Celiac vs. Gluten Intolerance

nomenclature

Source: Sapone A, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine. 2012; 2013

Gluten is the scary gremlin on the health scene. Just because your best friend, neighbor, or favorite celebrity is gluten-free, does that mean you should be too?

What is gluten? It’s a collective term for a group of proteins found in grains such as wheat, rye, barley and derivatives (i.e. spelt, einkorn). Gluten is well-recognized for giving breads a doughy, elastic structure; but beyond breads, it is used as a thickening agent and flavor enhancer.

Quick note: Gliadins and glutenins are the two main components of the gluten fraction of the wheat seed. Some experts maintain that gliadins are catalysts for problems typically attributed to gluten.

Celiac disease

For those with celiac disease (CD), exposure to gluten triggers an autoimmune attack on the intestines. When the villi (finger-like projections) of the intestines become damaged, the body cannot absorb nutrients into the bloodstream, which can lead to malnourishment and serious chronic health conditions.

People generally develop celiac from a combination of genetic disposition for the disease, a stressful event triggering the genes, and a diet with exposure to gluten, wheat, gliadin, barley, etc.

The diagnosis of celiac disease can be challenging since it shares symptoms to other conditions such as Crohn’s, ulcerative colitis, irritable bowel syndrome, diverticulosis, and even lactose intolerance. Blood tests can reveal auto-antibodies to gluten and often an endoscopy follows; this is where a biopsy can reveal intestinal damage, if one hasn’t started a gluten-free diet already. The presence of genetic markers HLA-DQ2 and/or HLA-DQ8 only shows you may develop CD; it is not a confirmed diagnosis for CD as not all of our genes fully express. Because those with celiac are at risk of malnutrition , other auto-immune conditions, cancer, and osteoporosis, proper diagnosis and support is essential.

For those with celiac disease, it is essential to avoid gliadin/gluten for the remainder of life.

Wheat allergy

Wheat is one of the 8 most common food allergens in the United States. The reaction to ingesting wheat can include rashes, hives, swelling of the eyes, face, mouth, a rapid heart-rate and anxiety.

Unlike celiac disease, where there’s an immune reaction to all gluten-containing grains, for those with a wheat allergy there is only a reaction to the proteins in wheat. Wheat allergies can be diagnosed via a skin prick or blood test.

Sometimes wheat allergies are diagnosed in children but can fade in time.

Non-celiac gluten sensitivity

People with non-celiac gluten sensitivity (NCGS) may experience
similar symptoms as those with CD (including gas, bloating, abdominal pain, fatigue, headaches, forgetfulness/foggy thinking), however, antibodies to gluten are not produced nor is there intestinal damage (two hallmarks of CD). There’s not enough evidence to know for sure if eating small amounts of gluten causes damage.

Interestingly enough, there is evidence linking gluten intolerance to a number of other health conditions including autism, depression, digestive disorders, even schizophrenia.

The symptoms often improve after removal of gluten from the diet.

Detecting gluten sensitivity is difficult since there is currently no accepted diagnostic test for NCGS. It is important to rule out celiac disease and wheat allergy. An elimination diet should be done under supervision of an expert nutritionist.

If you suspect you have celiac disease, wheat allergy, or gluten sensitivity, it is important to get a proper diagnosis and work with a qualified healthcare professional on an elimination diet and food sensitivity test as well as support for following a gluten-free diet.

gluten testing

The results of an individual’s food sensitivity testing showing gluten, gliadin, and wheat as issues.

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