Celiac Disease vs. Gluten Intolerance: What's the Difference?

For most people, there's no reason to give up gluten for good.

But that's not so easy for folks with two gluten-related medical conditions: celiac disease and gluten intolerance, according to Dr. Sarmed Sami, a gastroenterologist at Mayo Clinic Healthcare in London.

In recent years, there has been a growing awareness of gluten-related issues, leading many people to question whether they might be affected by conditions like celiac disease or gluten intolerance. While both conditions involve sensitivity to gluten, they are distinct in their mechanisms, symptoms, and long-term implications. In this article, we will explore the key differences between celiac disease and gluten intolerance to help you better understand these often misunderstood conditions.

Celiac Disease: An Autoimmune Disorder

Gluten is a protein found in grains including wheat, barley and rye.

In people with celiac disease, eating it triggers an autoimmune reaction that causes cell damage to the small intestine. That reaction can cause diarrhea, fatigue, weight loss, bloating, anemia and lead to serious complications, Sami says.

Symptoms of Celiac Disease

Celiac disease can manifest with a wide range of symptoms, making it a challenging condition to diagnose. Some common symptoms include:

Digestive Issues: These can include abdominal pain, diarrhea, bloating, and constipation.
Fatigue: Many individuals with celiac disease experience persistent fatigue and weakness.
Skin Problems: Skin rashes like dermatitis herpetiformis can occur.
Weight Loss: Unexplained weight loss may be a sign of celiac disease.
Nutritional Deficiencies: Due to impaired nutrient absorption, individuals with celiac disease may develop deficiencies in vitamins and minerals, such as iron, calcium, and vitamin D.
Neurological Symptoms: Some people with celiac disease experience neurological symptoms like headaches and neuropathy.
Joint Pain: Joint pain and inflammation can also be associated with celiac disease.

It's important to note that not everyone with celiac disease experiences obvious digestive symptoms. Some individuals may have what's known as "silent celiac disease," where they exhibit no noticeable symptoms, but intestinal damage still occurs.

Diagnosis and Treatment

To diagnose celiac disease, doctors start with a blood test to determine whether the body views gluten as an invader and reacts by generating high levels of antibodies. After a positive blood test, an endoscopy can take biopsies to check for damage in the small intestine.

"We typically recommend that people should not be on a gluten-free diet if they are being tested for celiac disease, because that can create false negative results on the blood test," Sami adds.

The only effective treatment for celiac disease is a strict lifelong gluten-free diet. This means avoiding all sources of gluten, including bread, pasta, and many processed foods that may contain hidden sources of gluten.

Gluten Intolerance: A Broad Spectrum of Sensitivity

Gluten intolerance is more common, according to Sami.

"In gluten intolerance, there is no cell damage or inflammation. It's more of a sensitivity: 'Gluten doesn't agree with me,'" Sami said in a clinic news release. "If you eat gluten and have an immediate reaction, such as diarrhea, that's more likely to be gluten intolerance than celiac disease, which is a slow process that you don't tend to feel immediately."

Unlike celiac disease, gluten intolerance, also referred to as non-celiac gluten sensitivity (NCGS), is not an autoimmune disorder and does not cause the same type of intestinal damage. Instead, it represents a spectrum of symptoms related to the consumption of gluten without the autoimmune response seen in celiac disease.

Symptoms of Gluten Intolerance

The symptoms of gluten intolerance can be quite varied and may include:

Digestive Discomfort: Bloating, gas, diarrhea, or abdominal pain after consuming gluten-containing foods.
Headaches: Some people experience headaches or migraines triggered by gluten.
Fatigue: Like in celiac disease, fatigue can be a symptom of gluten intolerance.
Joint Pain: Joint pain and muscle aches may occur.
Brain Fog: Difficulty concentrating or cognitive issues.
Mood Disturbances: Irritability, anxiety, or depression may be linked to gluten intake.
Skin Problems: Skin issues, such as eczema or acne, can be triggered by gluten in sensitive individuals.

Diagnosis and Treatment

Diagnosing gluten intolerance can be challenging because there are no specific blood tests or biopsies that definitively confirm the condition. Diagnosis is often made by ruling out celiac disease and wheat allergy while observing symptom improvement on a gluten-free diet. Treatment for gluten intolerance involves avoiding gluten-containing foods. Many individuals with gluten intolerance find relief by adhering to a gluten-free diet, similar to those with celiac disease.

Key Differences

Autoimmune vs. Non-Autoimmune: Celiac disease is an autoimmune disorder, while gluten intolerance is not.
Intestinal Damage: Celiac disease causes damage to the small intestine, while gluten intolerance does not typically result in structural damage.
Diagnosis: Celiac disease can be definitively diagnosed through blood tests and biopsy, whereas gluten intolerance is often diagnosed through symptom improvement on a gluten-free diet.
Severity: Celiac disease is generally considered more severe due to the potential for serious long-term complications if left untreated.
Treatment: Both conditions require a gluten-free diet, but celiac disease necessitates strict adherence due to its autoimmune nature.

In conclusion, celiac disease and gluten intolerance are distinct conditions with different mechanisms and implications. If you suspect you may have either condition, it is crucial to seek medical evaluation and guidance. Proper diagnosis and management can lead to improved health and a better quality of life for individuals affected by these gluten-related issues. Remember that self-diagnosis and self-treatment are not advisable, and consulting a healthcare professional is essential for accurate assessment and guidance.