Gluten

Gluten: Are you hypersensitive or do you have celiac disease?

gluten in bread

Gluten is a hot topic in the health debate, but for many people it is more than just a dietary trend. For people with celiac disease or non-celiac gluten sensitivity, consuming wheat, rye, and barley can lead to debilitating stomach pain, fatigue, and long-term health problems.

In this post, we look at how gluten affects the body and why it is crucial to have a gastroscopy before eliminating gluten from your diet.

What exactly is gluten?

Gluten is a protein found in most types of grain. It acts as a kind of "glue" that gives bread its elasticity and structure. While most people digest gluten without any problems, the immune system of some people reacts as if the protein is a dangerous enemy.

Three different reactions to gluten

1. Celiac disease (autoimmune disease)

In celiac disease, the immune system attacks the lining of the small intestine when gluten is present. This leads to the destruction of the small intestinal villi, making it impossible for the body to absorb important nutrients.

Symptoms: Diarrhea, weight loss, iron deficiency, and osteoporosis.

2. Non-celiac gluten sensitivity (NCGS)

Here, you experience symptoms similar to celiac disease (bloating and abdominal pain), but without any detectable damage to the intestine or specific antibodies in the blood. It often overlaps with the diagnosis of irritable bowel syndrome (IBS).

3. Wheat allergy

A classic allergic reaction to proteins in wheat, which can cause rashes, breathing difficulties, or stomach problems shortly after consumption.

The path to diagnosis: Why gastroscopy is necessary

If you suspect that you are gluten intolerant, it is important to get a correct diagnosis.

The most important advice: Never start a gluten-free diet before you have been fully examined! If you stop eating gluten, your intestines will begin to heal, and then your doctor will not be able to see signs of celiac disease during an examination.

How is the examination conducted?

Blood tests: The doctor checks for specific antibodies (transglutaminase).
Gastroscopy: To make a definitive diagnosis, a gastroscopy must be performed. This involves inserting a thin tube into the small intestine, where the doctor takes small tissue samples (biopsies). Under a microscope, it is possible to see whether the intestinal villi are flat (atrophy), which is a sure sign of celiac disease.

Scientific source: According to guidelines on PubMed, histological examination (tissue sample) via gastroscopy remains the gold standard for diagnosing celiac disease in adults, as blood tests alone can be misleading in certain cases (Source: Rubio-Tapia A. et al., 2013, PubMed).

Can you live healthily without gluten?

Yes, but it requires knowledge. If you remove whole grain products, you risk lacking fiber and B vitamins. Therefore, a gluten-free diet should always be composed with a focus on naturally gluten-free ingredients such as vegetables, legumes, nuts, quinoa, and rice.

PubMed-based sources for further reading:

Diagnostic guidelines: Rubio-Tapia A, et al. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol. 2013.
Gluten sensitivity vs. celiac disease: Sapone A, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012.
Long-term effects of untreated celiac disease: Lebwohl B, et al. Celiac disease and non-celiac gluten sensitivity. BMJ. 2015.

endoscopy, gastrointestinal tract, intestines

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