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Gluten intolerance, or non-coeliac gluten sensitivity, is a highly controversial topic. While it is an internationally recognised condition, the prevalence of non-coeliac gluten sensitivity is stated to be between 0.6 and 6% of the population in the Western world. In Australia, around 11% of adults follow a gluten-free diet, with less than 0.5% diagnosed with coeliac disease. This figure is supported by a 2020 study, which found that around a quarter of the 1000 participants avoided gluten, despite only 1% of Australians suffering from coeliac disease. The rise in gluten-free diets is partly due to the perception of health benefits, despite a lack of evidence to support this.
| Characteristics | Values |
|---|---|
| Percentage of people with coeliac disease | 1% |
| Percentage of people with self-reported non-coeliac wheat sensitivity | 14% |
| Percentage of people with self-reported non-coeliac wheat sensitivity in 2018 | 5.3% |
| Percentage of people with self-reported non-coeliac wheat sensitivity in 2015 | 5.7% |
| Percentage of Australian adults following a gluten-free diet | 11% |
| Percentage of people following a gluten-free diet due to diagnosed coeliac disease | <0.5% |
| Percentage of people with the 'coeliac genes' | 50% |
| Percentage of people with the 'coeliac genes' who may develop coeliac disease | 2.5% |
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What You'll Learn
Coeliac disease affects 1% of Australians
Coeliac disease is an autoimmune disease that affects about 1% of Australians. It is caused by an abnormal immune response to gluten, a protein found in wheat, rye, oats, triticale, and barley. This disease can have significant long-term health impacts, but most people living with the condition are unaware of it. Coeliac disease can manifest at any age and is often asymptomatic, making it challenging to diagnose. However, it can cause symptoms such as diarrhoea, constipation, abdominal pain, and general unwellness.
The prevalence of coeliac disease in Australia is estimated to be around one in 70 people, and it is on the rise. The exact reasons for this increase are unclear, but changing environmental factors and the hygiene hypothesis, which suggests that reduced exposure to bacteria and viruses may negatively impact health, are considered possible explanations. The disease is triggered by specific HLA genes, which are carried by around 50% of Australians. However, only about 1 in 40 HLA gene carriers will develop coeliac disease due to the influence of environmental factors.
Coeliac disease is a chronic condition with no known cure. The only treatment is a strict, lifelong gluten-free diet. Even small amounts of gluten can trigger an immune response, damaging the small bowel. Maintaining a gluten-free diet can be challenging, requiring new skills such as reading and interpreting food labels. Early diagnosis and treatment are crucial to reducing the risk of developing associated complications, as untreated coeliac disease can lead to nutrient deficiencies, increased inflammation, and long-term health issues.
It is important to distinguish coeliac disease from non-coeliac gluten sensitivity or intolerance. Non-coeliac gluten sensitivity is a recognised condition, but its prevalence is controversial, estimated between 0.6% and 6% in the Western world. Many people in Australia and worldwide adopt gluten-free diets without a clinical diagnosis of coeliac disease, believing it to be healthier or to alleviate gut symptoms. However, studies have suggested that FODMAPs, not gluten, may be the trigger for gut irritability in these cases.
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Self-reported wheat sensitivity is 14%
Self-reported wheat sensitivity is a common phenomenon, affecting about 10% of people worldwide. In Australia, 14% of respondents in surveys from 2015 and 2018 reported wheat sensitivity. This percentage remained stable over the years, with similar numbers of new and resolved cases.
Wheat sensitivity is distinct from coeliac disease, an immune-mediated condition affecting about 1% of Australians. Coeliac disease is diagnosed through serological testing and duodenal biopsy, and it requires a strict, lifelong gluten-free diet. While non-coeliac wheat sensitivity does not have a formal diagnosis, it is characterised by gastrointestinal symptoms after consuming wheat, which are not attributable to coeliac disease or wheat allergy.
The factors associated with self-reported wheat sensitivity include being younger, female, and having functional dyspepsia. Additionally, about one-quarter of respondents in the Australian surveys reported avoiding dietary gluten. This may be due to the perception of health benefits associated with gluten-free diets, or the belief that gluten causes gut symptoms in people without coeliac disease.
The prevalence of self-reported wheat sensitivity in Australia is notable, and it has contributed to the increasing demand for gluten-free foods. However, it is important to differentiate between wheat sensitivity and coeliac disease, as the latter requires a strict gluten-free diet to manage the condition effectively.
Furthermore, it is worth noting that the term "gluten intolerance" is often used interchangeably with "non-coeliac gluten sensitivity." Gluten intolerance is not an allergy but a sensitivity that can develop at any point in life. The exact causes are not well understood, and there is no specific test for gluten intolerance. The diagnosis is made through a process of eliminating other conditions and observing symptom improvement on a gluten-free diet.
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Non-coeliac gluten sensitivity is controversial
Coeliac disease affects about 1% of the Australian population. However, many Australians without coeliac disease also avoid gluten, believing that they are gluten intolerant. Self-reported wheat sensitivity affects about 10% of people worldwide, and 14% of Australians according to a 2015 and 2018 survey. A notable proportion of people without coeliac disease avoid dietary gluten.
Non-coeliac gluten sensitivity (NCGS) is a controversial disorder that can cause gastrointestinal and other problems. It is characterised by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing foods in the absence of coeliac disease and wheat allergy. The pathophysiology of NCGS is largely unclear, and there is much debate in the scientific community as to whether it is a distinct clinical disorder. The prevalence of NCGS in the general population is stated to be between 0.5% and 13%.
