For many, avoiding gluten isn’t just a wellness fad to help you lose weight. It’s a necessity driven by health conditions like celiac disease or a gluten intolerance (which is often referred to as non-celiac gluten sensitivity or non-celiac wheat sensitivity).
But how can you tell which condition you might be experiencing? Anyone who struggles with digestive problems like bloating, cramping, stomach pain and diarrhea after eating gluten ― or even other symptoms like depression, fatigue and brain fog ― could have either celiac disease or gluten intolerance. And it can be difficult to tell them apart, doctors say.
That being said, the two conditions are hardly the same. Below, experts break down the differences between gluten sensitivity and celiac disease, signs that you’re experiencing one and not the other, and advice for managing both.
The Fine Line Between Sensitivity And Celiac Disease
Celiac disease affects about 1 percent of Americans and develops in response to gluten exposure in people who are genetically predisposed. It’s an autoimmune disorder in which the body’s immune system mistakenly launches an attack on the small intestine, inhibiting its ability to properly absorb nutrients and resulting in inflammation.
“This inflammation in the small intestine can have health ramifications for the patient because it can impact their ability to absorb foods, can cause malnutrition, and they can have weight loss,” said Rabia De Latour, a gastroenterologist and assistant professor of medicine at NYU Langone Health.
Gluten-containing food can cause people with celiac disease to experience uncomfortable gastrointestinal symptoms like bloating, diarrhea, weight loss and constipation, along with other problems like vitamin and mineral deficiencies, iron deficiency, anemia, joint pain, osteoporosis and more.
Non-celiac gluten sensitivity, on the other hand, is not an autoimmune disorder and doesn’t involve gut inflammation. People living with this issue “typically don’t have the more serious complications of celiac, like malnutrition and weight loss, because, at the end of the day, their small intestine isn’t actually inflamed,” De Latour said.
Gluten sensitivity is also more mysterious in terms of how it presents, how long it lasts, how it can be diagnosed and its long-term risks or complications.
“The mechanism of celiac disease is fairly well understood, although with each passing year we’re learning more and more, whereas non-celiac gluten sensitivity is kind of the newer player in all of this,” said Amy Burkhart, an integrative medicine physician and registered dietician based in Napa, California.
“The mechanism of celiac disease is fairly well understood, although with each passing year we’re learning more and more, whereas non-celiac gluten sensitivity is kind of the newer player in all of this.”
Burkhart added that celiac disease is a lifelong illness and also can be hereditary, while less is known about gluten sensitivity. “There are definitely cases of temporary gluten sensitivity, where these people have these reactions and then for whatever reason, they’re gone,” she said.
And both conditions can present in a range of ways, meaning not only will the signs and symptoms vary from person to person, but some individuals may become far sicker than others.
Getting A Diagnosis
A stark difference between non-celiac gluten sensitivity and celiac disease is that celiac disease is diagnosable. When a physician wants to figure out what’s going on with a patient who is having trouble tolerating gluten, celiac is pretty easy to determine based on testing.
“We can easily screen for celiac disease with a simple blood test that looks for specific antibodies, or immune proteins,” said Guy Weiss, gastroenterologist and leader of the Celiac Disease Program at the University of California, Los Angeles.
“In people with … high suspicion for the disease, we proceed with an upper endoscopy with biopsies of the small intestine to confirm the diagnosis,” he continued. This essentially means that if you’re suspected of having celiac disease, your doctor will insert a long and thin tube through your mouth and down into the small intestine to look around and take samples. This is a way of checking for and confirming the presence of active inflammation that’s typical of the condition.
Diagnosing non-celiac gluten sensitivity is a bit trickier, because there’s no clear-cut test or finite way to determine if you have the condition, De Latour said. A doctor needs to rule out other illnesses, such as celiac disease and wheat allergy, before making a determination.
This lack of straightforward testing leads to high rates of self-diagnosis, which are often incorrect, according to Weiss.
“Symptoms can overlap with those seen in other conditions, like small intestinal bacterial overgrowth, irritable bowel syndrome (IBS) and pelvic floor dysfunction, to name a few,” he said.
“Symptoms can overlap with those seen in other conditions, like small intestinal bacterial overgrowth, irritable bowel syndrome (IBS) and pelvic floor dysfunction, to name a few.”
It’s hard to detect how common non-celiac gluten sensitivity is without a diagnostic test, according to Burkhart, though it’s believed to be more common than celiac disease. Weiss said up to 6 percent of the population is currently estimated to have the condition, but the exact number is unclear.
While celiac testing is a bit more straightforward, it comes with an important caveat: The patient must be eating gluten when they’re being examined. If a person is on a gluten-free diet, the blood test could show a false negative and intestinal inflammation could go down, leading doctors to believe the patient has non-celiac gluten sensitivity when they actually have celiac disease.
“If a patient who has celiac disease just has not been touching any food with gluten in it for a long time, their antibodies can become negative,” De Latour said. “And when you’re trying to distinguish between the two, it’s the antibodies that really help you do that.”
Figuring out which condition you’re dealing with is arguably one of the most challenging parts of living with gluten issues. But there is some good news — once a diagnosis is made, both of these illnesses can usually be managed with a gluten-free diet.
Gluten is found in grains like wheat, barley and rye, so to avoid gluten, you’ll want to steer clear of breads, pastas, baked goods and processed foods that contain those grains. The amount of gluten you can tolerate may vary from person to person, but most doctors recommend that patients with either condition avoid gluten just to be safe.
Treatment for non-celiac gluten sensitivity can sometimes be a bit different, depending on the reason for the sensitivity. In some cases, a wheat-free diet may be recommended rather than a gluten-free diet. This is because some people’s troubles stem from a reaction to a carbohydrate in wheat called fructan, rather than gluten (which are basically proteins found in wheat and other grains).
For these patients, doctors recommend a low FODMAP diet, which means limiting consumption of specific, fermentable carbohydrates like garlic, onion and mango. This sort of diet is said to help reduce bloating, stomach pain and other symptoms. Of course, your doctor knows best, so you’ll want to follow their advice.
And should you avoid gluten if you don’t have a sensitivity to it? That’s probably not the greatest idea. Experts stress that unnecessarily cutting out gluten could reduce the overall quality of your diet and have negative effects. It isn’t necessarily a weight-loss solution.
“This misconception is very common, and recent studies actually show how limiting gluten without the proper indication may be associated with weight gain, diabetes and decreased bone density,” Weiss said. “Not to mention that these diets are expensive, restrictive and not always readily available.”
For anyone living with gut issues or even other unexplained non-gastrointestinal symptoms, it’s always a good idea to see a physician to figure out what’s going on. Life’s so much better when you can eat pain-free.