What Are the Differences Between Gluten Sensitivity and Celiac Disease?

Gluten sensitivity and celiac disease are not the same thing. However, with both it is recommended and important to avoid gluten consumption 100%. Gluten sensitivity and celiac disease have been shown to cause malabsorption of vitamins, minerals, and other nutrients. Both have been linked to over 200 medical conditions. Gluten can cause leaky gut syndrome which often cause people to develop additional food allergies and sensitivities. Measuring for food allergies is an important next step to help to determine what other dietary exposures are contributing to these problems.

Gluten sensitivity is not a disease, but if ignored can trigger many diseases, especially celiac disease. The current, yet antiquated definition of gluten sensitivity is an immune reaction to the protein gluten found in wheat, barley, and rye. The definition sometimes includes oats and sometimes does not. Gluten allergy is typically considered to be an allergy (immune mediated response). The response is acute anywhere from 30 minutes to 3 hours and involves the IgE leading to inflammation. Gluten intolerance is considered to be an inability to tolerate or digest gluten (immune and non-immune mediated). The response is delayed and can involve IgG, IgA, IgM, T-cells and immune complexes. However, IgG is typically tested over the others. Gluten sensitivity is a mesh of both gluten allergy and gluten intolerance.

Celiac disease is a disease triggered by genetics and environment. Celiac disease is an autoimmune disease of the small intestine caused by gluten induced damage. What happens physiologically when someone with celiac disease ingests gluten, is they usually have an autoimmune response, which begins attacking the lining of the small intestine - severely damaging the villi and impairing digestion and absorption. Specifically, the immune response is a TH1 response (helper T-cells, type 1). Specific T-cells release the cytokine IFN-gamma in response to gluten. There is also an innate immune response that is mediated by IL-5. Generally, it’s flattening or atrophy of the villi. With celiac disease symptoms are systemic, meaning they can negatively affect every tissue in the body.

Ninety-eight percent pf people with celiac disease have 2 specific genes: HLA class II haplotypes DQ2 and/or DQ8. However, just because you have the genes for celiac disease doesn’t mean they are actively being expressed. Thirty percent of healthy people have these genes and do NOT have celiac disease. HLA-DQ gene testing with clinical symptoms is the gold standard for recognition. Extraintestinal manifestations of gluten intolerance are a major cause of missed diagnosis in developed nations worldwide.

It is important to note that some people with celiac disease will have NO symptoms, but still have autoimmune damage to their small intestine which is known as silent celiac disease. For this reason, it is important to get tested if there is a family history of the disease or autoimmune diseases in general, or if they begin to have some of the long-term complications of celiac disease.

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