Gluten sensitivity
The term “gluten intolerance”
Celiac disease means that you cannot tolerate gluten. In everyday speech, celiac disease is often referred to as “gluten intolerance.” However, celiac disease is not an intolerance but an autoimmune disease that requires a strict gluten-free diet. In addition to celiac disease, there are other conditions in which people feel better on a gluten-free diet, including something that has been called gluten sensitivity or wheat sensitivity and which in many cases may be a form of IBS. These other conditions have also been called “gluten intolerance,” which is confusing. To avoid misunderstandings, the term “gluten intolerance” should therefore be avoided entirely (i.e., for all conditions).
Sensitive to foods containing gluten?
Feeling like you can’t tolerate gluten is common today. What it really means is that you don’t feel well after eating foods that contain gluten. But it’s uncertain whether gluten itself is what causes the problems. It’s also impossible to test this on your own, because you can’t remove only gluten from your diet—other substances are removed too. So the cause of the symptoms may not be the gluten protein, but for example other proteins or a certain type of carbohydrate that is also found in wheat, barley, and rye.
There are many other proteins in wheat, barley, and rye. However, in many cases the symptoms seem instead to be due to a certain type of carbohydrates that are also found in wheat, barley, and rye.
Many names
There are several names and expressions for people who feel they do better on a gluten-free diet despite not having celiac disease. The first term, non-coeliac gluten sensitivity in English, was translated into Swedish as glutenkänslighet utan celiaki or icke-celiakirelaterad glutenkänslighet. Unfortunately, it has sometimes been called “gluten intolerance” (see above). Today, most researchers instead use the terms non-coeliac wheat sensitivity, vetekänslighet utan celiaki, or icke-celiakirelaterad vetekänslighet. This is because researchers are studying whether the condition is caused by some other component—rather than gluten—mainly in wheat.
The symptoms overlap
The symptoms of non-celiac wheat sensitivity can resemble those of celiac disease, such as abdominal pain, bloating, diarrhea, constipation, fatigue, and joint pain. Many symptoms also overlap with those of IBS (irritable bowel syndrome). Wheat protein allergy can also cause similar symptoms. There is still a lot that is unclear and controversial about non-celiac wheat sensitivity. Research is ongoing into the mechanisms, diagnosis, and prevalence. In some countries, non-celiac wheat sensitivity is determined by first carefully ruling out celiac disease and wheat allergy and then concluding that the person gets symptoms from gluten-containing foods and that the symptoms disappear on a gluten-free diet. In other countries (including Sweden), the diagnosis is not made because there is not enough information about what it actually is.
IBS and FODMAP
Wheat, barley, and rye contain a type of carbohydrate called fructans. They belong to the FODMAP group, which is an abbreviation for fermentable oligo-, di-, and monosaccharides and polyols. With IBS (irritable bowel syndrome), it’s common to be sensitive to different types of FODMAPs. Some studies suggest that many people who believe they are sensitive to gluten-containing foods are actually sensitive to fructans and may, rather than having non-celiac wheat sensitivity, have a form of IBS.
Many symptoms overlap with IBS
Undiagnosed celiac disease.
Many people have celiac disease without knowing it. Naturally, these people will also feel that they do better on gluten-free food. Because celiac disease is an autoimmune disease that requires a very strict gluten-free diet for life, it is unfortunate that so many people today self-test and simply reduce the amount of gluten in their diet. Eating gluten-free because of celiac disease means always being careful and reading ingredient labels. It is not enough to just cut down a little on gluten intake.
Get tested in healthcare while you are still eating gluten
If you suspect that you can’t tolerate gluten, it’s important not to start eating gluten-free on your own before you’ve been tested—within healthcare and with professional help—for celiac disease and wheat protein allergy. Otherwise, it can be very difficult to confirm or rule out celiac disease, which is usually a prerequisite for moving on to look for other causes. Read more about why here. It’s important to know the reason you feel better on certain foods. There can be many different causes that are important to identify, just as it’s important to identify celiac disease.