For many people, avoiding gluten is more than just a health fad to help with weight loss. This is a necessity driven by health conditions such as celiac disease or gluten intolerance (often called non-celiac gluten sensitivity or non-celiac wheat sensitivity).
But how do you know which scenario you might be dealing with? Anyone who experiences digestive issues like bloating, cramping, stomach pain, and diarrhea after eating gluten, or even other symptoms like depression, fatigue, and brain fog, may have celiac disease or a gluten intolerance. Doctors say it’s difficult to tell them apart.
Having said that, these two conditions are hardly the same. Below, experts break down the differences between gluten sensitivity and celiac disease, signs that you’re experiencing one but not the other, and tips for managing both conditions.
The Fine Line Between Sensitivity And Celiac Disease
About 1% of Americans have celiac disease, which occurs when people who are genetically susceptible are exposed to gluten. It’s an autoimmune disease in which the body’s immune system mistakenly attacks the small intestine, inhibiting its ability to absorb nutrients properly and causing inflammation.
Inflammation of the small intestine can have an impact on a patient’s health because it affects their ability to absorb food, can lead to malnutrition, and can lead to weight loss.
Foods containing gluten can cause uncomfortable gastrointestinal symptoms in people with celiac disease, such as bloating, diarrhea, weight loss, and constipation, as well as other problems such as vitamin and mineral deficiencies, iron deficiency, anemia, joint pain, and osteoporosis wait.
Non-celiac gluten sensitivity, on the other hand, is not an autoimmune disease and does not involve intestinal inflammation. People with this problem usually don’t develop more serious complications of celiac disease, such as malnutrition and weight loss, because at the end of the day, their small intestines aren’t actually inflamed.
Gluten sensitivity is also more mysterious in how it manifests, how long it lasts, how it is diagnosed, and its long-term risks or complications.
The mechanisms of celiac disease are fairly well understood, and although we’re learning more and more over time, non-celiac gluten sensitivity is just a newer player in all this.
Celiac disease is a lifelong condition that can also be hereditary, while gluten sensitivity is poorly understood. There are definitely cases of temporary gluten sensitivity where people will have these reactions and then for whatever reason, they go away.
Both conditions come in many forms, which means not only do the signs and symptoms vary from person to person, but some people may have the condition much more severely than others.
Getting A Diagnosis
The clear difference between non-celiac gluten sensitivity and celiac disease is that celiac disease is diagnosable. Celiac disease is easily identified based on testing when a doctor wants to know what’s going on in a patient who is intolerant to gluten.
We can easily screen for celiac disease with a simple blood test that looks for specific antibodies or immune proteins.
For people with a high suspicion of having this disease, we perform an upper endoscopy and small bowel biopsy to confirm the diagnosis. This essentially means that if you suspect celiac disease, your doctor will insert a long, thin tube through your mouth and down into your small intestine to look around and take samples. This is a way to check and confirm the presence of active inflammation typical of a condition.
Diagnosing non-celiac gluten sensitivity is a little tricky because there are no clear tests or limited ways to determine whether you have the condition. Doctors need to rule out other conditions, such as celiac disease and wheat allergies, before making a decision.
The lack of direct testing results in high rates of self-diagnosis, which is often wrong.
Symptoms may overlap with those seen in other conditions, such as small intestinal bacterial overgrowth, irritable bowel syndrome (IBS), and pelvic floor dysfunction.
Without diagnostic testing, it’s difficult to find out how common non-celiac gluten sensitivity is, although it is thought to be more common than celiac disease. It is currently estimated that up to 6% of the population has the disease, but the exact number is unknown.
While the celiac disease test is simpler, it comes with an important caveat: Patients must eat gluten while undergoing the test. If a person follows a gluten-free diet, blood tests may show false negatives and intestinal inflammation may decrease, causing doctors to think the patient has non-celiac gluten sensitivity when in fact they have celiac disease.
If people with celiac disease are not exposed to any foods containing gluten for a long time, their antibodies can become negative. When you’re trying to differentiate between the two, what can really help you do that are antibodies.
Tackling Treatment
Figuring out which condition you’re dealing with is arguably one of the most challenging parts of facing gluten issues. But there’s some good news – once diagnosed, both diseases can usually be managed with a gluten-free diet.
Grains such as wheat, barley and rye contain gluten, so to avoid gluten you need to avoid breads, pastas, baked goods and processed foods that contain these grains. The amount of gluten you can tolerate may vary from person to person, but most doctors recommend that patients with both conditions avoid gluten to be safe.
Treatment for non-celiac gluten sensitivity may sometimes vary, depending on the cause of the sensitivity. In some cases, a wheat-free diet may be recommended instead of a gluten-free diet. That’s because some people’s problems stem from a reaction to a carbohydrate in wheat called fructans, rather than gluten (gluten is basically a protein found in wheat and other grains).
For these patients, doctors recommend a low-FODMAP diet, which means limiting the intake of specific fermentable carbohydrates, such as garlic, onions, and mangoes. The diet is said to help reduce bloating, stomach pain and other symptoms. Of course, your doctor knows best, so you need to follow their advice.
Should you avoid gluten if you are gluten-insensitive? This might not be the best idea.Experts stress that unnecessary elimination of gluten may reduce the overall quality of the diet and have negative consequences. It doesn’t have to be a weight loss solution.
This misconception is common, and recent research actually shows that limiting gluten without proper instruction may be linked to weight gain, diabetes, and reduced bone density. Not to mention these diets are expensive, restrictive, and not always easy to obtain.
For anyone suffering from bowel problems or even having other unexplained non-gastrointestinal symptoms, it’s always a good idea to see a doctor to figure out what’s going on. Life gets better when you can eat pain-free.