Celiac Disease vs. Gluten Intolerance
Published: May 2021
For a number of us, gluten can make us feel not-so-good… hence the increasing popularity of gluten-free diets. But the reason why we might want to avoid gluten varies. People who have celiac disease can become quite ill from even a trace amount of gluten. More commonly, you can have sensitivity to gluten for other reasons—and have symptoms ranging from cloudy thinking to an upset stomach.
To uncover the varied reasons why wheat, barley and other staples from our cupboards might make us feel unwell, I interviewed Dr. Marie Robert, a nationally recognized gastrointestinal surgical pathologist and Professor of Pathology and Medicine at Yale University School of Medicine. Dr. Robert, who also served as Chief Medical Officer for Beyond Celiac, also provided tips for what to do if you suspect it's celiac disease—and, she offered some advice about gluten-free diets that you might find surprising!
What is the difference between celiac disease and gluten sensitivity?
Everyone appears to be jumping on the gluten-free bandwagon these days. And while approximately 1% of the population has celiac disease, an autoimmune disorder that prevents them from consuming gluten-containing food, others just feel better without gluten. The latter may have non-celiac gluten sensitivity, a medically-recognized phenomenon that occurs in an estimated 0.5 to 13% of the population.
Let’s take a step back. What exactly is gluten?
Gluten is a mixture of two types of proteins in cereal grains that include wheat, rye and barley. Gluten is a Latin word meaning "glue," which is an apt description for the elastic property gluten imparts to dough. Because wheat is the most commonly consumed grain in the U.S. and many other parts of the world, gluten can be hard to avoid.
What are some of the signs and symptoms of celiac disease?
Possible adverse effects associated with celiac disease include bloating, gas or abdominal pain, diarrhea, constipation, general fatigue, itchy skin, tooth discoloration, joint pain, irritability, weight loss, delayed growth in children, fractures and thin bones, migraines, infertility, miscarriages and an association with other autoimmune diseases.
Many of these celiac disease symptoms may also be associated with non-celiac gluten sensitivity, although usually to a lesser extent.
What is Gluten Sensitivity?
If you've been tested for celiac disease and it came back negative, but you still deal with gastrointestinal upset and other symptoms associated with celiac, non-celiac gluten sensitivity is a likely culprit.
The difference between celiac and gluten sensitivity is that celiac is an autoimmune disease, while gluten sensitivity is not. And while the symptoms of gluten sensitivity are similar to celiac, they are generally less severe.
Interestingly, it might not actually be the gluten, but other parts of wheat, such as non-gluten protein, that trigger these symptoms!
You can take a blood test to see whether you have a sensitivity to gluten. Following a FODMAP diet, and observing whether your symptoms subside when you remove wheat and other gluten foods, is a good next step.
Is there a test for celiac disease?
A simple and inexpensive blood test for anti-tissue transglutaminase antibody IgA can provide a celiac disease diagnosis in over 90% of those who have the disease. The test detects the presence of an antibody to an enzyme in the body known as tissue transglutaminase, which is attacked by the immune system in celiac disease. Since a minority of individuals can have false negative celiac disease test results, concomitant testing of other factors, such as deamidated gliadin IgA and serum IgA is suggested.
Non-celiac gluten sensitivity is currently only diagnosed by gluten withdrawal and a double-blind placebo-controlled gluten challenge.
When should someone test for celiac disease?
Seek diagnostic testing as soon as possible when the disease is suspected.
What should people do if they are diagnosed with celiac disease?
The burden of disease is very high on individuals and their families. But I'm happy to say there are 13 drugs in clinical trials now at various stages and some of them have shown great promise to allow for a better life for patients with celiac disease, even to the point of perhaps inducing a tolerance so that one doesn't react anymore.
(To find out if you are eligible for a clinical trial, visit https://www.clinicaltrials.gov/.)
I have not yet been diagnosed with celiac disease. Should I avoid gluten just to be on the safe side?
No. You should avoid self-diagnosis. That really muddies the waters and may not be necessary.
So there you have it—Dr. Robert's tips on what to do if you suspect celiac. Whether you do have this disease, or a gluten intolerance, healthy, gluten-free options abound. Following a Mediterranean diet has been associated with many health benefits—and since its staples are fresh fruits, vegetables, lean protein and healthy fats, you won't even miss that blueberry muffin.
References
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- Volta U et al. Expert Rev Gastroenterol Hepatol. 2010 Feb;4(1):31-5.
- Barbaro MR et al. F1000Res. 2018 Oct 11;7.
- Cedars-Sinai Staff. "Is Eating Gluten-Free a Good Idea?" Cedars Sinai, March 2018, https://www.cedars-sinai.org/blog/gluten-free-good-idea.html
- Mayo Clinic Staff. "Celiac Disease." Mayo Clinic, October 2020, https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220
