We know, right? So confusing. Is there a difference between celiac disease and gluten intolerance? Is gluten intolerance even a real thing? If you have celiac disease, aren’t you allergic to wheat? Why so many ways to say the same thing?
The thing is, they aren’t the same thing. Gluten intolerance is different from celiac disease and both are different from a wheat allergy. We get this question a lot, so we want to break it down in grain plain and simple terms. Let me start with my credentials, or more accurately, lack thereof. I’m neither a doctor nor a scientist. If you need medical advice, definitely talk to a doctor. If you need more info about protein, molecules, or our bodies’ cells, check out PubMed for scholarly articles on these subjects.
The credentials I do have, however, are all three of the following diagnoses: celiac disease (14 years ago), wheat allergy (8 years ago), and oat allergy (2 years ago). This post is coming from someone who lives with a gluten free diet and is written like I would tell it to my friends, family, coworkers, and people I meet at social gatherings who wonder why I’m not partaking in the canapés.
If you’re starting at Gluten Question Numero Uno, you’re currently asking “What is Gluten?” Gluten is a type of protein found in wheat, rye, and barley. (It is often in oats too–not inherently, but rather, because of cross-contamination at the field, farm, storage, transportation, or production levels.)
What is gluten intolerance? Difficult to diagnose but it is a real thing. Also called non-celiac gluten intolerance. Simply, it means that your body doesn’t do well when you eat gluten but you don’t have a blood test or biopsy to substantiate the claim. I’ve heard it said that because gluten is such a large protein, it’s taxing on your body to break it down, so you’re working harder for your nutrients. Some people feel that going on a gluten free diet and opting for gluten free foods makes them feel more energized and more alert with decreased belly discomfort, seasonal allergy symptoms, headaches, and more. Gluten can cause inflammation in one’s body, and that person might say they are gluten intolerant or have gluten sensitivity. Someone with gluten intolerance might use an enzyme supplement to help their bodies break down the gluten protein if they choose to eat foods with gluten.
What is celiac disease? A genetic autoimmune disease triggered by ingesting gluten. What does that mean?
- Genetic: you’re born with it
- Autoimmune disease: your body attacks itself with its own immune system!
- Ingesting: eating
- Gluten: that pesky protein mentioned above
Other names for the disease include celiac sprue, coeliac disease, non-tropical sprue, and gluten sensitivity enteropathy. There’s no cure for celiac disease (yet!) but it can be managed with a totally gluten free diet. That means no “cheating” or sneaking and eating gluten. It means even a little bit is not okay. It means cross contamination needs to be avoided. It's more than an intolerance, so gluten enzyme supplements are not a viable option for managing the disease.
What happens when you have celiac disease? It’s a complicated process with lots of science behind it. In very basic terms, the body does not know how to properly react to the gluten protein and instead of just breaking it down like any other protein, an immune response signal is sent to the brain and the body unfortunately attacks the healthy cells of the villi in the small intestines. Flashback to high school biology for anyone who forgot: villi are the finger-like projections in the intestine that increase surface area for nutrient absorption. When someone with celiac disease eats gluten on an ongoing basis (i.e. before diagnosis,) the wall of their small intestine smooths out, which means the villi are terribly damaged and the much smaller interior surface area means much fewer nutrients absorbed, thus the patient suffers from malabsorption.
Which is why celiac disease is often overlooked for dianosis! When your body doesn’t have enough nutrients, anything can go wrong. Some patients suffer from gastrointestinal symptoms and discomfort such as bloating, diarrhea, and flatulence and abdominal pain. Others have mental or emotional symptoms like inability to concentrate or irritability. Women may find difficulty with fertility or early osteoporosis. Without specific, telling symptoms, sometimes doctors aren’t sure where to start in the diagnosis. I was misdiagnosed with asthma before it was discovered that I had celiac disease!
What is wheat allergy? It's different from celiac disease, but is also an immune response. In allergies, the immune system does not attack healthy cells of the body like it does with autoimmune diseases, but it responds to allergenic proteins with a chemical called histamine, sending a cascade of signals to the brain calling for protection of the body. Allergic reactions vary greatly in their severity and symptoms, and many are similar to the symptoms lots of folks experience with seasonal or environmental allergies. Mild symptoms might include a runny nose, a few sneezes, or a bit of an itchy throat. For people with mild reactions, an oral dose of an over-the-counter antihistamine drug is usually sufficient treatment. On the other hand, some allergic responses are very severe, even life-threatening, including anaphylaxis, which happens quickly after exposure to an allergen and escalates rapidly, often restricting breathing of the person experiencing the reaction. Anaphylaxis is combated with an injection of epinephrine, usually followed by a few days of steroids to help prevent a secondary reaction. Epinephrine is a neurotransmitter, naturally made by the body, which counteracts the signals sent by histamine. A synthetic version is available in auto-injectors so people with food allergies can administer their own life-saving medicine before going to the hospital. A food allergy is also a no-cheat zone: no cross-contamination and just a little exposure is too much exposure.
Now, there are a few “rare birds” (the doctor’s words, not mine) like myself who have both celiac disease and a wheat allergy. Before I was diagnosed with celiac disease, I ate pizza, noodles, and wheat bread just like everyone else without any allergic reaction. Once I was diagnosed, of course wheat was eliminated from my diet. Six years later or so, I learned from a few unfortunate cross-contamination episodes (ultimately resulting in a trip the emergency room) that I had developed an allergy to wheat. The explanation I got from the doctor who later tested to confirm the allergy was that once your body hasn’t been exposed to an allergen for quite some time, it then forgets how to recognize the protein, seeing it now as an intruder and a threat. Two years ago I was enjoying gluten free oats and had an allergic reaction. Back to the doctor, and another test later, I left with yet another diagnosis, this time an oat allergy. Sigh.
There you have the layman’s terms differences of gluten intolerance, celiac disease, and wheat allergy. I encourage you to check out the many valuable resources available online to answer more in-depth question you may have about the specific reactions that take place in the body in each of these scenarios. If you think you may have celiac disease or another dietary need, share your symptoms with your doctor.
Lucky for those with gluten sensitivity, celiac disease, and wheat allergy, we at Bob’s Red Mill are very careful with our gluten free products. See here for more on our gluten free promise. Back when I was diagnosed with celiac disease in 2002, I was living in Ohio and I was told that Bob’s Red Mill was the brand I could trust. Now I am proudly sitting here at the Mill directly above the gluten free facility I have known, loved, and trusted for fourteen years! Look for these trusty symbols on our packages to know that our gluten free products have been processed and tested in our dedicated gluten free facility: