Celiac Disease and Gluten Intolerance Should Be Treated Differently

June 2016

Avoiding gluten has never been easier. Today, you can find grocery store aisles dedicated to gluten-free products, while many restaurants offer gluten-free versions of popular menu items. 

But why would someone eat a gluten-free diet? Those who have been diagnosed with celiac disease, a hereditary autoimmune disorder, manage the disease by avoiding gluten. Meanwhile, others who are gluten intolerant (non-celiac gluten sensitivity) often feel their health improves by avoiding gluten. 

What’s important to remember is that celiac disease and gluten intolerance are different things. With May being Celiac Disease Awareness Month, Kara Regan, MD, Washington University gastroenterologist at Barnes-Jewish West County Hospital, explains what this all means. 

Celiac Disease: What Is It Exactly? 

“Celiac disease is a condition in which the body develops an autoimmune response after ingestion of gluten — a protein found in grains like wheat, barley and rye,” Dr. Regan says. “The body views gluten as a foreign invader, which can lead to damage in the small intestine. This is different from a grain allergy which most people outgrow in childhood. 

Celiac disease may manifest itself in childhood, but can be newly diagnosed in adulthood. Celiac disease can also be found in association with other autoimmune conditions, such as diabetes, thyroiditis, microscopic colitis and others.” 

Although celiac disease has a strong genetic component, with up to 30 percent of individuals being genetically predisposed to celiac disease, only 1 percent of the U.S. population may actually develop the disease in their lifetimes, Dr. Regan adds. 

Celiac Disease: Warning Signs And Screening 

Dr. Regan recommends people undergo screening for celiac disease if they have common warning signs or symptoms, such as:

  • Diarrhea
  • weight loss
  • iron-deficiency anemia
  • bloating
  • abnormal enzymes 

The most commonly used screening is a blood test called a tTG antibody test, which checks for celiac disease antibodies. If a person tests positive, an endoscopic biopsy of their small intestine is typically recommended to confirm the diagnosis. 

Individuals undergoing a biopsy for celiac disease should see a gastroenterologist like Dr. Regan, who will conduct the outpatient procedure to further confirm the diagnosis and determine level of damage to the small intestine. 

Celiac Disease: Changing Your Diet 

Gluten avoidance is the most effective treatment once a person has been diagnosed with celiac disease, Dr. Regan says. 

In addition to seeing their gastroenterologist regularly, patients diagnosed with celiac disease also are encouraged to work with a dietitian for nutrition counseling to understand their limitations. 

“Beyond the items that we know have gluten, there may be hidden sources like medications, preservatives and cross contamination from other foods,” she says. “It requires a lifestyle change. People must be cautious about what they eat and how they eat in settings such as restaurants. You must know not only what is being cooked, but how it is being cooked.” 

Celiac Disease And Gluten Intolerance Are Very Different 

It is difficult to determine the exact number of people who may experience true gluten intolerance.  

“In contrast to celiac disease, where there is an identifiable problem with the immune system that can be diagnosed by laboratory and endoscopic testing, we don’t really have good parameters to define non-celiac gluten sensitivity,” Dr. Regan says. “Much of what is believed to be sensitivity to gluten is likely a sensitivity to other components of the wheat, and other foods we ingest. Especially those high in carbohydrates. Symptoms  include gas and bloating, irritable bowel, diarrhea and constipation, abdominal discomfort, and fatigue.”  

Going Gluten-Free: What You Need to Know

Dr. Regan does not recommend a true gluten-free diet for patients unless they are diagnosed with celiac disease. She recommends patients who are experiencing symptoms of possible gluten intolerance modify their diet to try to identify triggers that may be causing symptoms. The most common triggers include:

  • lactose
  • fructose
  • onions
  • garlic
  • and other fermentable carbohydrates (FODMAPs) 

“A gluten-free diet may not be the best thing,” she says. “A gluten-free diet is not indicated for weight loss, in fact, you can gain weight because many gluten-free items contain more sugars and fat to make up for taste. Gluten-free doesn’t mean healthy; it just means it doesn’t contain a significant amount of gluten.” 

Limiting gluten may actually limit the amount of certain carbohydrates and grains, which may help account for some of the symptom benefit that people experience, she explains. However you also may be limiting important micronutrients that are derived from these foods. It’s important for people to weigh the benefits of “going gluten-free.” 

Whether you have been diagnosed with celiac disease or experience the symptoms of gluten intolerance, your physician and/or gastroenterologist should monitor you regularly. In addition, Dr. Regan recommends support groups and other informational tools, such as the Celiac Disease Foundation. 

Barnes-Jewish West County Hospital treats a wide range of digestive diseases, learn more about what conditions we treat 

To schedule an appointment with Dr. Regan or another specialist, call 314.542.WEST (9378) or toll-free 844.542.9378 or request a call for an appointment. 

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