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November 9, 2016

Do you have Celiac? Or Are you just Gluten Intolerant?

The symptoms of celiac disease, a genetic condition which affects an estimated 2 million Americans, and gluten intolerance are sometimes similar but vary from person to person. Despite some similarities, the primary difference between celiac disease and gluten intolerance is that celiac disease involves your immune system and causes long-term damage to the villi (finger-like projections) that line your small intestine. Celiac disease causes nutrients to be mal-absorbed and causing a variety of unhealthy consequences.

In contrast, gluten intolerance is a digestive tract reaction that causes you to experience a variety of gastrointestinal discomforts, but where there is no damage and no danger. In most cases, if a blood test for celiac disease is negative but you clearly feel bad when eating gluten products, the diagnosis is gluten intolerance rather than celiac disease.

Many experience abdominal discomfort, nausea and diarrhea. Symptoms overlap greatly with irritable bowel disorder and other digestive conditions. If you suspect you are gluten intolerant, your doctor can order blood work and a diagnostic analysis to rule out celiac disease and evaluate other causes of the symptoms. Sometimes it becomes clear, or at least very possible, that gluten intolerance may be causing symptoms, but the condition is not celiac disease, and the dietary advice and monitoring of the condition are quite different.

The solution for relief in both conditions may be to limit gluten in food, but there is a vast difference! In celiac disease, all minute traces of gluten should be avoided, lifelong, and patients with celiac disease soon learn how complex that is. The much larger number of individuals with gluten intolerance need to learn just how much gluten they can consume without bothersome symptoms, or how to balance minor symptoms with tolerable amounts of gluten intake.

The goal of gluten restriction with gluten intolerance is comfort. There is virtually never anything to be gained from absolute gluten restriction, lifelong, if the problem is intolerance. It is much like lactose intolerance: some people can have a glass of milk; others must avoid nearly any dairy product with lactose to stay comfortable.

So, what to eat if you want to restrict gluten but don’t have to remove “every bit” of gluten? Remember, the goal is comfort, and some gluten (but less than what you used to consume) may not be a problem.

To best treat an disease or intolerance, please visit your gastroenterologist. Additionally, supplementary information about causes and treatment for diseases and intolerance can be found on our Patient Education Page.