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Differentiating Gluten Intolerance and Celiac Disease

written by valerie smoliakova Sep 09, 2024

If you consistently struggle with fatigue, depression, or abdominal pain, you may unknowingly have gluten intolerance or celiac disease. Though these symptoms can have a variety of causes, foods with gluten are often overlooked as the potential culprit. It wouldn’t be surprising if some of these symptoms went unnoticed, as gluten-related conditions regularly go undiagnosed. In this article, we will distinguish between these two conditions and share why it is important to get tested for them if you exhibit any symptoms. 

What is celiac disease?

Celiac disease is an autoimmune disease that targets the small intestine. The small intestine is an organ in our body where nutrients and vitamins from food are absorbed. It is genetically inherited, meaning it is mostly likely to be passed down from either of your parents, just like physical traits. Celiac disease can manifest at any age, meaning a person with the celiac gene can randomly have it triggered at any point in their life, even after years of eating gluten. 

To understand this autoimmune disease, think of your small intestine as a castle, your immune system as the army that protects it from foreign invaders like viruses and bacteria, and your antibodies as the individual soldiers. 

Normally, the army can easily differentiate between harmless substances and foreign invaders that enter to know who to target and fight. If an invader is detected, the army will trigger an immune response that produces antibodies, i.e. the soldiers, who attack and kill the invaders. 

However, in some people, the army will malfunction and mistake harmless substances as invaders, creating antibodies that attack the harmless proteins and the small intestine itself, causing unnecessary damage and the onset of unpleasant symptoms. 

This confused immune system reaction is what happens in those with celiac disease if they consume gluten, a protein typically found in wheat, barley, and rye. In these cases, the immune system is triggered by gluten and tries to fight against it like it would a virus. When consumed in any form, it triggers inflammation and other symptoms that, if consistent over time, can lead to long-term or permanent damage to the small intestine. 

Why does celiac disease often go undiagnosed?

Celiac disease is known for its inconsistency in symptoms among various individuals, with some even being asymptomatic and showing no symptoms, preventing them from ever getting tested or diagnosed. Oddly enough, it is estimated that about 1% of Americans have celiac disease, though about 83% of Americans with this illness are undiagnosed or misdiagnosed. Since symptoms can vary drastically in presentation and severity among individuals, this condition commonly gets misdiagnosed as gastric ulcers, irritable bowel syndrome, diverticular disease, and other similar intestinal diseases.

Why is it important to identify symptoms early? 

According to the NIH, the broad range of symptoms can include:

  • Gastrointestinal problems, like diarrhea, constipation, gas, and unpleasant stools
  • Abdominal pain and bloating
  • Skin rashes
  • Fatigue
  • Mental health issues, including depression or anxiety
  • Nausea or vomiting
  • Vitamin deficiencies 
  • Pain in joints/bones

Even small traces of gluten can cause damage to the small intestine, which is why it’s important for those who are diagnosed to phase out the protein from their diet completely. If left untreated, the condition can worsen and lead to many negative non-intestinal symptoms, including

  • Anemia: A condition where the body has a low amount of red blood cells. 
  • Osteoporosis: A bone disease that causes bones to become brittle and weak. 
  • Reproductive issues, such as infertility and inconsistent menstrual cycles.
  • Malnutrition: When the body cannot acquire nutrients and vitamins properly
  • Liver damage 

It is important to keep an eye on some non-food products as well, as gluten can also be found in commercial products such as lip balms and vitamins. 

Distinguishing gluten intolerance from celiac disease:

Gluten intolerance, also known as non-celiac gluten sensitivity (NCGS), is a condition that involves a negative, non-allergic response to gluten consumption without the presence of celiac disease. When a patient has shown a negative response to gluten and has tested negative for celiac disease, they are usually diagnosed with gluten intolerance instead. It is estimated that about 6% of the U.S. population is gluten intolerant. 

Though some studies indicate that gluten intolerance may be linked to genetics, the exact cause of this condition remains unknown. Gluten intolerance should not be confused with a wheat allergy, a separate condition involving a different immune system response. Gluten intolerance is not necessarily an allergy, and though gluten is found in wheat, those allergic to wheat specifically have an allergic reaction to the wheat protein. 

Is gluten intolerance an autoimmune condition? 

Unlike celiac disease, which involves an autoimmune response that targets the small intestine lining with antibodies, the gluten intolerance response does not involve antibodies.

The mechanism of gluten intolerance is not fully understood, with some studies suggesting it may involve a different part of the immune system or issues with the gut. Similarly to celiac disease, the body detects gluten as an invader, leading to inflammation of the intestinal lining and causing a cascade of unpleasant symptoms. 

Though the symptoms of gluten intolerance can sometimes look identical to celiac disease, it differs in the fact that it does not cause damage to the small intestine. Additionally, celiac disease symptoms tend to be more severe and longer-lasting.

What are the typical symptoms of gluten intolerance? 

  • Gastrointestinal problems, like diarrhea, constipation, gas, and unpleasant stools
  • Abdominal pain
  • Bloating
  • Nausea
  • Changes in bowel patterns
  • Chronic fatigue
  • Depression
  • Headaches
  • Joint and muscle pain
  • Weight loss 
  • Anemia 

Since these conditions have almost identical physical and mental manifestations, these conditions cannot be diagnosed with symptoms alone. Physicians and healthcare professionals will usually conduct a specific screening to rule out celiac disease first, and then determine exactly what the patient is suffering from. 

Currently, a diet completely absent of gluten is the only successful form of treatment for people suffering from either condition. Though it may sound like both conditions are adversely life-changing, if a patient strictly follows a gluten-free diet, they can live a healthy, normal life free of pain and discomfort. In this day and age, more companies and restaurants are emphasizing gluten-free options and variations. Continuing to spread awareness and educate others will ensure that more people will get tested and take the steps towards a healthier lifestyle. 

 

Written by Valerie Smoliakova

Edited by Hash Brown Taha

 

References:

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