Gluten Sensitivity versus Celiac Disease
ByJoanne Aponte, ND •December 6, 2022
Even if you do not have Celiac disease you could still be gluten sensitive and you could still feel much better on a gluten free diet.
What is celiac disease?
Celiac disease is an autoimmune condition that occurs in genetically predisposed individuals in which the proteins gluten and gliadin found in wheat and certain other grains induce a T cell-meditated immune response. These immune cells by mistake, attack small intestine cells called enterocytes and lead to damage of the gut lining. Because of this damage, the gut lining becomes “blunted” and nutrients from food are not able to be absorbed. Celiac disease can cause a long list of symptoms and chronic health issues. Click here to learn more about the most common symptoms.
What is Non-celiac gluten sensitivity?
Non-celiac gluten sensitivity is when your body is having an inflammatory reaction to gluten but it is not an autoimmune process like in Celiac disease and autoantibodies against gluten are not present in the blood. In general this is a less severe reaction to gluten and there is less damage to the gut but it can still cause people to feel very sick. Gluten sensitivity can cause a wide variety of symptoms including irritable bowel like symptoms, abdominal pain, bloating and alternating diarrhea or constipation. Systemic symptoms are also common, such as brain fog, headaches, fatigue, joint and muscle pain and rashes.
How to differentiate Celiac Disease versus Gluten Sensitivity with testing:
Celiac disease – diagnosis of Celiac disease is made by a combination of testing. In Celiac disease a blood test will be positive for gluten autoantibodies. To confirm the diagnosis a small intestine endoscopy is needed to visualize damage to the enterocytes of the small intestine. Genetic testing is also available and can be very helpful.
- There are four blood tests for Celiac – (1) Tissue transglutaminase IgA, (2) Tissue transglutaminase IgG, (3) Deaminated gliadin Ab (DGP) and (4) Total Serum IgA. Oftentimes only the transglutaminase antibody is run and this can miss Celiac. Also, it is possible that these antibodies will be negative even when there is Celiac disease, especially if it is early in the disease process or if you are not eating gluten on a daily basis. In these cases, genetic testing is more helpful.
- Endoscopy is needed to confirm – An upper GI endoscopy is needed to confirm a diagnosis of celiac if antibodies are present in the blood. Endoscopy is a procedure used to visually examine the upper digestive system and to look for damage to the small intestine. During the endoscopy biopsies are taken to confirm the diagnosis.
- Genetic testing – Celiac disease occurs in genetically predisposed individuals. Persons with the HLA-DQA1 and HLA-DQB1 genes are more likely to develop Celiac. If you do not carry these genes, then the possibility of having Celiac disease is very unlikely. These gene tests are particularly helpful if a person is already on a gluten free diet since the antibody blood tests and endoscopy are only useful if a person is eating gluten on a daily basis. At Lakeside Natural Medicine, we offer this gene testing.
- Elimination challenge – There is no single test that can confirm gluten sensitivity. The best test is an elimination diet in which you avoid gluten completely for 6- 8 weeks. If symptoms improve and you feel better, this tells us you have some level of gluten sensitivity and that gluten is an inflammatory trigger for you.
- IgG food intolerance testing – Another option for identifying gluten sensitivity is an immunoglobulin IgG food sensitivity test. Here at the clinic we run the US Biotek IgG food sensitivity test. This is a blood test that looks for non-specific IgG immune antibodies. If gluten is an inflammatory trigger for you, your body will make higher amounts of these IgG antibodies when gluten is consumed.
There are other reasons why you could be reacting negatively to gluten that are not dependent on your immune system. For persons with microbiome imbalances, dysbiosis or SIBO (small intestine bacterial overgrowth), gluten might be causing symptoms because of a local gut reaction. Gluten is a high Fodmap food, meaning it is a highly fermentable. So if you have a gut condition like dysbiosis or SIBO, you could have much trouble digesting gluten because of that bacterial imbalance. In these cases, treating the underlying condition and improving the microbiome, can help your digestive tract better digest and break down gluten.
Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.