical of a food allergy and more diverse, including gut reactions (stomach ache, vomiting, diarrhoea), skin reactions (itching, swelling, rashes) and respiratory reactions (runny nose, sneezing, coughing and wheezing). Wheat allergy is most prevalent in children under the age of three who, in many cases, outgrow the allergy.
Non-coeliac gluten sensitivity
Whereas coeliac disease and wheat allergies are recognised and usually straightforward to diagnose, gluten sensitivity is not. According to coeliac UK, it is not clear how the immune system is involved in triggering symptoms or how/which antibodies are associated with this type of sensitivity. Despite this, non-coeliac gluten sensitivity is recognised as an issue and a common complaint, with many sufferers reporting improvements in symptoms upon following a gluten-free diet.
A recent study carried out by Chris van Tulleken and his team for the BBC programme Trust Me, I’m A Doctor, looked at participants who claim to experience symptoms of non-coeliac gluten sensitivity as well as ones with no reported or suspected sensitivity. All of these were asked to cut out gluten from their diets for a month. Participants were unknowingly offered gluten-containing pasta rather than the gluten-free pasta the rest of the sample was given for periods of time during the month. Many of the participants who consumed gluten for two weeks of the experiment reported symptoms during this period.
However, the biochemical markers measured in participants suggested that the levels of inflammatory markers during gluten consumption did not show any significant differences/changes. Tulleken and his team are clear about the limitations of the study and express the fact that, other than the suggestion that more studies and more knowledge about this condition is necessary, no concrete conclusion about gluten sensitivity can be drawn from this experiment. Read more about the experiment here.
Gluten-free options
‘Free-from’ as a sector is growing rapidly. According to Mintel, the free-from market is set to reach £673m by 2020. Mintel’s research also shows that 12% of food innovations launched in the UK in 2015 claimed to be free from gluten.
Traditionally, gluten free options were sparse and typically considered inferior in flavour and texture to their gluten-containing counterparts. However, an increased focus on innovation in the free-from sector along with demands for gluten-free and other free-from products surging has led to a greater availability and increased popularity of gluten-free alternatives. 
Gluten-free guideline
The following is a quick overview of certain ingredients
Some ingredients that contain gluten:
  • Wheat, including bulgar wheat, durum wheat, Farro, Kamut, spelt/dinkel
  • Semolina (including couscous)
  • Triticale (wheat and rye hybrid)
Always check the following products for gluten-containing ingredients:
  • Pasta
  • Bread
  • Oats and oat-based products
  • Cakes, pastries, biscuits
  • Muesli and cereal products
  • Products that are cooked in batter or breadcrumbs
  • Soups, stews and ready meals
Ingredients and products that are generally safe to consume (always check the label first):
  • Buckwheat
  • Amaranth
  • Corn/maize, polenta
  • Millet, sorghum
  • Teff
  • Tapioca
  • Rice
  • Potato
  • Quinoa
  • Soya
  • Chestnut
  • Oats that are labelled gluten-free
If you are following a strictly gluten-free diet (for example, if you suffer from coeliac disease), always look out for gluten-free labels or the term ‘suitable for coeliacs’. Take caution with products that ‘may contain gluten’ or ‘may contain traces of gluten’ and ask the manufacturer if you are unsure about what this means to you.
NB! This blog recognises the importance of following a gluten-free diet as a diagnosed coeliac disease sufferer. However, this blog does not encourage excluding any food groups without consulting a dietitian or a GP first.