You feel better since you cut back on bread, so you conclude: I must have something with gluten. Reasonable, but this is exactly where it often goes wrong. "Something with gluten" can mean three very different things, with three different approaches. And if you go gluten-free right now, you make a reliable celiac test impossible for months.
My stance: do not cut gluten before you are tested. It feels like self-care, but it takes away the very evidence your doctor needs to confirm or rule out celiac disease.
Celiac disease, gluten sensitivity or wheat allergy: the difference
The three conditions share overlapping symptoms but are medically very different. The table below is your decision aid: per feature it shows what you are looking at and which test belongs to it.
| Feature | Celiac disease | Gluten sensitivity (NCGS) | Wheat allergy |
|---|---|---|---|
| Mechanism | Autoimmune disease | Unknown, no detectable gut damage | Allergic (IgE) reaction |
| Gut damage | Yes, damages the small intestine | No | No |
| Reliable test | Yes: tTG-IgA in blood, then doctor | No validated test | Specific IgE, assessed by a doctor |
| Reaction | Often delayed, gradual | Hours to a day | Fast, sometimes within minutes |
| Approach | Lifelong strict gluten-free | Reduce after ruling out celiac | Avoid wheat, sometimes emergency medication |
Celiac disease affects roughly 1 in 100 people, and according to figures from the Dutch public health institute RIVM and the Dutch College of General Practitioners (NHG), a large share stays undiagnosed. If your main complaints are bloating and changing bowel habits, also read what your blood says about stomach complaints.
How do you test reliably for celiac disease?
The first step is a blood test for specific antibodies, usually called tTG-IgA (tissue transglutaminase IgA). If it is raised, your GP normally refers you to a gastroenterologist, who confirms the diagnosis with a gut biopsy. A celiac disease blood test measures these antibodies, together with total IgA to rule out a false-negative result.
The condition people most often miss: you must still be eating gluten at the time of the draw, ideally for several weeks in a row. If you are already gluten-free, the antibodies can normalise and the test looks falsely reassuring.
The test is negative but the complaints remain. Now what?
This is more common than you would think. It could be non-celiac gluten sensitivity (NCGS), but equally lactose intolerance, irritable bowel syndrome or something else. There is no reliable blood test for NCGS. The Netherlands Nutrition Centre (Voedingscentrum) advises against permanently cutting foods on a hunch, because an unnecessarily restricted diet can itself cause deficiencies.
A structured elimination and reintroduction process, ideally guided by a dietitian, gives more insight here than an expensive self-test. To understand why the well-known IgG food tests give no answer, read food intolerance testing: what works and what does not.
Who should seriously consider testing for celiac disease?
Celiac disease does not always give the classic picture of diarrhoea and stomach pain. The silent forms in particular get missed. There are a few situations where targeted testing is extra worthwhile, even without pronounced gut complaints:
- Unexplained anaemia or a stubbornly low ferritin that does not improve with iron.
- Persistent fatigue without a clear cause.
- A first-degree relative with celiac disease, since the predisposition is partly hereditary.
- Another autoimmune disease, such as type 1 diabetes or a thyroid condition, which occurs more often alongside celiac disease.
- Bone loss at a young age or unexplained weight loss.
If you recognise yourself in this, it is wise to raise it with your GP rather than choosing a diet from the internet yourself.
How do you read the result of a celiac test?
A raised tTG-IgA is a strong indication, but not a final verdict. The higher the value, the more likely celiac disease, but confirmation happens through further investigation by a doctor. A mild rise can also have other causes. Your total IgA is often measured as well: if you have an IgA deficiency, the tTG-IgA can read falsely low and a different test is needed. A normal result while you were still eating gluten makes celiac unlikely but does not rule out gluten sensitivity. That distinction is exactly why a professional assessment of your result is valuable.
Frequently asked questions
Can I go gluten-free before the test?
No. Keep eating gluten until the draw. Going gluten-free can lower the antibodies and make the result unreliable. Discuss timing with your GP.
Is celiac disease hereditary?
There is a genetic predisposition. If celiac disease runs in your close family, testing on complaints can be worthwhile, even without clear stomach symptoms. Discuss this with your GP.
Can I have celiac disease without stomach complaints?
Yes. Sometimes the first signs are unexplained fatigue, anaemia or low iron. An abnormal value is then a reason to look further.
What you can do now
My advice: keep eating gluten until you are tested, and for a concrete suspicion choose the validated tTG-IgA test instead of a broad intolerance test. Every blood test result at Vitalcheck includes a professional assessment by a BIG-registered doctor. A blood value is not a diagnosis: always discuss treatment decisions with your GP.
Sources
- NHG guideline on food hypersensitivity. Dutch College of General Practitioners. Accessed 2026.
- Voedingscentrum (Netherlands Nutrition Centre). Celiac disease and gluten-free eating. Accessed 2026.
- RIVM. Celiac disease: figures and context. Accessed 2026.
- Thuisarts.nl / NHG. I have celiac disease. Accessed 2026.
الوسوم
الكاتب
