Gluten Sensitivity vs. Celiac Disease

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Sixty percent of American adults now live with at least one chronic condition and 42 percent have more than one. Chronic diseases not only bring about great emotional and physical costs, but also they put unsustainable financial burdens on the private and public sector.

In my many years of studying celiac disease and gluten related disorders, I’ve come to realize that what we eat (and what we don’t eat) is the most powerful tool we have to combating this onslaught of chronic diseases.

“All disease begins in the gut,” is something the great Hippocrates once said, and never before has there been more truth to this statement as we see gluten sensitivities, food allergies and a slew of other chronic disorders on the rise.

One of the indisputable contributors of many chronic diseases is inflammation caused by the consumption of gluten. I promise you, going gluten-free is not a fad diet for the millions of people who struggle with their health. Need proof? Studies show that anyone – even if they do not have celiac disease or a gluten sensitivity – experiences some sort inflammatory response upon consumption of gluten.

Gluten Sensitivity vs. Celiac Disease

If you experience any sort of chronic inflammation or pain, eliminating gluten might be the first step to extinguishing the inflammation fire inside your body. But before you say goodbye to gluten for good, let’s first understand what is celiac disease vs. gluten sensitivity.

(1) Celiac Disease

Celiac disease is an autoimmune disease signaled by an immune system attack on the small intestine. Every time someone eats gluten (the trigger food), the white blood cells produce antibodies that mistakenly attack the lining of the small intestine, resulting in intestinal damage and villous atrophy.

The small intestine is a 20-25 foot long tube lined with microvilli. These villi are finger-like follicles that surround the small intestine and look a lot like shag carpet. Villi serve an essential role as they soak up nutrients from food and help your body get those nutrients where they need to be to keep you healthy. The villi in someone with celiac disease are completely worn down and look more like a flat surface than a shag carpet. When the villi are destroyed, the small intestine is no longer properly absorbing nutrients. This is why most people with celiac disease suffer from some sort of nutritional deficiency or a disorder related to a nutritional deficiency.

Some of the many symptoms signaling celiac disease include chronic fatigue, anemia, bone density issues, dental and oral issues, muscle and joint pain, digestive issues, skin disorders, mental disorders, and infertility. As you can imagine, without proper nutrition, the body is unable to function properly, therefore allowing disease to ensue.

According to Dr. Alessio Fasano, one of the world’s leading celiac disease researchers, about 1 in 133 people, or 1 percent of the U.S. population, has celiac disease. This puts celiac disease as humankind’s most prevalent genetically linked disease, occurring much more frequently than type 1 diabetes, cystic fibrosis or Crohn’s disease, according to  Dr. Fasano in his book, Gluten Freedom.

Dr. Fasano says that celiac disease is caused by a combination of three factors – each which must be present for celiac disease to arise: (1) genetic predisposition, (2) consumption of the trigger food (gluten), and (3) intestinal permeability.  I encourage you to read more about what causes celiac disease. Celiac disease is the most researched autoimmune disease in the world and the ONLY autoimmune disease in which the environmental trigger (gluten) has been identified.

People with celiac disease cannot eat gluten, which is found in wheat, barley, rye and a slew of products derived from these ingredients. After eliminating gluten, the microvilli in most celiac disease patients will regenerate.

There is no cure for celiac disease, nor any approved treatment options beyond the gluten-free diet.

(2) Gluten Sensitivity (aka Gluten Intolerance)

Gluten sensitivity has only just started to be recognized as a real medical disorder and unfortunately, there is still a lot of confusing information about how to classify gluten sensitivity and a lot of controversy about how to diagnose and treat it, too.

When someone is sensitive to gluten, it means that they experience some sort of inflammatory response every time they consume the protein. Unlike people with celiac disease who have villous atrophy, people with a gluten sensitivity have normal looking and functioning microvilli. People with a gluten sensitivity also do not develop tissue transglutaminase (tTg) auto-antibodies, which, if present, signals celiac disease.

While gluten sensitivity is considered a gluten-related disorder, is not classified as an autoimmune disease at this time. However, gluten sensitivity, if untreated, can be just as serious, and sometimes even more serious, than celiac disease. (Keep reading to find out why.)

People with a gluten sensitivity often develop and experience the SAME symptoms as those with celiac disease when exposed to gluten, and, if unmanaged, a gluten sensitivity will create the same chronic symptoms and damaging diseases as someone with diagnosed celiac disease. Read: 10 Gluten Sensitivity Symptoms [With or Without Celiac Disease]

The main issue when it comes to understanding gluten sensitivities is that MANY MORE people have gluten sensitivities than celiac disease. According to the Center for Celiac Research, gluten sensitivity affects 18 million people, or six percent of the U.S. population.

