NCGS vs Coeliac Disease

🤼 Why the Distinction Matters

Unlike coeliac disease, where strict gluten avoidance is essential, gluten intolerance (also known as non-coeliac gluten sensitivity) varies from person to person. Many people with gluten intolerance follow a process of trial and error to figure out how much gluten - or which types - they can tolerate without symptoms.

Because of these medical differences, people navigating gluten free diets will approach them differently - especially when it comes to eating out, shopping, cooking at home, and reintroducing gluten.

It's important to note that even though gluten intolerant individuals can technically allow for small amounts of gluten, many choose to be super strict with what they consume in order to prevent any kind of flare ups.

🍽️ Eating Out

When eating out, you might notice restaurant staff asking, "Is it an allergy or an intolerance?" - with coeliac disease typically (though not entirely accurately) grouped under the 'allergy' umbrella. This question helps them determine whether to take strict precautions against cross-contamination, or whether you're avoiding gluten for a more flexible reason.

For example, many restaurants offer 'gluten free' chips (fries), but if they're cooked in shared fryers with gluten-containing items, they're unsafe for those with coeliac disease - but may or may not be a problem for someone with a gluten intolerance.

This is a contentious issue because:

• Marking something as 'gluten free' when it's not safe for coeliacs can be misleading, and may put people at risk if they don't ask follow-up questions
• Whilst coeliacs must avoid all traces of gluten, some gluten intolerant individuals may also have strong reactions to trace amounts and choose to be equally as strict
• There should ideally be labelling to distinguish between items that are 100% gluten free (no gluten ingredients, cooked separately) and gluten free ingredients only, but cooked or prepared in ways that may involve cross-contact

That said, most people with gluten intolerance can tolerate small traces of gluten, so cross-contamination tends to be less critical in restaurants.

1️⃣ Eating Out with Coeliac Disease

• Inform staff you have coeliac disease
• Ensure food is prepared in a 100% gluten free environment - no shared fryers, utensils, or surfaces
• Avoid buffets or self-serve stations, where cross-contamination is likely

2️⃣ Eating Out with a Gluten Intolerance

• Let your server know you have a gluten intolerance, especially if you react to traces
• You might be okay with shared equipment, like fryers, but it depends on your symptoms and personal experience
• If you're unsure of your severity, it's best to be cautious at first

👉🏼 Read all about how to communicate your dietary requirements when eating out

🍳 Cooking at Home

If you live in a household where gluten is still present, preventing cross-contamination is key - but how strict you need to be will vary.

1️⃣ At Home with Coeliac Disease

• Use separate toasters, cutting boards, wooden utensils
• Store gluten and gluten free items away from each other
• Have separate condiments like jam, butter, and spreads or have a strict 'no double-dipping' rule
• Thoroughly clean kitchen surfaces before prepping gluten free meals
• Where possible, avoid sharing ovens/air fryers at the same time where gluten particles could circulate

2️⃣ At Home with a Gluten Intolerance

• You may or may not need separate utensils and appliances - it depends on how sensitive you are
• Storing gluten free products separately helps prevent mistakes
• Cooking gluten and gluten free food at the same time is usually fine, but listen to your body

In short, those with coeliac disease must eliminate any cross-contact, regardless of symptoms, whilst gluten intolerant individuals can adjust their precautions based on symptoms.

👉🏾 Read more about preventing cross-contamination in the home

🛒 Shopping for Gluten Free Food

Both those with coeliac disease and gluten intolerance need to read labels - but coeliacs have to be more cautious.

1️⃣ Shopping with Coeliac Disease

• Avoid products with 'may contain' warnings for gluten sources - even small traces can cause damage

2️⃣ Shopping with a Gluten Intolerance

• 'May contain' products might be fine unless you're particularly sensitive - adjust based on your symptoms , what's safe for one person may not be for another

👉🏽 If you need an extra hand with understanding label reading and 'may contain' statements, click here

👋 Reintroducing Gluten

One of the biggest differences between the two conditions is whether gluten can ever be reintroduced.

1️⃣ Reintroducing Gluten with Coeliac Disease

• Gluten must be avoided for life
• Even if you don't feel symptoms, it still causes internal damage
• Long-term exposure can lead to serious health risks

2️⃣ Reintroducing Gluten with a Gluten Intolerance

• Some people can reintroduce small amounts of gluten over time
• Keeping a food and symptom diary can help identify your personal limits
• Reintroduction should always be done with a doctor or dietitian's guidance

❗Before You Go Gluten Free...

Don't cut out gluten before being tested for coeliac disease.

For accurate results, you need to be eating gluten for at least 6 weeks before the blood test. Reintroducing gluten later can be difficult - and testing after eliminating gluten often leads to inconclusive results.

👉🏽 Read more about testing for coeliac disease here