What Is the Difference Between Celiac Disease and Gluten Intolerance?

Celiac disease (spelled Coeliac disease in British English) is an autoimmune disorder where consuming gluten leads to the production of antibodies that damage the lining of your small intestines. Gluten Intolerance, referred to as non-celiac gluten sensitivity (NCGS), involves experiencing symptoms similar to Celiac disease without a responsible autoimmune response or intestinal damage. [1]

A third condition frequently confused with celiac disease or gluten intolerance is the wheat allergy. While an immune response also causes the wheat allergy, your immune system reacts to specific proteins found in wheat, which makes it distinct from the autoimmune reaction seen in Celiac Disease. Wheat allergy can result in various allergic symptoms ranging from mild to severe. [1]

While all three involve adverse reactions to gluten or wheat, their underlying biological mechanisms and manifestations differ.

We will sum this up once more below:

Celiac Disease

• Definition: An autoimmune disease where eating gluten damages your small intestine. In celiac disease, a specific wheat protein—called gluten — causes an abnormal immune system reaction. The immune system produces antibodies in response to gluten ingestion, and these antibodies target the body's tissues, specifically the small intestine's villi, tiny, fingerlike projections that absorb nutrients from food. [1]

• Symptoms: Digestive issues (diarrhea, constipation, bloating), fatigue, weight loss, anemia, dermatitis herpetiformis (skin rash), joint pain, neurological symptoms.

• Prevalence: Approximately 1% of the population worldwide.

• Treatment: Strict, lifelong gluten-free diet.

Gluten Intolerance (NCGS)

• Definition: Your body reacts badly when you eat gluten-containing grains or other foods even though you tested negative for celiac disease and wheat allergy. NCGS still needs to be wholly understood by scientists and needs further study. It might even be possible that the bad reactions stem from something else in the grain instead of gluten. [1] [2]

• Symptoms: Digestive issues (abdominal pain, bloating, diarrhea), fatigue, headache, joint pain, brain fog.

• Prevalence: Estimated to affect around 0.5-13% of the population, although precise numbers are unclear since there is no biomarker to diagnose NCGS.

• Treatment: Gluten-free diet, although some people may tolerate small amounts of gluten.

Wheat Allergy

• Definition: A wheat allergy is often confused with celiac disease, but the condition is different. Wheat allergy occurs when your body produces antibodies to proteins found in wheat. [3]

• Symptoms: Skin reactions (hives, eczema), respiratory symptoms (wheezing, nasal congestion, asthma), digestive issues (nausea, vomiting, diarrhea), anaphylaxis (rare but severe).

• Prevalence: More common in children than adults, estimated prevalence varies widely among different populations.

• Treatment: Strictly avoiding wheat and wheat-containing products, carrying an epinephrine auto-injector for emergency use in severe reactions.

How Do You Know If You Have Celiac Disease or Gluten Intolerance?

Is gluten intolerance the same as coeliac disease? No. Celiac Disease, Non-Celiac Gluten Sensitivity (NCGS), and Wheat Allergy involve adverse reactions to components found in wheat or gluten, but their underlying mechanisms are different. Therefore, they require different diagnostic approaches.

• Celiac Disease Diagnosis: Blood tests for specific antibodies (anti-tissue transglutaminase antibodies and anti-endomysial antibodies), followed by confirmatory intestinal biopsy. [1]

• NCGS Diagnosis: Exclusion of Celiac Disease (through a blood test) and wheat allergy, symptom improvement on a gluten-free diet, and relapse upon gluten reintroduction. [1]

• Wheat Allergy Diagnosis: Skin prick test, blood tests for specific IgE antibodies, oral food challenge. [1]

Can You Be Gluten-sensitive and Not Celiac or Vice Versa?

If you have celiac disease, you are inherently sensitive to gluten because it triggers an autoimmune response damaging your small intestine. However, having gluten sensitivity doesn't necessarily mean you have celiac disease, as the latter involves a specific autoimmune reaction that can be confirmed through diagnostic tests.

Please never diagnose yourself and have a healthcare professional diagnose the cause of your difficulties when you eat gluten.

What Are the Risk Factors for Celiac Disease and Gluten Intolerance?