Gluten Sensitivity vs. Celiac Disease

Now that I’ve explained celiac disease and gluten sensitivity in detail, I want to outline the main differences and similarities between the two gluten spectrum disorders.

Number of people affected by gluten sensitivity vs. celiac disease:

Only about 1 percent of the U.S. population has celiac disease, while about six percent of the population has a gluten sensitivity. A large percentage of people with celiac disease and people with gluten sensitivities is undiagnosed (aka, people have it, but don’t know they have it).

Symptoms of gluten sensitivity vs. celiac disease:  

Exposure to gluten in both celiac disease and gluten sensitivity patients can result in similar symptoms, including by not limited to gastrointestinal disorders, skin conditions, bone, joint and muscle pain, nutritional deficiencies, mental health disorders, and oral or dental diseases.

If you suspect your body reacts poorly to gluten, you should get tested for both celiac disease and a gluten sensitivity BEFORE going on a gluten-free diet.

Immune response of gluten sensitivity vs. celiac disease:

Celiac disease is classified as an autoimmune disease, gluten sensitivity is a gluten disorder often referred to as a “sensitivity” or “intolerance.” Celiac disease and gluten sensitivity cause two different immune system responses.

People with gluten sensitivities tap into the body’s innate (nonspecific) immune system. Innate immunity is the body’s first defense against foreign invaders that want to attack your cells, such as viruses, bacteria, parasites. Your innate immunity occurs naturally, as it’s “innate.”  In order for a pathogen to attack your cells, it’s going to have to get past your innate immune response first.

On the other hand, people with celiac disease experience an adaptive (or acquired) immune system response to gluten over time. Adaptive immunity is your body’s second line of defense against invaders and is much more complex. Once an invader (gluten) is introduced in the body, the adaptive immune system creates an army of immune cells designed to attack that specific antigen. The immune system remembers those antigens so it can initiate future attacks more efficiently.

Damage caused by gluten sensitivity vs. celiac disease:

People with celiac disease experience damaged and flattened microvilli (villous atrophy) while people with gluten sensitivities have normal villi.

Mortality rates related to gluten sensitivity vs. celiac disease:

This will shock you!

A 2009 study published in the Journal of the American Medical Association (JAMA) set out to understand mortality issues associated with gluten disorders. This is the largest study ever published on this topic. Researchers examined 351,000 intestinal lining biopsies and found 46,121 patients on the “celiac spectrum.” Specifically, researchers found:

• 29,096 had celiac disease (with damaged microvilli)
• 17,025 showed early stages of celiac disease development (the microvilli were showing early signs of being damaged)
• 13,000 did not have worn-down microvilli or positive blood work, yet they had gluten sensitivity and inflammation

Researchers found that celiacs had a 39 percent increased risk of early mortality; however, what is even more shocking is that people with inflammation due to a gluten sensitivity had a 72 percent increased risk of early mortality!  In other words, someone with gluten sensitivity has a higher risk of early death than someone with celiac disease!!

Prevalence of other diseases in gluten sensitivity vs. celiac disease: 

Research indicates that 25 percent of patients with autoimmune diseases have a tendency to develop additional autoimmune diseases. Because celiac disease is an autoimmune disease, people with celiac disease might have a higher risk of collecting additional autoimmune diseases than someone with a gluten sensitivity.

On the flip side, if you have celiac disease, your chance of also having IBS is less (only one percent). If you have a gluten sensitivity, however the frequency of IBS is much higher (30 percent)!

What Do You Have?

If you eat gluten and experience chronic symptoms as a result, it’s important that you talk to your doctor about whether you might have celiac disease or a gluten sensitivity.

For celiac disease, a simple blood test, followed by an endoscopy (where a trained doctor looks for villous atrophy), will help you understand if you have celiac disease. If there is no evidence of celiac disease, but you still have an inflammatory reaction every time you eat gluten, you likely suffer from a gluten sensitivity instead.

There are blood tests available from Cyrex Labs that can test for gluten sensitivity (your doctor must order these labs – be sure to show him/her exactly what you want and be firm in your request as many doctors are unaware these tests exists as it is well beyond their scope of training or knowledge).

You can also do an AT-HOME food sensitivity test from Everlywell (read about my Everlywell experience in this article). If your food sensitivity test indicates a sensitivity to gluten, you should eliminate gluten from your diet for 3-4 weeks, then slowly introduce it back in and see how you feel. It’s best to work with a trained holistic health professional during this process to ensure your health is being closely monitored. (Read more about how food sensitivity tests work.)

Remember, in order to be tested for celiac disease or a gluten sensitivity, you must be eating gluten. Do not initiate a gluten-free diet until you’ve ruled out celiac disease and have been tested for a gluten sensitivity. I discuss the many reasons why YOU MUST get tested first BEFORE you go gluten-free in this important article.

Good luck!