Do I have celiac disease or gluten sensitivity?

By Michael Newman, M.D.
Gastroenterology in Melrose and Wakefield, MA

Patients often ask, “What’s the deal about celiac disease? How is it different from gluten sensitivity? What is gluten, anyway?”

Celiac disease and gluten sensitivity have several similarities, but there also is a big difference.

While both conditions can have unpleasant symptoms, celiac disease can cause diarrhea, malnutrition, and vitamin deficiency if left untreated.

How gluten affects the intestines

The biggest difference between celiac disease and gluten sensitivity is the amount of damage that occurs when people ingest gluten, a protein found in wheat, barley, oats, and rye.

Inside the small intestine are fing­er-like projections called villi. The villi extend from the walls of the intestine and are very absorbent. Imagine a square of shag carpeting. The shaggy, absorbent fibers are the villi, and the backing is the intestinal wall.

For people with celiac disease, gluten destroys the villi, leaving the intestinal wall with no fibers to absorb vitamins and minerals from the food you eat. People with gluten sensitivity do not experience intestinal damage caused by gluten.

What is celiac disease?

Celiac disease is an autoimmune disease that affects 1 in 133 Americans. It can develop at any point in their lives.

Although celiac disease is genetic, we’ve diagnosed many people without a family history of the condition. That’s not surprising, because the way we diagnose celiac disease has changed a lot in the last few decades. Family members may have had the gene but did not have celiac disease.

The symptoms of celiac disease can include:

• Gas
• Diarrhea
• Mild anemia
• Weight loss
• Low iron levels
• Low B12 levels

If you experience these symptoms/signs, even if they’re minor, you should be tested for celiac disease. One of my recent patients, Paul, had some unusual symptoms he thought were minor. It turns out they were more important than he thought!

The screening we perform uses a blood test that looks for a specific antibody. However, blood tests can produce false positives and false negatives, depending on your diet and existing medical conditions. If your blood tests positive for the gene, we usually recommend an endoscopic biopsy to confirm the condition. During this 10-minute procedure, tissue samples are taken from the small intestine with the patient sedated and comfortable. We then examine the tissues to determine the diagnosis.

If you have type 1 diabetes, we also recommend you get a blood test for celiac disease, even if you aren’t experiencing any symptoms. It is estimated that about 5 percent of patients with type 1 diabetes will develop celiac disease.

If you are diagnosed with celiac disease, we’ll help you adjust to a gluten-free diet. We always tell patients who have celiac disease to be cautious about what they eat at restaurants. Even if a food is marked gluten-free on the menu, there’s a risk of cross-contamination in the kitchen. The batter on your fried fish, for example, may be gluten-free, but it may be fried in the same oil as gluten-containing foods.

What is gluten sensitivity?

Research estimates that millions of Americans have gluten sensitivity. If you have gluten sensitivity, you can still have some gluten in your diet, but you need to get a feel for how much you can have before it causes symptoms.

People with gluten sensitivity have some of the same symptoms as people with celiac disease, so the conditions are often mistaken for each other. Gluten causes symptoms in people with gluten sensitivity, but it does not damage the villi in their small intestine.

Symptoms of gluten sensitivity include:

• Bloating
• Diarrhea
• Constipation
• Abdominal pain

If you have a blood test to check for celiac disease and it comes back negative, but you are still experiencing symptoms, you may have gluten sensitivity.

My advice

In recent years, there has been more attention on gluten and the way it affects the digestive tract. Some people, I’m sure, are avoiding gluten in their diet due to all this publicity. A lot of people avoid gluten because it also has been promoted as a weight-loss solution.

I do not recommend going gluten-free if your goal is to lose weight without discussing this with your doctor. Gluten-free foods are often high in calories because they include potato starch.  

Don’t try to self-diagnose your condition. The tests we offer can tell you if you should cut gluten out of your diet or if something else is causing your symptoms.

If you are experiencing symptoms or have questions about celiac disease, schedule an appointment online with one of our doctors or call (800) 540-9191.