What is the difference between coeliac disease and gluten sensitivity / intolerance?

the difference between coeliac disease and gluten sensitivity cartoon on pudding-girl.deThe term gluten sensitivity / intolerance and coeliac disease are often mistakenly used interchangeably by many people because symptoms are pretty identical. Except with coeliac disease the damage done by gluten is far more serious and impacts the immune system in the long run.



If you are intolerant or sensitive to something it basically means your body doesn’t react to it very well and may give you stomach upset symptoms. Of course some people think they are intolerant to start with and then are found to have coeliac disease later because the symptoms are so similar and it has taken a while to diagnose, which makes telling the difference between the two difficult. (See spectrum guide at the bottom)

Some people have what is known as subclinical coeliac disease, which means they may have intolerance to gluten now and if they continue to eat gluten, the intolerance will develop into coeliac disease later. While some people who do not have coeliac disease but have gastrointestinal problems when gluten is eaten, prefer to lead a gluten free diet. Both coeliac and gluten sensitive people generally see improvements on a gluten free diet so if you haven’t been diagnosed coeliac but have trouble with gluten products then it might be worth trying a gluten free diet and seeing if symptoms disappear. If they do, then you are probably gluten sensitive.

But be advised, if you have been tested for coeliac and it came back negative it may be that the test was inaccurate or ‘false’. It can take a few years to properly diagnose someone with coeliac disease as the blood tests and biopsies can be inconclusive so if you’ve been tested once but still have problems then it is worth chasing up doctors and getting tested again. Other tests are coming out on the market like the stool test, which has shown much more accurate gluten readings than the blood and biopsies so ask your doctor about other means of testing.

Coeliac disease is more serious than gluten sensitivity and symptoms are multi systemic being found in all areas of the body. The damage though is done to the small intestine. In fact once you have been diagnosed coeliac it is imperative that you never eat gluten again! For coeliac patients, gluten is usually a genetic intolerance and when gluten is ingested the immune system reacts to gluten by attacking the gluten molecule. It also attacks your own body cells. This is called an autoimmune response, the same as what happens in autoimmune thyroid disease if you have or know of that. Usually other autoimmune diseases like autoimmune thyroid disease also benefit from a gluten free diet and in some cases thyroid disease can also be associated with coeliac disease. With coeliac disease the small intestine is damaged by gluten; the little blood villi type fingers are blunted down causing nutrients not to be absorbed so often patients before they are diagnosed coeliac tend to have major vitamin and mineral deficiencies. Unlike gluten sensitivity not all the symptoms for coeliac disease are gastrointestinal, making it harder to diagnose. Coeliac patients do not necessarily have to have diarrhoea all the time and be super skinny as some believe; many people are diagnosed when they are obese or suffer from constipation.

Some gastrointestinal symptoms include:

Abdominal pain and distension
acid reflux
gas and flatulence
greasy, foul smelling stools
weight loss or weight gain

Some non gastrointestinal symptoms:

Fatigue / weakness
vitamin and mineral deficiencies
headaches including migraines
joint / bone pain
depression, irritability, listlessness and mood disorders
fuzzy brain or inability to concentrate
abnormal menstrual cycles
dental enamel deficiencies
nerve damage
lactose intolerance
respiratory problems
other autoimmune disorders
easy bruising
low blood sugar
muscle cramping
swelling and inflammation
night blindness

You may not have all these symptoms but these are just a few examples of both gastro and non gastrointestinal complaints that both gluten sensitive and coeliac patients have. There are many more symptoms as well I just couldn’t fit them all on here! Some people however may have no symptoms at all, silent coeliac disease may run in the family and they decide to get tested and WHAM! They are now coeliac on a gluten free diet. Coeliac disease can also be triggered out of stress, trauma, illness, pregnancy or other factors. The trouble is the symptoms are so varied that they could also be linked to other health problems like neurology problems for migraines or IBS for gastrointestinal complaints or diabetes with low blood sugar so the process to eliminate each ailment and find the cause for it can take a while before all the symptoms are linked together and the doctor comes up with coeliac disease as the last resort.

If you do get tested and have gluten sensitivity you may be able to eat gluten from time to time but if test results were inconclusive then you might want to avoid gluten and get another test done later. If you prove to be positive for coeliac disease the other members of your family will need to be tested too as it is a genetic condition and all those affected must follow a strict gluten free diet immediately.

So to summarise what is the difference between coeliac disease and gluten sensitivity? well gluten sensitivity / intolerance is having reactions to gluten and feeling unwell but no damage is done to the small intestine nor is the immune system compromised. Coeliac disease is the worse of the two and takes on many symptoms and erases the small intestine villi so ulcers occur, cells attack their own and people often have major vitamin or mineral deficiencies as the villi cannot extract any goodness out of the food you eat and the immune system is too weak to fight off illnesses. If you think you are gluten sensitive or have coeliac disease, you must get tested and keep getting tested to make sure the results are correct. The only way to tell which category you are in is by testing. Talk to your doctor about the tests available and if all else fails, try a gluten free diet and jot down your symptoms and see how you feel after a month. You can take your findings to the doctor as well to help support your concerns.

Here is a rough guide for you:

Spectrum of gluten sensitivity:

Little or no sensitivity

Immune system reactions (gluten sensitivity)
in the gastrointestinal tract
often characterised by bloating but sometimes there are no symptoms

Immune system reactions (gluten sensitivity) in the blood,
which can affect any system of the body
characterised by symptoms ranging from none to mild to severe,
with minor damage and malabsorption in the small intestine
sometimes taking place

Silent / subclinical coeliac disease
characterised by little or no symptoms but with the
 autoimmune response and overt damage in the small
intestine (and often health complications) that
characterise coeliac disease

Classic coeliac disease
characterised by the autoimmune reaction and severe
damage in the small intestine with overt gastrointestinal
symptoms and often serious health complications.

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Be well!

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