NCGS is difficult to recognise and diagnose due to the absence of reliable biomarkers and the fact that some people do not have digestive symptoms. Diagnosis is generally performed only by exclusion criteria, such as the exclusion of coeliac disease and wheat allergy. The onset of symptoms may be delayed by hours to a few days after gluten ingestion, making it hard to pinpoint.
There is also a lack of empirical evidence to support the claim that modern wheat cultivation, by breeding for high ATI content, plays a role in the onset and course of NCGS. As of 2018, there were no studies directly comparing modern wheat versus ancient cultivars with low ATI content. The role of gluten as a trigger of NCGS symptoms is also contested. Some studies have shown that FODMAPs, not gluten, might be triggering gut irritability.
Despite the controversy, NCGS is an internationally recognised condition. People with NCGS often go unrecognized by specialists and lack adequate medical care and treatment. They often have a long history of health complaints and unsuccessful consultations with physicians, and thus many resort to a gluten-free diet and a self-diagnosis of gluten sensitivity.
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Gluten-free diets are popular in Australia
First, there is a common self-reported wheat sensitivity, with about 14% of respondents in surveys from 2015 and 2018 claiming wheat sensitivity. Many Australians without a coeliac disease diagnosis avoid gluten due to reported physiological symptoms associated with gluten ingestion. Additionally, some people believe that avoiding gluten is essential for a healthy lifestyle and helps alleviate gut symptoms or fatigue. The gluten-free movement has become mainstream, with cafes and restaurants offering gluten-free options and even iconic Australian brands like Vegemite releasing gluten-free versions of their products.
Another factor contributing to the popularity of gluten-free diets in Australia is the perception of health benefits. Some people avoid gluten because of its presumed general health benefits, despite evidence to the contrary. Sales of gluten-free foods have skyrocketed, with a rapid growth observed in Australia, similar to trends in the USA and the UK. This demand is driven primarily by those without a clinical diagnosis of coeliac disease.
Furthermore, non-coeliac gluten sensitivity is an internationally recognised condition, with a prevalence of 0.6 to 6% in the Western world. However, the condition remains controversial, and studies have challenged the validity of self-diagnosed gluten intolerance. For example, a study by Professor Gibson found that FODMAPs, not gluten, might be triggering gut irritability in people without coeliac disease. Additionally, Dr Potter's study suggested that many Australians avoid gluten or wheat for weight control or general health reasons without convincing evidence.
In conclusion, gluten-free diets are popular in Australia, with a significant number of people avoiding gluten despite not having coeliac disease. The popularity of gluten-free diets can be attributed to self-reported wheat sensitivity, perceived health benefits, and the mainstreaming of the gluten-free movement. However, studies have questioned the validity of self-diagnosed gluten intolerance and emphasised the lack of evidence supporting the health benefits of gluten-free diets for those without coeliac disease.
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Gluten intolerance symptoms are not caused by gluten
In Australia, about 11% of adults follow a gluten-free diet, with less than 0.5% diagnosed with coeliac disease. Coeliac disease is an autoimmune disease that affects the small bowel and is triggered by exposure to dietary gluten. The treatment is a strict, lifelong gluten-free diet. However, many Australians without coeliac disease also avoid gluten, believing it to be the cause of various symptoms such as bloating, flatulence, anaemia, tiredness, irritability, and joint pain.
Gluten intolerance, or non-coeliac gluten sensitivity, is a condition where individuals experience symptoms such as bloating, diarrhoea, nausea, headaches, fatigue, and abdominal pain after consuming gluten. While these symptoms overlap with those of coeliac disease, people with gluten intolerance do not suffer from intestinal damage or the presence of antibodies found in coeliac patients.
The link between gluten and gut symptoms has been challenged by research. A study found that FODMAPs, not gluten, may be the trigger for gut irritability. Participants with self-diagnosed non-coeliac gluten sensitivity and irritable bowel syndrome were placed on a diet that restricted FODMAPs, and all experienced reduced gut symptoms. When gluten was reintroduced without FODMAPs, no specific symptoms were induced. This suggests that FODMAPs, rather than gluten, could be the culprit for gut issues in people without coeliac disease.
While gluten intolerance can cause a range of digestive and extra-intestinal symptoms, it is important to distinguish it from coeliac disease. Coeliac disease is an autoimmune disorder where the body attacks itself in response to gluten, damaging the small bowel. The condition can lead to nutritional deficiencies and increased inflammation in the body, potentially affecting the skin, joints, bones, liver, pancreas, thyroid, and nervous system.
In summary, while gluten intolerance symptoms can be debilitating, they are not caused by gluten itself. The current evidence suggests that FODMAPs are more likely to be responsible for the gut symptoms experienced by individuals with non-coeliac gluten sensitivity. However, more research is needed to fully understand the role of gluten in gut health and to determine if there are other factors contributing to the symptoms associated with gluten intolerance.
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Frequently asked questions
Around 1% of Australians have coeliac disease, which is an autoimmune disease that affects the small bowel. This means that around 250,000 Australians suffer from gluten intolerance.
The symptoms of gluten intolerance can include diarrhoea, constipation, abdominal pain, and general unwellness.
Blood tests and genetic tests can be used to screen for gluten intolerance, but only a gastroscopy with a small bowel biopsy can confirm a diagnosis.
The treatment for gluten intolerance is a strict, lifelong gluten-free diet. It is important to read and interpret food labels and be aware that gluten can also be present in some medications.
Gluten intolerance has become more common due to the increasing popularity of gluten-free diets and the perception that avoiding gluten is essential for a healthy lifestyle. However, there is little scientific evidence to support this, and studies have shown that FODMAPs, not gluten, may be triggering gut irritability.
