What is the Difference Between Celiac Disease and Gluten Sensitivity?

You may have seen the term gluten-free or GF at a restaurant or grocery store and wondered, what does that actually mean...

Curious? Let’s explore.

Gluten is a general name for the proteins found in wheat (wheatberries, durum, farro, semolina, graham, KAMUT Khorasan wheat, emmer, farina, spelt, and einkorn), rye, barley and triticale - which is a cross between wheat and rye.

It is the binder or glue that holds different foods together and gives them their “stretchy” quality.  Think of a pizza maker tossing and stretching pizza dough.  Without the gluten, the dough would rip.

So, why would a pizza shop offer gluten-free pizza if they want the dough to stick together? (And wouldn’t the pizza fall apart…)

I’m so glad you asked!

For most, gluten is safe and something that does not need to be avoided.  But, for those who have celiac disease or a gluten sensitivity, it’s a different story.  While they are different, they do have a common fix - removing gluten.

It will help to first understand what the difference is between celiac disease and non-celiac gluten sensitivity (NCGS)/non-celiac wheat sensitivity (NCWS).

‍
Celiac Disease

‍‍
Celiac disease is an autoimmune disease characterized by inflammation in the small intestine.  Individuals with this disease have an immune response to the protein (gluten) found in wheat, rye, barley, and triticale.  This disease is hereditary which means it runs in families.

When this protein is consumed by someone with celiac disease, it triggers an immune response that causes damage to the villi in their small intestine.  The villi are tiny finger-like projections that help pass fluid and nutrients from the intestine into their bodies.  The inflammation and damage from gluten cause the villi to atrophy or become “smooth”.  When the villi get damaged, nutrients cannot be absorbed properly into the body.

Symptoms of celiac disease include diarrhea, wasting of the body, malabsorption, failure to grow, bloating, and abdominal cramps.  Some individuals with this disease do not show or have symptoms.

In some cases, individuals will test negative for celiac disease but still show symptoms when consuming gluten.  The terms non-celiac gluten/wheat sensitivity are used in these situations.

‍

Non-Celiac Gluten/Wheat Sensitivity

‍‍
Non-Celiac Gluten/Wheat Sensitivity was considered a non-autoimmune response to consuming gluten up until 2016 when researchers at Columbia University Medical Center showed otherwise.  They published a study confirming that wheat exposure to this group is triggering a systemic immune response and causing intestinal damage.

At this point, research has not confirmed that gluten is the culprit triggering the immune response in these individuals.  Other potential triggers include amylase-trypsin inhibitors (ATIs) and fructans which are found in FODMAPs.  Each of these contains gluten but gluten may not be the cause of the symptoms. At this time more research is needed.
‍

Gluten Free Diet

‍
The gluten-free diet is currently the only treatment for those with celiac disease.  Those living with non-celiac gluten/wheat sensitivity also benefit from a gluten-free diet.  With both of these utilizing diet as treatment, there needs to be an agreement on what this diet looks like.

In addition to removing wheat, rye, barley, and triticale from their diet, cross-contamination with these grains during food processing, preparation, and handling must also be avoided.  The ingestion of even a small amount of gluten can cause intestinal damage.  It is important that careful monitoring of ingredients and processing is a key part of the gluten-free diet.

This could lead some to think that a gluten-free diet would be difficult but that is not the case.  There are many naturally gluten-free foods that can be a part of a healthy diet.  Here is a list below:

• Fruits and vegetables
• Beans, seeds, legumes, and nuts (in their natural and unprocessed forms)
• Eggs
• Lean, unprocessed meats, fish and poultry
• Most low-fat dairy products
• Amaranth
• Arrowroot
• Buckwheat
• Corn
• Gluten-free flours (rice, soy, corn, cassava, potato and bean flours)
• Millet
• Quinoa
• Rice
• Sorghum
• Soy
• Tapioca
• Teff
• Oats – while naturally gluten-free, they may be contaminated during production with wheat barley or rye. Oats labeled gluten-free have not been cross-contaminated.

A gluten-free diet is not necessarily a cure-all.  It is common for some to struggle with symptoms even after going gluten-free.  Keep in mind that it does take time for your body to heal.  If you are still having symptoms, it is important to speak with your doctor about them.  Your doctor and a registered dietitian can help you to determine if you are still consuming gluten or if something else might be causing your symptoms.

It should be noted that a gluten-free diet cannot replace a formal consultation, diagnosis, or recommendation from a physician or trained healthcare professional.