Are Gluten Intolerance and Celiac Disease the Same Thing?
You may often hear or see the terms celiac disease, celiac sprue, gluten-sensitive enteropathy, gluten intolerance and gluten sensitivity being used interchangeably. But, do they refer to the same condition? Not exactly, though they all relate to the same problem, a negative reaction to gluten found in foods made with wheat, rye or barley.
The term gluten intolerance is used to describe the entire category of gluten-related problems. Gluten intolerance can be caused either by celiac or non-celiac sensitivity to gluten, or by wheat allergy. Thus, you can have gluten intolerance without having celiac disease.
About one percent of the population in North America and Europe experience gluten intolerance triggered by an immune reaction to gluten when ingesting foods containing wheat, rye or barley. This type of gluten intolerance known as celiac disease (celiac sprue and gluten-sensitive enteropathy are synonyms for celiac disease) is characterized by inflammation and subsequent tissue damage in the wall of the small intestine and can be diagnosed with biopsy. When patients with celiac disease consume foods containing gluten, they usually develop abdominal bloating and pain, diarrhea as well as bleeding into the intestine. Because this condition also impairs the ability of the small intestine to absorb nutrients, it can also lead to malnutrition, fatigue, weight loss, anemia and osteoporosis.
Non-Celiac Gluten Sensitivity
There are also people who have never been diagnosed with celiac disease and still react to gluten in foods negatively. They have the so-called non-celiac sensitivity to gluten, sometimes also referred to as non-celiac gluten intolerance. This means their adverse reaction to gluten is not caused by an inflammatory immune response and no detectable damage to the intestinal wall occurs. Unlike celiac disease, non-celiac gluten sensitivity cannot be confirmed with biopsy and the only method of diagnosing it is a diagnosis of exclusion. Many of the symptoms of non-celiac gluten sensitivity are similar to those of celiac disease with mental fatigue and lack of energy being the most characteristic signs of the disease. However, nutrient absorption is not compromised with this form of gluten intolerance. Non-celiac gluten sensitivity is a poorly understood condition though the number of people in North America and Europe living with this disorder is estimated to be six to seven times higher than the number of those with celiac disease.
Wheat allergy usually manifests itself as a food allergy (i.e., reaction to ingested food containing wheat) but it can also be a contact allergy, resulting from occupational exposure to substances containing wheat (e.g., flour, dough, etc.). Gluten intolerance can be caused by an immune response to gluten found in ingested wheat but it cannot be a result of external exposure to wheat. However, in case of wheat allergy, this immune response is not limited to gluten but involves several proteins from wheat and is usually fast and time-limited. The symptoms of wheat allergy include gas and bloating, diarrhea and vomiting but also nausea, irritation of the mouth and throat, eye irritation, nasal congestion, difficulty breathing, hives and skin rash. Like non-celiac gluten sensitivity, wheat allergy does not cause lasting harm to the tissues of the intestinal wall and, therefore, cannot be diagnosed with biopsy.
Other Health Issues Related to Gluten Sensitivity
Oats are sometimes mentioned in the same sentence with wheat, barley and rye as gluten-bearing grains. However, oats contain no gluten, though about one percent of people with gluten sensitivity report gluten-related symptoms after consuming a large amount of oats.
There is also an interesting association between gluten intolerance and dermatitis herpetiformis, a rare disease characterized by itchy nodules on the skin. Almost all patients with dermatitis herpetiformis have or will develop celiac disease and, therefore, also gluten intolerance. Why these two diseases are associated with each other remains a mystery at this time.