Going gluten free was all the rage a few years ago. But the trend masked real health conditions: celiac disease and gluten sensitivity. It’s easy to get these mixed up if you’re not in the know. So what does the difference between celiac disease and gluten sensitivity look like when played out? Let’s chat.

What is celiac disease?

Celiac disease is a medical condition where the intake of foods containing gluten causes an immune response leading to tissue damage in the small intestine. This damage can lead to GI symptoms and other negative effects such as decreased nutrient absorption. Though celiac disease can also be asymptomatic, some common symptoms include: 

• GI distress such as bloating and abnormal bowel movements 
• Fatigue
• Mouth ulcers
• Skin rashes, specifically one called dermatitis herpetiformis 
• Anemia due to lack of absorption of nutrients
• Serious reactions such as neurological symptoms 

The gold standard (meaning the one deemed best by the medical society at large) for the diagnosis of celiac disease is by taking a biopsy of the tissue from the small intestine and looking at it under a microscope. There is also the option to start with a blood test to look for certain antibodies in the bloodstream (most commonly tissue transglutaminase). If those are positive, it is typically recommended to confirm the diagnosis with a biopsy. 

Celiac disease treatment

The way you treat celiac disease is by avoiding gluten entirely in the diet. Without gluten, the immune system does not continue to cause damage to the intestinal lining. It is important to note that for testing, you have to be eating a diet that contains gluten otherwise you will not be able to capture signs of a heightened immune response on testing, which is why I typically recommend testing for celiac disease if indicated before cutting out gluten altogether.

RELATED: Should I go gluten free?

Non-celiac gluten sensitivity 

Non-celiac gluten sensitivity is different from celiac disease because there is not the same immune response and subsequent inflammatory destruction of the small intestine with the intake of gluten. So, those with non-celiac gluten sensitivity will test negative for celiac disease when testing is performed. 

Non-celiac gluten sensitivity often presents as having GI symptoms when eating gluten. This can be best determined by following an elimination diet for a short period of time and then reintroducing gluten containing foods and monitoring for symptoms. 

While I do believe it is possible to be sensitive to foods, clinically I see food sensitivities as a symptom of sometimes bigger going on in the GI tract, such as increased intestinal permeability (aka leaky gut) or chronic unmanaged stress, leading to poor digestive function.

RELATED: Why you should consider a stool test if you’re having gut issues.

Should I be cutting out gluten?

I do not recommend cutting out gluten from the diet unless it is medically indicated, as there are plenty of nutrient dense foods that contain gluten out there! It is best to choose organically grown whole grains and avoid conventionally farmed and processed grain products when you do partake in eating gluten to optimize nutrient intake and avoid exposure to harmful pesticides/herbicides that are used in the conventional farming process.

If you’re having GI symptoms and wonder if gluten is what you’re reacting to, give us a call. We can partner with you for better health.

Dr. April Jones

Dr. Jones graduated from the National University of Natural Medicine in Portland, Oregon as a Doctor of Naturopathic Medicine and with a Master of Science in Nutrition degree. She believes that the most important part of any treatment plan is first establishing a solid foundation of health. This looks different for each patient and changes over time, and Dr. Jones’ guidance on your health journey will depend on your needs.