Written by Courtney Human RD(SA)

It is with great pleasure that I step away from the nightclub analogy of insulin resistance to tackle another minefield of digestive confusion that lands on my desk daily: the tangled web of gluten, wheat, and intolerance VS allergy VS sensitivity. Grab your notebook, because this is going to be a wild ride down the small intestine because if you’ve spent five minutes on social media, you’ve probably heard someone proudly declare they are “gluten-free.” Is it really the wellness flex of our time?

I’m going to be honest for people (including some registered dietitians or health care professions, like myself) classifying and understanding the difference between a wheat allergy, Coeliac Disease (which is a severe form of gluten intolerance), and Non-Coeliac Gluten Sensitivity (NCGS) is as clear as a bottle of murky home-brew.

Let’s start by creating glossary to classify the big three mentioned above. A Wheat Allergy is a classic food allergy, meaning it’s an IgE-mediated immune response to a protein found in wheat (not just gluten). Your body launches a full-scale emergency, usually within minutes to hours. We’re talking hives, swelling, wheezing, and in the worst-case scenario, anaphylaxis. Diagnosis requires skin prick tests and blood tests looking for specific IgE antibodies to wheat.  Next up is Coeliac Disease, which is an autoimmune disorder where every time you eat gluten (a protein found in wheat, rye or barley), the immune system attacks the lining of your small intestine involving the beautiful, tiny villi responsible for nutrient absorption. It’s not an allergy; it’s your body turning on itself. The damage is real, causing malabsorption, fatigue, and long-term health risks. Diagnosis involves blood tests for specific antibodies (like tTG-IgA) followed by a definitive small intestine biopsy while you are still eating gluten. Crucial South African Dietitian Note: Never go gluten-free before testing, or the results will be as useless as a sunroof on a submarine. Finally, there’s Non-Coeliac Gluten Sensitivity (NCGS) or Gluten Intolerance where you get all crappy symptoms of bloating, abdominal pain, diarrhoea “brain fog,” and fatigue – after eating gluten, but your wheat allergy and Coeliac Disease tests come back negative. The damage is less severe than Coeliac, but the discomfort is real. It’s thought that in some cases, it might not even be the gluten itself, but other components in wheat like FODMAPs (fermentable sugars) that are the real troublemakers. Diagnosis requires ruling out Coeliac and Wheat Allergy first, followed by symptoms improving significantly on a gluten-free diet and return when gluten is reintroduced in a blind test. Personally, I would be the angriest if I got this one and couldn’t even flex gluten intolerance but felt crappyall the time. Crucial South African Dietitian Note: These patients hate us the most, and good luck to us trying to figure them out. But we still love you non-coeliac gluten sensitivity people & promise to try our best-est to help.

Regardless of the above diagnosis, the million-rand question driving us dietitians up the wall is always, “So am I gluten free or wheat free?” If you are strictly gluten-free for Coeliac Disease you must be wheat-free because wheat contains gluten. You also need to avoid rye and barley that contain gluten. However, if you are strictly wheat-free for a Wheat Allergy you are not automatically gluten-free. Why? Because you can still eat gluten-containing grains that are not wheat such as rye and barley (if they don’t contain other proteins that trigger your specific wheat allergy). In reality, because wheat is the main culprit and primary source of gluten in most Western diets, the terms often overlap in the supermarket aisle, but scientifically, they are not the same.

Truth be told, in practice the biggest driver of self-diagnosed NCGS is simple: We are eating trash.

“I’m bloated and my gut is a mess. I cut out bread and pasta and feel great! I must be gluten intolerant.” Here’s the thing: most of the standard wheat products people eat – white pasta, white bread, pies, vetkoeks, biscuits – are highly refined carbohydrates. They often sugar or fat laden and fall below the current high fibre guideline aiming for >5g of dietary per 100g (on the product label). But when you swap your white bread for a gluten-free alternative you’re not always getting a health upgrade! Many gluten-free products are still refined made from tapioca, potato or rice flour. Additionally, to make them taste less like cardboard, manufacturers often add more fat, salt and sugar often containing even less fibre than the wholewheat original. This can set you up for constipation – a classic gut symptom people then mistakenly blame on the tiny amount of gluten they might have consumed by accident.

The real lightbulb moment happens for my patients with the ‘wholewheat’ revelation. Yes, if your problem is genuine NCGS or Coeliac Disease, a strict gluten-free diet is the only treatment. But if you’re just sensitive to the refined rubbish, the registered dietitian solution is much simpler. I challenge many self-diagnosed gluten-sensitive patients to stop the white, refined flour products and introduce wholewheat starches. More often than not, the bloating, diarrhoea or constipation improves. Why? Because they’ve finally introduced a decent source of fibre! The symptoms weren’t caused by the gluten itself, but by a crippling low fibre modern western diet. I do acknowledge that it’s not always this simple for everyone, but it is worth seeing if you are a lucky one who doesn’t have to go gluten-free- (Especially, if you share the sentiment of whole-heartedly loving gluten containing wholewheat carbs.)

In conclusion, always remember rule number one: Don’t self-diagnose and unnecessarily remove entire food groups or replace them with potentially nutritionally inferior and expensive substitutes, without addressing the root cause. Which may just be a diet without gut-loving whole grains. If you suspect an issue, see your doctor to definitively rule out Coeliac Disease and a Wheat Allergy before you change your diet. Then, of course hit up your registered dietitian so we can navigate the journey down your intestines together, perhaps with a side of scientific evidence too.