In recent years, the gluten-free diet has become more widely known and practiced. People with celiac disease, an autoimmune disorder that causes damage to the intestine when gluten is consumed, removed gluten from their diets out of necessity. Increasingly, however, a large group of people with non-celiac gluten sensitivity have followed suit, using gluten-free recipes and reporting better digestion and energy. But what is the difference between non-celiac gluten sensitivity and celiac disease?
What is Gluten?
Gluten is a composite of proteins found in wheat, barley, rye, farro, spelt, triticale, kamut, and other wheat-derived grains like durum, semolina, and einkorn. Gluten is gluey, and helps foods like breads and pizza crusts maintain their shape and chewy texture. Gluten is found in baked goods, pastas, soups, cereals, salad dressings, cakes, pastries, condiments, and other foods. It’s often hidden in processed, packaged, and commercial foods where you’d least expect it. So-called “natural flavors,” sauces, and food colorings, for example, often hide ingredients containing gluten.
When is Gluten a Problem?
Some argue that gluten isn’t an ideal food for anyone, as it’s difficult for the body to break down and digest. That said, gluten sensitivity, wheat allergies, and celiac disease are specific medical conditions that have impact systemic and gastrointestinal health. Is it possible to have non-celiac gluten issues? Yes. Non-celiac gluten sensitivity is a real concern. So what’s the difference, and how do you know which is which?
Celiac Disease (CD)
Celiac is a genetic autoimmune illness in which ingestion of gluten results in damage of gastrointestinal (GI) tissue. The body's response ultimately destroys and flattens the villi (villous atrophy) in the GI tract. This can lead to severe malabsorption of nutrients over time, resulting in poor health, inflammation, gastrointestinal dysfunction, low body weight, lack of developmental growth in children, and vulnerability to other illnesses, cancers, and infections. There are over 200 identified symptoms of celiac disease, including anemia, infertility, and behavioral changes. Dermatitis herpetiformis is celiac disease manifesting as a skin rash, and is common in those with the condition. There is no known cure for celiac disease beyond managing it with strict adherence to a gluten-free diet.
Non-Celiac Gluten Sensitivity (NCGS)
Non-celiac gluten sensitivity may present with symptoms similar to celiac, but it doesn’t cause the autoimmune response of CD, or the anaphylactic reaction that wheat allergies do. Some researchers suspect that NCGS does involve an immune component, but this isn’t established. While tests and biomarkers exist for CD (and for wheat allergies), none conclusively indicate the presence of NCGS. Working with your doctor on an elimination diet can help distinguish non-celiac gluten sensitivity from other food intolerances.
Wheat allergy is distinct from CD and NCGS. When someone has a wheat allergy, B-cells (a type of white blood cell) send out immunoglobulin E (IgE) antibodies to “attack” the wheat, while other chemical messengers are released to alert the body to the invasion. This causes a rapid reaction that can result in itching, hives, swelling of the tongue, stomach pain, nausea, trouble breathing, or anaphylaxis — which is potentially life-threatening. Children sometimes outgrow a wheat allergy, but adults usually have it for life. It's managed with a strict wheat-free diet.
Thoughts Regarding a Gluten-Free Diet
If you have medical or personal reasons for going gluten free, keep in mind that when “gluten free” is listed on a food package, it doesn’t necessarily equate with healthier eating. The best way to ensure your health on a gluten free-diet is to adopt nutritious habits. If you can tolerate eating grains, opt for whole, certified (tested) gluten-free grains like brown rice, millet, and quinoa. Be sure to eat lots of fresh fruits and vegetables, as well as high quality fats and proteins. Many packaged gluten-free foods are highly processed and contain refined starches, sugars, and industrialized oils, and those diagnosed with CD often fail to thrive after going gluten free when consuming these highly processed products. Choose your foods wisely to ensure optimal health, healing, and recovery for the long term.