Celiac Versus Gluten Intolerance: What’s the Difference?

The terms “gluten intolerance” and “gluten sensitivity” are often used interchangeably, and sometimes they are even used interchangeably with “celiac disease.” So what’s the deal with these different terms that are used for people who are unable to digest gluten? Does it matter which term you use?

And, most importantly, do the nutritional concerns of a person with biopsy-confirmed celiac disease vary from the nutritional concerns of someone with serious non-celiac gluten sensitivity?

Let’s take a look at what these terms mean, and why using the right one can improve your health.

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Know the Difference Between Celiac Disease and Gluten Intolerance

Celiac disease: An autoimmune disease also known as celiac sprue or gluten-sensitive enteropathy. Gluten consumption contributes to intestinal villi damage, causing malabsorption. Even the smallest amounts of gluten can cause villi damage and contribute to risk factors for osteoporosis, certain cancers and other maladies. Celiac disease is related to specific genes that are inherited, and it is estimated to affect about 1% of the population.

Non-celiac gluten intolerance or gluten sensitivity: An adverse reaction to the ingestion of gluten that is not autoimmune in nature and is not celiac disease. It is diagnosed only in the absence of celiac disease. Reactions may range from gastrointestinal to neurological, but do not include any damage to the intestinal villi and no malabsorption is noted. There is no known genetic component but it does appear to run in families. Incidence is not known but is estimated to be as high as 6% of the general population.

Why Does It Matter?

Knowing whether you have celiac disease or non-celiac gluten intolerance / sensitivity matters for several reasons. First, people with celiac disease are at risk for a number of diseases and disorders that are serious and potentially life-threatening if they don’t stick to a gluten-free diet for life.

There is no room for “cheating” for someone with celiac disease, whether or not they are symptomatic. Even after going gluten-free, celiacs should be followed by a physician to ensure their bone density is normal and they are not suffering from continued malabsorption.

People with non-celiac gluten intolerance, on the other hand, may in some cases find they can ingest small quantities of gluten without ill effect. Even if they do feel badly after ingesting gluten, there is not yet any proof that serious damage is occurring to their bodies. This means that they may not need to be as cautious about cross-contamination as a celiacs needs to be.

They should also rule out the presence of IBS, GERD or colitis, since gluten can trigger flares of these conditions in some people. (The key words here are “may” or “may not”. Individuals with gluten intolerance are at very different parts of the sensitivity spectrum – some are very sensitive to gluten and others are not so sensitive, so it’s important to keep in mind that everyone reacts differently.)

Is a Gluten-Free Diet the Answer for Celiacs and Gluten Intolerant Folks?

If you have celiac disease, you must be 100% gluten-free for life to avoid complications of untreated celiac disease.

If you don’t have celiac disease but experience fatigue, intestinal discomfort, diarrhea, constipation, heartburn, headaches, neurological symptoms, etc. after gluten ingestion, then a gluten-free diet is a good thing to try.

However, not so fast!

Before you go gluten-free you need to rule out celiac disease, which can only be tested for if you’re currently ingesting gluten. So get a celiac blood test (and, if possible, biopsy) before embarking on a gluten-free lifestyle. Once you’ve ruled out celiac disease, a gluten-free diet may help you improve your health and wellbeing.

Other Nutritional Considerations for Celiac Disease Versus Gluten Intolerance

For people with celiac disease:

• Take a bone density supplement, such as a supplement combining calcium, magnesium and vitamin D3.
• Consider iron and B12 supplementation, as celiacs are often low in both nutrients.
• Take a multivitamin to guard against deficiencies.

For people with non-celiac gluten sensitivity:

• Take a high quality probiotic to help alleviate intestinal discomfort.
• Consider fish oil to reduce general inflammation in the body.
• Supplement with B vitamins and possibly iron in order to replace the nutrients that are normally added to fortified wheat flour that’s found in pasta, cereal, and bread.

While new research on celiac disease is coming out all the time, we’ve noticed a lack of research on non-celiac gluten intolerance, and we hope to see more in the future. So many non-celiacs are benefiting from a gluten-free diet, and there is still no conclusive evidence about why some people who are not celiac are unable to digest the gliadin and glutenin proteins found in wheat, barley, and rye.

In the meantime, the gluten-free market is growing so there is no shortage of gluten-free food for anyone who needs or prefers it. Just make sure you know what your diagnosis is so you can ensure that you are meeting your nutritional requirements.