Once thought to be a rare childhood disease celiac disease has come to be recognized as a serious and detrimental disease with a global footprint.
Celiac disease is a genetic autoimmune disease where the ingestion of gluten leads to damage in the small intestine.
When people with celiac disease eat gluten (a protein found in wheat, rye, barley, and triticale) their body mounts an immune response that attacks the small intestine, damaging the villi — small finger-like projections that line the small intestine and promote nutrient absorption.
When the villi are damaged, nutrients cannot be absorbed properly into the body.
Celiac disease affects approximately one percent of the world’s population, including three million Americans, but most cases remain undiagnosed.
There are more than 200 known symptoms and long-term health complications associated with celiac disease which can affect every organ in the body, ranging from chronic diarrhea and vomiting to osteoporosis and infertility, recurrent miscarriage, heart disease, and intestinal cancers.
Celiac disease can develop at any age, and the only treatment for the disease is life-long adherence to a gluten-free diet.
While many people now follow a gluten-free diet, it is only recommended for those with medical needs. In addition to celiac disease, there are two other conditions for which a wheat-free or gluten-free diet is the only treatment: wheat allergy and non-celiac gluten sensitivity.
Wheat allergy
While wheat allergy and celiac disease both trigger adverse food reactions, their underlying causes are very different.
Wheat allergy is an immune-mediated reaction to the proteins found in wheat products, and the only treatment is a strict wheat-free diet. This population does not need to avoid rye, barley, or oats not labeled ‘gluten-free’ like patients with celiac disease.
Although the gastrointestinal symptoms of wheat allergy may look similar to celiac disease, other symptoms of wheat allergy include hives, itching around the mouth or throat, anaphylaxis (problems breathing and swallowing, coughing, swelling, and loss of consciousness), among others.
While celiac disease is a life-long condition, wheat allergy is most often reported in young children. Some research indicates that two-thirds of children with a wheat allergy outgrow it by age 12. A percentage of individuals with wheat allergy and all people with celiac disease never outgrow their condition.
Non-celiac gluten sensitivity
With the growing interest in the gluten-free diet, many people have “gone gluten-free” in the absence of a celiac disease diagnosis or clear health benefits. Some people experience celiac disease-like symptoms when they consume gluten, yet do not test positive for celiac disease.
The term non-celiac gluten sensitivity (NCGS) is generally used to refer to this condition — when removing gluten from the diet resolves symptoms after testing negative for celiac disease and a wheat allergy. It is estimated that the NCGS population is equal to or even exceeds the number of individuals with celiac disease.
Although NCGS is poorly understood, research shows that the immune system plays a large role. The most common gastrointestinal symptoms associated with NCGS are bloating, abdominal pain, diarrhea, nausea, and reflux. Other symptoms may include headache, general tiredness, blurred mind, fibromyalgia, lack of well-being, dermatitis (skin rash), joint pain, and depression.
Because of overlapping symptoms, an evaluation for alternative causes of symptoms, such as irritable bowel syndrome, small bowel bacterial overgrowth (SIBO), and intolerance to FODMAPs is necessary. It is important to rule out celiac disease and wheat allergy before adopting a gluten-free diet and self-diagnosing NCGS.
Celiac disease, wheat allergy, and non-celiac gluten sensitivity are different conditions with similar, but not identical, treatments. It is important to understand these differences to make the necessary dietary changes and assure proper care with a health professional.