Gluten Intolerance vs Celiac Disease: Learn the Differences in Symptoms and Treatment

Understanding Gluten and Its Effects on the Body

Gluten is a protein found in wheat, barley, and rye. For most people, consuming gluten doesn't cause any issues. However, for some, gluten can trigger an abnormal immune response that damages the small intestine.

When someone has a negative reaction to gluten, it's commonly referred to as gluten sensitivity. But gluten sensitivity can manifest in different ways, with the three main conditions being:

• Gluten intolerance
• Celiac disease
• Wheat allergy

These three conditions share an underlying cause - an adverse reaction to gluten. But there are important differences between them in terms of symptoms, severity, and treatment.

Gluten Intolerance

Gluten intolerance, also sometimes called non-celiac gluten sensitivity (NCGS), refers to a condition where gluten triggers uncomfortable digestive symptoms. Unlike celiac disease, gluten intolerance does not cause damage to the small intestine.

People with gluten intolerance may experience symptoms like bloating, abdominal discomfort, diarrhea, constipation, fatigue, and headaches when they eat foods containing gluten. The symptoms tend to come on shortly after consuming gluten and improve when gluten is removed from the diet.

Experts aren't entirely sure what causes gluten intolerance, but it's likely due to a combination of factors. Some theories suggest it may be related to poor digestion, intestinal permeability (leaky gut), immune system activation, and genetics.

Gluten intolerance is different from a wheat allergy in that it's not mediated by the immune system. While wheat allergy triggers an IgE-mediated reaction, gluten intolerance does not involve the IgE antibody.

Diagnosis of gluten intolerance involves ruling out celiac disease and wheat allergy. There are no lab tests that can definitively diagnose gluten intolerance, so an elimination diet is used. This involves removing gluten from the diet for several weeks and monitoring symptoms.

The only treatment for gluten intolerance is adhering to a strict gluten-free diet. Most people find their symptoms improve significantly or resolve completely by avoiding all sources of gluten.

Celiac Disease

Celiac disease is an inherited autoimmune disorder characterized by an abnormal immunological response to gluten. When someone with celiac disease eats gluten, it triggers immune system activity that damages the villi - the small, finger-like projections that line the small intestine.

Villi play a key role in nutrient absorption, so when they are damaged, the body is unable to properly absorb nutrients from food. As a result, people with celiac disease who continue eating gluten will become malnourished over time.

Symptoms of celiac disease may include digestive issues like diarrhea, bloating, and abdominal pain. But it can also cause symptoms outside of the gastrointestinal tract such as fatigue, joint pain, headaches, and skin rashes.

Celiac disease is primarily diagnosed through blood tests for certain autoantibodies, as well as an intestinal biopsy showing villous atrophy. It requires strict adherence to a gluten-free diet for life. Most patients with celiac disease who remove gluten from their diet find their symptoms and small intestine damage improve over time.

Wheat Allergy

A wheat allergy is different from gluten intolerance and celiac disease in that it's an allergy involving the immune system. With a wheat allergy, the immune system identifies certain proteins in wheat as harmful and triggers a response to get rid of them.

The proteins that trigger a wheat allergy are different from the gluten protein that causes issues for those with celiac disease or gluten intolerance. A wheat allergy can involve an IgE-mediated reaction with classic allergy symptoms like hives, swelling, breathing difficulties, and anaphylaxis in severe cases.

Non-IgE mediated wheat allergy symptoms typically include gastrointestinal issues like vomiting, diarrhea, abdominal pain, and gastroesophageal reflux. Some children may also develop atopic dermatitis as a symptom.

Diagnosis of a wheat allergy involves skin prick testing and blood tests to check for IgE antibodies to wheat proteins. An elimination diet can help confirm the diagnosis.

The primary treatment for a wheat allergy is strict avoidance of wheat and products containing wheat. Antihistamines and emergency epinephrine may be prescribed to help manage allergic reactions.

Key Differences Between Gluten Intolerance, Celiac Disease, and Wheat Allergy

Here is a quick overview of some of the main differences between gluten intolerance, celiac disease, and wheat allergy:

• Gluten intolerance - Adverse reaction to gluten ingestion characterized by uncomfortable digestive symptoms. Does not involve damage to the small intestine or a classic allergic response.
• Celiac disease - Autoimmune condition triggered by gluten exposure that causes damage to intestinal villi. Primarily involves gastrointestinal symptoms but can affect other organs.
• Wheat allergy - Allergic reaction mediated by IgE or non-IgE antibodies to wheat proteins. Often causes typical allergy symptoms like hives, swelling, breathing issues, vomiting, etc.

While these three conditions share an underlying link to wheat/gluten exposure, the mechanisms involved are different. Gluten intolerance is not an autoimmune disease like celiac and doesn't involve a classic allergic response like a wheat allergy.

Prevalence

It's estimated that about 1% of the U.S. population has celiac disease. However, less than 20% of cases are clinically diagnosed, meaning over 80% remain undiagnosed.

