A gluten-free diet can be beneficial for people who are gluten sensitive and for people who have celiac disease—but the two conditions should not be interpreted as one and the same.
Wondering about gluten sensitivity vs. celiac disease? Let’s get the facts straight!
Gluten sensitivity and celiac disease involve two different responses to the gluten protein, found in the grains wheat, barley, and rye. Symptoms are similar, which makes it hard to determine which condition you might have without specific medical tests.
Gluten sensitivity is not an autoimmune disease, and it does not cause intestinal damage, unlike celiac disease. Diagnosis of gluten sensitivity can be difficult. According to a study published in Gastrointestinal Endoscopy Clinics, gluten sensitivity symptoms are subjective.
Common symptoms include:
- Abdominal pain
- Tingling in hands and feet
Usually, a gluten-free diet is recommended, but it is still difficult to determine if the cause of these symptoms is indeed gluten.
Celiac disease is an autoimmune disease that damages the intestine and has long-term health consequences. Symptoms include:
- Weight loss
- Abdominal pain
- Skin rashes
- Joint pain
Celiac disease occurs when the immune system reacts to gluten ingestion by attacking the lining of the intestine. This results in intestinal damage and malabsorption of nutrients—and it can cause conditions such as osteoporosis.
Celiac disease is autoimmune in nature, which means that gluten is not directly responsible for the damage. The immune system’s reaction to the gluten protein urges white blood cells to attack the lining of the intestine. Celiac disease is also associated with other autoimmune conditions, including autoimmune thyroid disease and type 1 diabetes.
Gluten Sensitivity vs. Celiac Disease
The HuffPost, in 2012, interviewed Alessio Fasano, M.D., medical director of the University of Maryland Center for Celiac Research, to understand the difference between gluten sensitivity and celiac disease. He suggests looking at gluten ingestion on a spectrum at the end of which is celiac disease. Celiac disease causes damage to the lining of the intestine and malabsorption of nutrients. At the other end of the spectrum, we find the lucky people who consume gluten without experiencing any discomfort. In the middle, there are people who are sensitive to gluten.
The main difference between the two conditions is that gluten sensitivity does not cause the intestinal damage that characterizes celiac disease. Patients with gluten sensitivity present a prevalence of extraintestinal instead of gastrointestinal symptoms, including behavioral changes, skin rash, bone or joint pain, muscle cramps, leg numbness, weight loss, and fatigue—typical gastrointestinal symptoms, instead, include abdominal bloating and gas.
Is Gluten Sensitivity the Same as Gluten Intolerance?
As we are talking about the differences among diseases connected to gluten, it is important to mention that gluten sensitivity is sometimes mistakenly called gluten intolerance. In 2012, top celiac disease researchers met in Oslo, Norway, to establish a standard way of speaking about gluten-related disorders. They determined that gluten sensitivity, NOT gluten intolerance, is the proper way to refer to the condition.
How to Determine if You Have Gluten Sensitivity or Celiac Disease
We have mentioned above that the gastrointestinal and extraintestinal symptoms of gluten sensitivity and celiac disease are similar. For these reasons, it can be hard to reach a definitive diagnosis. A study conducted by Dr. Fasano recommends a diagnostic algorithm that can help determine if you have one or the other. According to the suggested method, the doctor has to rule out celiac disease using specific blood tests, then the patient participates in a gluten challenge, first eliminating gluten from the diet to see if symptoms disappear, then adding gluten back into the diet to see if symptoms return. If symptoms return after reintroducing gluten, it indicates that the patient has gluten sensitivity.
There are several blood tests available to determine if you have celiac disease, but the most common is called a tTG-IgA test. You need to eat gluten for the test to work, and if the result suggests celiac disease, the doctor will recommend a biopsy of the small intestine to confirm the diagnosis. This procedure is performed by a gastroenterologist. During the procedure the intestine is analyzed to see if there is any damage connected to celiac disease.
Experts recommend testing for celiac disease if you have first-degree relatives with celiac disease and if you have an associated autoimmune disorder or other condition, especially type 1 diabetes mellitu, autoimmune thyroid disease, autoimmune liver disease, Down syndrome, Turner syndrome, Williams syndrome, and selective immunoglobulin A (IgA) deficiency. Children older than 3 and adults experiencing symptoms of celiac disease should also be screened.