Understanding the risk factors for celiac disease and gluten intolerance can help you navigate your medical diagnostic journey to optimize your health.

Celiac Disease Risk Factors

• Genetic predisposition: Having a family member with celiac disease. [1]
• Presence of other autoimmune diseases: Such as Type 1 diabetes or autoimmune thyroid disease.
• Genetic disorders: Like Down syndrome and Turner syndrome. [4]

Gluten Intolerance (Non-Celiac Gluten Sensitivity) Risk Factors:

• Other sensitivities: People with lactose intolerance or other food sensitivities may be more prone to NCGS.
• Family history: Though less clear than celiac, a family history of food sensitivities might increase your risk.
• Environmental factors: Some suggest that factors like gut health and overall diet may play a role, though research is ongoing. [2]

Can Gluten Intolerance and Celiac Disease Be Treated?

Both gluten intolerance and celiac disease can be managed effectively through dietary changes. The primary treatment for both conditions involves strictly avoiding gluten-containing foods like wheat, barley, and rye. [1]

For those with celiac disease, adhering to a gluten-free diet is crucial to prevent damage to the lining of the small intestine and avoid long-term health complications. While gluten intolerance doesn't cause the same intestinal damage, avoiding gluten can significantly alleviate symptoms and improve quality of life. [1]

Working with a healthcare provider or dietitian is vital to ensure your diet is balanced and nutritious to avoid malnutrition.

Gluten-Free Diet – What to Avoid

Foods to Avoid:

• Wheat and Wheat Variants: Includes durum, spelt (dinkel), farro, and kamut. Wheat is commonly found in breads, pasta, cereals, and many processed foods.
• Rye: Often found in bread, rye beer, and some cereals.
• Barley: Common in malt, food coloring, soups, and beer.
• Triticale: A less common grain that is a cross between wheat and rye, found in some cereals and breads.
• Bulgur: A kind of dried cracked wheat, often used in Middle Eastern cuisine.
• Seitan: Also known as wheat gluten or wheat meat, commonly used as a protein source in vegetarian and vegan diets.

Tricky Foods That Contain Gluten

Navigating a gluten-free diet can be tricky, primarily since gluten is found in many unexpected foods.

Here's a list of items that often contain gluten, which might surprise you [3]:

• Soy Sauce: Many brands of soy sauce are made with wheat, making them a hidden source of gluten.

• Salad Dressings: Some salad dressings use wheat-based thickeners or malt vinegar, which contains gluten.

• Soups and Broths: Many canned or prepared soups and broths use wheat flour as a thickener.

• Processed Meats: Gluten can be found in deli meats, sausages, and hot dogs as a binder or filler.

• Imitation Seafood: Products like imitation crab meat often contain wheat as a main ingredient.

• Beer: Most beers are made from barley, which is a source of gluten, though gluten-free options are available.

• Licorice and Candy: Some candies, including licorice, use wheat flour as a binder.

• Communion Wafers: Traditional communion wafers are made from wheat.

• Medications and Supplements: Some pills and vitamins use gluten as a binder or filler.

• Beauty Products: While not ingested, some beauty products, like lip balms can contain gluten and cause issues for highly sensitive individuals.

Tips for Avoiding Gluten:

• Read Labels Carefully: Gluten can hide in unexpected places, such as sauces, condiments, and medications or supplements, so always check the ingredient list.

• Choose Naturally Gluten-Free Foods: Focus on a diet rich in fruits, vegetables, meats, fish, dairy, nuts, and gluten-free grains like rice, quinoa, and corn.

• Be Cautious with Cross-Contamination: Even a tiny amount of gluten can cause symptoms. Use separate cooking utensils and surfaces for gluten-free foods.

• Explore Gluten-Free Alternatives: Many stores now offer gluten-free alternatives to your favorite foods, including pasta, bread, and snacks.

• Stay Informed: Gluten-free labeling regulations can change, and new gluten-free products are constantly being developed. Keep up with the latest information to safely manage your diet.

Remember, going gluten-free is a significant change, but with careful planning and a bit of creativity, you can enjoy a diverse and delicious diet while maintaining your health.