Understanding Gluten

Celiac disease versus gluten sensitivity



Illustration by Brittany Inglese

Judith Englander was a health-conscious vegetarian and avid exerciser when she started to experience recurring stomachaches in her early 50s. “As things got worse, I started losing my energy,” says Englander, now 72 and recently relocated from Henniker to Vermont. “I felt like I almost had to lean on things to walk around.”

After rounds of tests failed to come up with anything, one finally pointed to a probable cause: celiac disease, a disorder that triggers the immune system to attack the small intestine in response to gluten — a protein found in wheat, barley and rye. Upon receiving the diagnosis, Englander was thankful. “Relieved doesn’t even begin to [describe] how I felt,” she says. “I had thought I had cancer, so it was this huge, just immense joy when I found out that I had control over what it was that was causing me such horrible discomfort.”

Not everyone reacts to a celiac disease diagnosis as Englander did, nor do they immediately change their diet as she did to eliminate foods that contain gluten. Perhaps there is less motivation among those whose symptoms are mild — some people don’t even realize they have the disorder. But others who have celiac disease are “profoundly symptomatic” with nausea, vomiting, diarrhea, constipation or symptoms seemingly unrelated to the digestive system, such as joint and muscle pain or an itchy rash, says Stephanie A. Ballentine, APRN, a nurse practitioner at St. Joseph Hospital Gastroenterology.

Regardless of the severity of initial celiac disease symptoms, those who have the disorder but continue to nosh on their favorite Friday night gluten-containing pizza risk suffering long-term fallout; in a person with celiac disease, each time gluten is consumed, the immune system assaults the villi, or finger-like projections that line the small intestine. As the villi degrade, the body becomes less able to absorb nutrients from food, increasing the person’s vulnerability to anemia, vitamin deficiency, persistent hunger, problematic weight loss, osteoporosis and a host of other problems, including intestinal cancer.

Some people who don’t feel well when they eat gluten yet test negatively for celiac disease have what’s known as gluten sensitivity (also called non-celiac gluten sensitivity or gluten intolerance). Symptoms of gluten sensitivity mirror those of celiac disease, but with one key difference: Untreated gluten sensitivity does not result in harm to the small intestine as untreated celiac disease does.

In addition, some people who believe they have trouble with gluten might in reality have a problem related to carbohydrates, says Eileen Behan, RDN, a registered dietitian at Core Physicians. Americans get most of their calories from grain-based foods, Behan says, and when people stop eating gluten, it is likely that they also change the carbohydrates in their diet. So, some individuals might feel better after giving up gluten, Behan says, because they have inadvertently but substantially altered the carbohydrate portion of their diet.

Though it might seem counterintuitive, those who suspect they have a problem with gluten but have not yet been tested for celiac disease should not take it upon themselves to eliminate gluten from their diet, Ballentine notes. One of the ways doctors typically diagnose the disorder is through a blood test that looks for the presence of antibodies that occur in response to gluten. If no gluten has been consumed, the lack of antibodies might result in a false-negative.

People who have been swept up in the trend of going gluten-free even though they have no medical need to do so also might want to reconsider their self-imposed ban on all things gluten. Although many suffer no real ill effects from gluten but insist on eating gluten-free due to the belief that shunning gluten will somehow improve health or help with weight loss, the idea that foods with gluten are bad for everyone is a fallacy. Many healthful foods contain gluten, Behan says, and abstaining from gluten can actually lead to weight gain because some gluten-free products are higher in calories than their gluten-containing counterparts.

The best approach, Behan says, is to see your doctor if you seem to react badly to gluten. Get a diagnosis and then work with a dietitian to revamp your diet as needed. If you are diagnosed with celiac disease, do not consume gluten. Likewise, the only treatment for gluten sensitivity is to go gluten-free. But people who have no trouble digesting gluten, Behan says, should not hesitate to include healthful, gluten-containing food as part of their balanced diet.  

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