About 0.5-1% of the population is believed have a wheat allergy. Non-celiac gluten sensitivity (gluten intolerance) could affect anywhere from 0.5-13% based on various studies, but there is no definitive data.

Onset & Duration

Gluten intolerance can develop at any age after gluten is introduced into the diet. Symptoms may come and go over time. Celiac disease also develops after gluten is introduced, usually after 6 months of age. Symptoms are chronic if gluten exposure continues. Wheat allergy typically presents in childhood but can appear at any age. Allergy symptoms begin rapidly after wheat ingestion.

Symptoms

All three conditions may cause gastrointestinal symptoms, but other associated symptoms differ. Gluten intolerance mainly involves digestive complaints like diarrhea and bloating. Celiac disease can affect many organs, including the gut, joints, skin, brain. Wheat allergy primarily causes rapid allergic reactions like hives, breathing issues, and anaphylaxis.

Diagnosis

Gluten intolerance is diagnosed by a process of elimination. Celiac testing involves blood tests and intestinal biopsy. Wheat allergy diagnosis includes skin or blood testing for IgE antibodies to wheat. Wheat allergy testing yields clear immunologic evidence of allergy, while celiac testing shows specific autoantibodies and intestinal changes.

Treatment

All three conditions are primarily treated by removing gluten/wheat from the diet. For celiac disease, adherence to a gluten-free diet helps resolve intestinal damage over time. Medications like antihistamines may be used to control wheat allergy reactions. But the avoidance of all wheat/gluten is the main strategy for managing all types of gluten/wheat sensitivity.

Gluten-Free, Wheat-Free, or Both?

Eliminating gluten from your diet means avoiding all foods and products containing wheat, barley, and rye. This includes breads, cereals, baked goods, pasta, etc. made with these gluten-containing grains.

A wheat-free diet involves avoiding all food and products containing wheat. This includes breads, cereals, baked goods, pasta, etc. made with wheat specifically.

For celiac disease and wheat allergy, a diet free of all wheat sources is required. For gluten intolerance, a gluten-free diet without wheat, barley and rye is needed to manage symptoms.

Some people may only require eliminating wheat, while people with celiac disease or gluten intolerance will need to exclude all sources of gluten to prevent symptoms and damage.

Reading Labels

When following a gluten-free or wheat-free diet, it's important to read food labels carefully. For gluten-free, look for the words "gluten-free" or check the ingredients for wheat, rye, and barley. For wheat-free, look for "wheat-free" or scan ingredients for any wheat sources.

Watch out for foods with vague labels like "wheat flour" - this does contain wheat. Foods labeled with "whole grains" may still contain gluten/wheat. Oats are naturally gluten-free but are often contaminated, so look for "certified gluten-free" oats.

Avoiding Cross-Contamination

Cross-contamination is another concern, where gluten/wheat gets into your food from shared kitchen tools or cooking surfaces. Using a separate toaster, cookware, etc. is advised. Checking for "gluten-free" or "wheat-free" labels can help identify products less likely to be cross-contaminated.

Health Benefits of Eliminating Gluten and Wheat

Here are some of the health benefits that may be achieved by removing gluten and/or wheat sources from your diet:

Improved Digestive Health

Eliminating inflammatory compounds like gluten and wheat can help improve digestive symptoms and heal damage in the gastrointestinal tract for some people. This allows for better nutrient absorption.

Reduced Systemic Inflammation

The proteins in wheat and gluten can increase immune activity and inflammation throughout the body. Minimizing these food sources may decrease systemic inflammation.

Stabilized Energy Levels

Wheat and gluten are high on the glycemic index, meaning they cause a rapid spike and crash in blood sugar. Removing these inflammatory grains can prevent energy fluctuations.

Weight Loss

Gluten-free and wheat-free diets eliminate many processed carbohydrates. This encourages eating more fruits, vegetables, and lean proteins - an approach associated with weight loss and management.

Improved Skin, Joints, and Brain

Research shows gluten and wheat sensitivity can negatively impact the skin, joints, and brain activity. Eliminating these grains may relieve associated symptoms and improve function of these organs.

Is Going Gluten-Free or Wheat-Free Right for You?

Adopting a gluten-free or wheat-free diet is a personal choice that can offer health benefits - but it's not necessarily required or recommended for everyone.

Avoiding gluten only needs to be strictly followed by those with diagnosed celiac disease or gluten intolerance. People with a wheat allergy need to eliminate wheat sources.

Others may try going gluten-free or wheat-free to see if it provides symptom relief. However, there is no evidence that eating gluten-free or wheat-free is inherently healthier if you don't have a gluten/wheat reaction.

It's best to check with your healthcare provider before making significant dietary changes. They can help determine if avoiding gluten, wheat, or both may be beneficial for your specific health status.

With a proper diagnosis and guidance, removing gluten and/or wheat can be a promising strategy for overcoming the many health issues these compounds can potentially trigger.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.