Celiac Disease vs Gluten Intolerance: What’s the Difference?

What is Celiac Disease?

Celiac disease is an autoimmune condition. That means your immune system mistakenly attacks your own body. In this case, the small intestine is the target, and gluten is the trigger. Gluten is a protein found in wheat, rye and barley.

When you have celiac disease and eat gluten, it damages the lining of your small intestine. Over time, this damage can lead to serious health issues, such as:

• Brain fog
• Nutrient deficiencies, because your body cannot absorb vitamins properly
• Ongoing stomach issues like bloating, diarrhea and constipation
• Skin rashes
• Tiredness and weakness
• Weight loss

People with celiac disease may also be at higher risk for other autoimmune disorders. These include rheumatoid arthritis, which affects the joints, and autoimmune hepatitis, which causes liver inflammation.

Your physician can check for celiac disease with a simple blood test. If the results are positive, they may do a small intestine biopsy (tissue sample) to confirm the diagnosis.

Celiac disease is being diagnosed more than ever because of a combination of increased physician and public awareness, better serologic blood and genetic testing that is available, and an increase in the incidence of celiac that may be related to environmental factors. Catholic Health specialists do targeted screenings for patients who are at a high risk for celiac disease because of a history of autoimmune conditions or family history, as well as general screening for patients who are exhibiting symptoms which may be related to celiac disease such as anemia or abdominal pain.

The only current treatment is a strict, lifelong gluten-free diet. Even small amounts of gluten can trigger symptoms, so it’s usually best to avoid it completely.

What is Gluten Intolerance?

Non-celiac gluten sensitivity (NCGS) is the medical term for what many people refer to as gluten intolerance or gluten sensitivity. This condition shares some symptoms with celiac disease, but it’s not the same thing. You may experience:

• Bloating and gas
• Brain fog
• Fatigue
• Headaches or joint pain
• Stomach pain

Unlike celiac disease, gluten intolerance does not damage your intestines or show up on standard medical tests. It is not considered an autoimmune disorder, but that doesn’t make the symptoms any less real — or less disruptive to daily life.

In fact, research shows that gluten intolerance often appears with irritable bowel syndrome (IBS), a condition that affects how your colon functions.

The good news is that many people with gluten intolerance feel much better when they avoid gluten. While there is no official cure, the right dietary changes can make a big difference in your everyday life.

What About Wheat Allergies?

In some cases, the problem is not gluten. It is a wheat allergy. This is a different condition where the immune system reacts to proteins in wheat, not just gluten alone. Symptoms appear quickly, sometimes within minutes after eating. You may experience:

• Difficulty breathing
• Hives or itching
• Nausea or vomiting
• Swelling, especially around the face or throat

Wheat allergies are more common in children, but can occur at any age. Some children outgrow it as they get older. Your doctor can diagnose a wheat allergy through allergy testing, which may include a skin prick or blood test.

Treatment usually involves avoiding wheat products. For severe allergic reactions, people may need an emergency medication, like an EpiPen® (epinephrine auto-injector).

How Do You Know Which One You Have?

This is where things get tricky, because there’s no single gluten intolerance test. Instead, figuring out what is causing your symptoms involves a process of elimination:

1. Start with a blood test: Your physician will likely begin by testing for celiac disease and wheat allergy. These tests check for certain antibodies in your blood. High levels may indicate an immune response to gluten. Sometimes, your physician will check for genes linked to celiac disease.
2. Biopsy, if needed: If your blood test results suggest celiac disease, your physician may recommend a small intestine biopsy. This allows them to see damage and inflammation in the tissue up close.
3. Try a gluten-free diet: If your physician rules out celiac disease, they might suggest removing gluten from your diet for a few weeks. During this period, keep a close eye on your symptoms. Do you feel less bloated? More energetic?
4. Reintroduce gluten carefully: After avoiding gluten, you will slowly add it back into your meals. Always do this gluten challenge with your physician’s guidance. If symptoms return, it may point toward gluten intolerance.

As you go through this process, keep track of any reactions you have, like skin rashes, stomach discomfort or fatigue. These findings help your provider get a clearer picture of what is going on.

Lifestyle Tips for Living Gluten-Free

Living with celiac disease or gluten intolerance means making some changes, but it doesn’t have to be overwhelming.

“I prioritize patient education and support,” says Dr. Freeman, “Once you know where gluten hides and have a plan in place, living gluten-free becomes much less daunting.”

Dr. Freeman adds, “We are at a point now with the resources patients have such as the Celiac Foundation as well as the increased availability of gluten free items at the grocery store and at most restaurants, it is much easier to include a gluten free diet into any patient’s lifestyle.”

These tips can make the transition smoother:

• Read ingredient labels carefully. Gluten can hide in unexpected places, including sauces, seasonings and supplements.
• Look for “certified gluten-free” labels to avoid cross-contamination.
• Explore naturally gluten-free foods like rice, quinoa, fruits and vegetables.
• Consider working with a registered dietitian for balanced meal planning.

Most importantly, be kind to yourself. Adjusting can take time, but you will start to feel better once you find what works for your body.