If gluten makes you feel unwell, you may wonder, “what is the difference between celiac disease and gluten intolerance?” While the conditions have many overlapping symptoms, there are a few key differences to be aware of.
In this article, we’ll review the signs and symptoms of celiac disease and gluten intolerance, as well as some tips for avoiding gluten if you’ve discovered that you’re sensitive to it.
If you plan on following a gluten-free diet, it’s best to consult with a dietitian to ensure that you’re meeting your nutrient needs while eliminating gluten.
What is Celiac Disease?
Celiac disease is a gut disorder that is estimated to affect about one percent of the population. It is a genetic autoimmune condition that damages the small intestine.
When people with celiac disease eat gluten, their body produces an immune response. This leads to damage to the small intestine. Specifically, it damages the villi, the small, finger-like projections in the small intestine that are used for nutrient absorption. Damage to the villi prevents nutrients from being properly absorbed by the body.
What are the Symptoms of Celiac Disease?
There are many symptoms of celiac disease, and not all are related to the gut. This can lead to a delay in diagnosis for individuals who present with extra-intestinal symptoms.
Some of the common symptoms of celiac disease include:
- Abdominal cramping
- Anemia (because damage to the villi prevents iron absorption in the small intestine)
- Brain fog
- Pain in bones and joints
- Stool abnormalities
- Vitamin and mineral deficiencies
- Weight changes
How is Celiac Disease Diagnosed?
Celiac disease is diagnosed through blood tests and upper endoscopy with biopsies of the small intestine.
The blood work for celiac disease involves checking for certain types of antibodies in the blood. One of the most common blood tests is the tTG test (tissue transglutaminase antibody). If levels of this antibody are above a certain level, it’s an indication of celiac disease.
It’s important to note that a person must consume gluten throughout the testing process to be accurate. If a person is excluding gluten from their diet at the time of the test, it can lead to a false negative or an inconclusive result.
While it can seem like a lot of work, it’s important to get an accurate diagnosis of celiac disease, since many other serious medical conditions have similar symptoms to celiac disease.
Nutrition Therapy for Celiac Disease
While there is no cure for celiac disease currently, nutrition therapy for celiac disease is an effective treatment. Specifically, following the gluten-free diet is the only known treatment for celiac disease. It’s important to stick to the diet strictly, as even small amounts of gluten can lead to damage of the villi in the small intestine.
Because the gluten-free diet is quite restrictive, it’s important to meet with a dietitian skilled in the management of celiac disease. During your consultation, your dietitian will complete a nutritional assessment, provide recommendations for treating nutrient deficiencies and provide education on how to follow a gluten-free diet.
What is the Difference Between Celiac Disease and Gluten Intolerance?
The main difference between celiac disease and gluten intolerance (also known as non-celiac gluten sensitivity or NCGS) is that people with gluten intolerance do not develop antibodies to gluten and therefore do not suffer from intestinal damage. It’s thought that gluten intolerance affects between 3 and 6% of the general population and is more common in females.
With gluten intolerance, symptoms usually occur after eating gluten and tend to disappear once gluten is removed from the diet.
Just as with celiac disease, there is a wide variety of symptoms common with gluten intolerance. Many of the symptoms are similar to irritable bowel syndrome (IBS) and can include abdominal pain, bloating, distention, and changes to stool frequency or consistency.
Gluten intolerance may also lead to extra-intestinal symptoms such as headaches, joint and muscle pain, muscle spasms, leg or arm numbness, chronic fatigue, brain fog, weight loss, anxiety, and depression.
Unlike celiac disease, there is no reliable test for gluten intolerance, and its diagnosis is based on excluding other possible causes of symptoms (such as irritable bowel syndrome, inflammatory bowel disease, and celiac disease).
What About Wheat Sensitivity?
While gluten appears to be the main culprit in causing symptoms in both celiac disease and gluten intolerance, there are other components of wheat that may cause symptoms.
For example, wheat contains a type of carbohydrate called fructans. Fructans are a type of FODMAP (carbohydrates that are fermented by gut bacteria) and may cause gastrointestinal symptoms in people with IBS.
Foods to Avoid for Gluten Intolerance and Celiac Disease
If you have celiac disease, it’s important to follow a strict gluten-free diet. If you have symptoms that you think are caused by gluten, it’s important to get a proper diagnosis before you start eliminating gluten from your diet. This is because the tests for celiac disease only work if you’re eating gluten. If you eliminate gluten before getting tested for celiac disease, your tests may produce a false negative or inconclusive result.
Reading Food Labels for Gluten-Containing Ingredients
Understanding food labels can be tricky. Luckily, there are a few tips that can make it easier for you.
- Look for the words “gluten-free”
In Canada, if a packaged food product is labelled as gluten-free, that means that the food should contain less than 20 ppm of gluten (this is the level below which gluten exposure does not damage the intestinal villi). If a food is labelled gluten-free, it’s safe for someone with celiac disease or gluten intolerance to eat.
- Read the ingredient list
In Canada, all priority allergens (including wheat) must be clearly labelled when used as an ingredient or component of a food product. You will either find them listed within the ingredients list or using a “contains” statement underneath the ingredient list.
It’s important to note that the “contains” statement is NOT the same as a “may contain” statement on a food label. A “may contain” statement is also known as a cross-contamination statement and is used on foods that don’t contain wheat as an ingredient but may have become contaminated during processing.
Here is a list of foods to avoid for gluten intolerance and celiac disease:
- Wheat (all varieties, including durum, einkorn, emmer, kamut, and spelt).
- Oats that are not certified gluten-free (while oats are naturally gluten-free, they may become contaminated during production)
- Brewer’s yeast
If the ingredient list contains any of the above ingredients, it is not safe for someone with celiac disease to eat.
- Look for third-party gluten-free certification
The Gluten-Free Certification Program (GFCP) in Canada has been designed to address all potential hazards, including gluten, as part of the manufacturer’s safety and quality management. This program does not allow the intentional addition of gluten in any concentration. If you see that a product has GFCP certification, you can be assured that it is safe to eat if you have celiac disease or gluten intolerance.
What to Do if I Accidentally Eat Gluten?
One of the most common questions I get asked is “what to do if I accidentally eat gluten?” If you do accidentally eat gluten, be sure to drink plenty of water. This is particularly important if eating gluten causes you to have diarrhea, which can dehydrate you.
If you accidentally eat gluten, it’s best to try and get some rest to allow your body to heal.
Finally, if you do accidentally eat gluten, don’t treat it as an “all or nothing” event and feel like you might as well eat more gluten since you already “ruined” your gluten-free diet. A small amount of gluten is less likely to cause damage than a large amount of gluten, so it’s best to immediately go back to avoiding gluten if you accidentally eat some.
A Celiac Dietitian Can Help
Celiac disease and gluten intolerance can both lead to unpleasant symptoms like abdominal pain, bloating, changes in stool frequency and consistency, and brain fog.
If you’re interested in following the gluten-free diet for celiac disease or gluten intolerance, it’s best to discuss it with a registered dietitian before embarking on your gluten-free journey. Click here to book an appointment today!