What is the difference between coeliac disease and non-coeliac gluten sensitivity NCGS?
Most people have never even heard of NCGS, but it's much more of a problem than you think.
After the last post, people were asking me what NCGS is. I thought this quick overview of different gluten and wheat related conditions might help. It’s adapted from my Allergy Definitions page.
(By the way, I hope you are enjoying these shorter, more frequent posts rather than the long weekly newsletter - better?)
Note I have a special section all about gluten illness here - I coined the term TrulyGlutenFree (TGF) back in 2008 when I wrote about the problem of NCGS - the first in the UK to do so, I thank you. I also eventually wrote the Gluten Plan to help - which is constantly evolving as we discover more and more in this field! There is also a whole section of TGF ebooks and factsheets here.
Anyway, let’s get on with some definitions - this is how I see each type of gluten illness:
Coeliac disease, gluten sensitivity/intolerance, gluten-related disorders, wheat allergy, wheat intolerance and maldigestion
Gluten-related disorders (GRDs). This is a new (ish) definition coined in recognition of the fact that there is now thought to be a ‘syndrome’ or ‘spectrum’ of gluten illnesses. GRDs can go all the way from coeliac disease to gluten intolerance. For more on this, see here.
Coeliac disease is an autoimmune condition in which the protein fraction, gliadin, found in wheat, barley and rye, causes the villi or fronds which line the small intestine to atrophy, thereby preventing the sufferer absorbing nutrition from what they eat and preventing its proper digestion. It can have wide ranging symptoms many of which may be digestive, but need not be. In fact, many experts now think, if it were found now, that it would be classed as a neurological disease rather than gut because it is so linked to eg. anxiety and depression but also to neurological issues like brain fog, loss of cognitive function, ataxia etc. It is thought to affect around 1 in 70 of the population although it is also thought to be very heavily under-diagnosed. That’s mainly because (IMHO), they only test for one peptide - 33-mer and one transglutaminase, when several different ones may be involved.
Non-coeliac gluten sensitivity (NCGS). NCGS is now thought to be quite common and far more so than coeliac disease. This goes some way to explaining why so many people feel better on a gluten free diet but who do not fit the coeliac diagnostic pattern.
Research is still continuing but essentially where coeliac disease is an autoimmune disease with gluten sparking an attack on the villi, NCGS is thought to be a non-autoimmune inflammatory disorder sparked by gluten that can affect anywhere in the body, but especially the brain and nervous system causing neurological disorders. It can latterly involve reactions auto-immune in nature. For much more on this, see my specialist section. You can actually have coeliac disease and NCGS - I have. Joy.
Gluten intolerance. This is an intolerance to the gluten which can be found in any or all grains.
Grain intolerance. This is an intolerance to grains, not necessarily to the gluten or protein fractions.
Wheat allergy – an IgE allergy to one or several of the proteins in wheat.
Wheat intolerance – an intolerance to one or several of the constituents (not necessarily proteins) of wheat. This appears to be most common in relation to highly processed, high-gluten flours and products made from them.
Wheat/Gluten/Grains/Carbs Maldigestion – the problem is not allergy or intolerance-related, more a lack of the digestive enzymes and stomach acid needed to digest them properly. Undigested food can ferment and cause symptoms such as bloating and wind.
All of these conditions are commonly confused.
Please ❤️ and restack/share/tell me if this kind of thing is useful. For more witterings from me, don’t forget to catch up on my more frequent little Notes here.
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PS I am happy either way, I find it all fascinating. As you can see I am sometimes late to the party cos I save my reading time for when I have a few moments to sit and actually read rather than do it in the middle of work / sorting out delivery emails 🙃
For people who are struggling with all the stuff in their inbox, this is what I did - downloaded the substack app and then turned off all the email notifications. That way I only ever access stuff through the app and my inbox continues to spam out unwanted marketing and delivery notifications without the good stuff getting mixed in 😂😂