Three Different Faces of Gluten Intolerance


I often find people understand the gluten intolerance phenomenon less than they realize. I can appreciate how this happens: because a food element triggers the problems, people assume it is a food allergy, which is not accurate. They also may come to a gluten-free life as a result of cultural influence rather than medical need, which may mean their understanding is more social than medical.

In this introduction to gluten intolerance, I’ll try to illuminate some important distinctions many people may not understand.

Celiac Disease

Celiac disease is a specific clinical diagnosis identified with a blood test and confirmed with a biopsy of the small intestine. It is a serious medical condition that can lead to other serious and even fatal illnesses (including cancer) if left unidentified and untreated.

When someone has celiac sprue disease, consuming any food with a trace of the protein composite gluten triggers his or her immune system to turn on itself and attack the lining of the small intestine. This triggers a domino-effect of symptoms and conditions resulting from both the inflammation and the malabsorption caused by this autoimmune response.

Just because “gluten doesn’t agree with you” doesn’t necessarily mean you have this frustrating condition, but the most common symptoms of celiac sprue disease are gastrointestinal problems, including gas, bloating, cramping, constipation and diarrhea.

If you think you might have celiac disease, it is important for you to visit with gastroenterologist experienced with diagnosing and treating this condition. To be honest, the term “intolerance” does not do justice to the severity of this disease.

Celiac disease is not a food allergy. Someone with a very serious case of celiac disease might be able to eat something dense with gluten and not experience any immediate symptoms (really!). But deep in this person’s gut, an autoimmune reaction will be quietly wreaking havoc on their insides.

It is important you understand this distinction: celiac disease is not a type 1 hypersensitivity like an allergy.

Wheat Allergy

A wheat allergy is not celiac sprue disease: it is a real food allergy involving wheat (and not necessarily other grains in the triticeae family). A food allergy involves a type 1 hypersensitivity where the body produces histamine and other chemicals in response to a foreign body the immune system identifies as a harmful intruder.

In a food allergy, the immune system is over-reacting while it attacks a foreign particle; in celiac disease, the immune system is attacking cells or tissues of its own body.

This allergic response almost always occurs immediately or very soon after consuming wheat.

Non-Celiac Gluten Sensitivity

Non-celiac gluten sensitivity (NCGS) was only formally identified and accepted by recent medical research (although many of us have been sure it existed for years).

Basically, NCGS will be diagnosed when you test negative for both celiac disease and a wheat allergy, but a carefully monitored gluten elimination diet strongly indicates that gluten is triggering your health problems. NCGS often manifests with symptoms beyond the digestive tract, such as with migraines, joint pain and skin rashes. NCGS does not cause the same damage to the small intestine as celiac disease.

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