Celiac disease v. gluten intolerance


NEW YORK — Many people are familiar with the gluten-free movement, even if they don’t tailor their diets around gluten-free foods.

What began as a relatively unknown dietary restriction among people diagnosed with a certain intestinal disease has branched out to include many other people who avoid gluten for various health reasons.

Not all the same

A sensitivity to or intolerance of gluten is not the same as suffering from celiac disease, a condition that requires people to refrain from eating gluten. Understanding the differences between the disease and the decision to avoid gluten can make it easier to understand the various effects gluten has on the body.

What is gluten?

Gluten is a protein composite found primarily in wheat and other grains, such as barley, rye and spelt.

Related: What’s the big deal about gluten?

Is a gluten-free diet appropriate for everyone?

Celiac disease or gluten sensitivity?

The stored proteins of corn and rice are sometimes called glutens, but their compositions differ from true gluten.

Gluten often is found naturally in foods and is an important source of protein. Gluten also may be added to foods to supplement their protein content.

Gluten gives dough its elasticity and helps breads rise and keep their shape. Gluten usually gives baked goods a chewy texture. Baking will make gluten molecules come together, which stabilizes the shape of the final product.

Gluten also may be used as a stabilizing agent in other foods, like sauces and ice cream.

Celiac disease

Celiac disease is an autoimmune disorder linked to the consumption of gluten. The Celiac Disease Foundation says the disease affects one in 100 people across the globe.

When those with celiac disease eat foods that contain gluten, their bodies see the protein as a foreign invader. As a result, the body mounts an immune system response and ends up attacking itself in the area of the small intestine, which is responsible for nutrient absorption.

When the small intestine is damaged severely, it is unable to extract vitamins and minerals from food, leading to various health problems, including malnutrition.

Often genetic

In many cases, celiac disease is hereditary. A person with a first-degree relative, meaning a parent, child or sibling, with celiac disease has a one in 10 risk of developing celiac themselves, according to the CDF.

In some instances, all it takes is one instance of consuming gluten to trigger an immune system reaction that continues for life.

There is no cure for celiac disease, and those diagnosed with the disease must avoid gluten to prevent serious health problems. Left untreated, celiac disease can lead to anemia, infertility, neurological conditions, and intestinal cancers.

Gluten sensitivity

When consuming gluten, a person with gluten sensitivity or intolerance does not experience symptoms as severely as one who has celiac disease does.

For example, those with sensitivity do not experience small intestine damage or develop the autoantibodies found in the tissue of those with celiac disease.

A research team led by celiac expert Alessio Fasano, MD, discovered that gluten sensitivity is associated with an immune response that is very different from the response seen in celiac disease patients.

According to the study, which included a four-month gluten challenge, individuals with gluten sensitivity showed no signs of intestinal damage or increased permeability, but they did exhibit an increase in an innate immunity marker. This is different from the immune response seen in celiac disease, which is noted by an increase in an adaptive immune marker.

Despite this, those with a gluten sensitivity may still exhibit similar symptoms to celiac disease. These include intestinal pain, bloating, diarrhea, and cramps. In addition, depression, skin rashes and irritability may occur.

Simple blood test

People who suspect a gluten sensitivity or celiac disease should visit a doctor for a simple blood test.

Gluten should be avoided only if advised by a doctor, and individuals should not self-diagnose and treat symptoms.

More information on celiac disease is available at Celiac.org.


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  1. Unfortunately, blood tests are not accurate. Most show a false negative. Enterolab (enterolab.com) in Dallas has a stool test that tests for gluten sensitivity. This topic, as well as an explanation of the numerous conditions that can be caused by a sensitivity to gluten, please read the book I co-authored with Dr. Shari Lieberman, The Gluten Connection (Rodale, 2007).


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