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Main Difference – Celiac Disease vs Gluten Intolerance

Celiac disease and gluten intolerance are two medical conditions which are basically triggered by a protein known as gluten present in cereals such as rye, wheat, and barley. These two terms celiac disease and gluten intolerance are often used interchangeably even by health care professionals due to several common features they share. However, celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine whereas gluten intolerance causes the body to mount a stress response which is different from the immunological response that occurs in celiac disease. This is the main difference between celiac disease and gluten intolerance.

This article covers,

1. What is Celiac Disease? – Cause, Signs and Symptoms, Diagnosis, Treatment and Management

2. What is Gluten Intolerance? – Cause, Signs and Symptoms, Diagnosis, Treatment and Management

3. What is the difference between Celiac Disease and Gluten Intolerance?How to Understand Celiac Disease and Gluten Intolerance

What is Celiac Disease

Celiac disease is an auto-immune disorder which is triggered by consuming Gluten, a protein present in cereals like wheat and barley. As far as the pathophysiology of this disease is concerned, the gluten damages the gut lining and its villi, resulting in poor digestion and malabsorption of nutrients over time.

The majority of the individuals diagnosed with this condition have a positive family history; this supports the fact that celiac disease has a genetic predisposition. Furthermore, this can be triggered by stress, viral infections and environmental factors; it can also trigger during pregnancy or following surgery.Individuals with underlying autoimmune thyroid diseases and Sjogren’s syndrome ( an autoimmune disorder with dry mouth and eyes) are also at a high risk.

Patients with Celiac disease will mainly experience signs and symptoms related to the gastrointestinal system, but there can also be extra-intestinal features.

Intestinal symptoms:

Diarrhea, pale-foul smelling stools, abdominal pain, loss of weight and appetite, constipation, acid reflux and heartburn

Extra-intestinal manifestations:

Headache, itching, rashes, anemia, osteoporosis, fatigue and joint pains

Effects of celiac disease during critical growth:

Failure to thrive in infants, delayed puberty in adolescents, short stature, irritability in the mood, weight loss, and dental enamel defects.

In order to make a proper diagnosis, a complete history of signs and symptoms, their duration, associated factors, diet and family history should be taken from the patient. A thorough physical examination will also be helpful to diagnose other associated diseases like autoimmune thyroid diseases and to exclude other conditions which might mimic celiac disease.

Upper endoscopy along with duodenal biopsy (show villous atrophy) and serological screening for coeliac disease assessing positive levels of HLA DQ2/DQ8 typing (the commonest gene associated with coeliac disease) will confirm the diagnosis.

Being a chronic and lifelong condition, there is no permanent cure for celiac disease, but a properly tailored treatment plan together with a gluten-free diet (avoid canned food, medication, and almost every eatable possibly containing gluten) will definitely improve the symptoms.

How to Understand Celiac Disease and Gluten Intolerance

Biopsy of small intestine showing celiac disease

What is Gluten Intolerance

Also known as Non-Celiac Gluten Sensitivity (NCGS), gluten intolerance characteristically causes signs and symptoms similar to that of celiac disease, without having an underlying celiac disease or wheat allergy. Researchers still trying to find a clear-cut etiology for this condition.

Patients will usually experience symptoms like mental fatigue (brain fog), physical fatigue, bloated feeling in the abdomen and headache.

Gluten intolerance is a diagnosis made by exclusion of other conditions like celiac disease and allergies to wheat in patients who are developing signs and symptoms following meals with Gluten. However, since there is no exact test to confirm the diagnosis, most physicians will advise patients to maintain a ‘Food and Symptom journal’ in relation to every meal they consume, so that a confirmed etiology of Gluten-diet could be revealed.

After the confirmation of the above feature, a gluten-free diet will be initiated which will have to be continued throughout the life.

How to Understand Celiac Disease and Gluten Intolerance

Difference Between Celiac Disease and Gluten Intolerance

Condition

Celiac disease is an inherited autoimmune disorder that affects the digestive process of the small intestine.

Gluten intolerance causes the body to mount a stress response which is different from the immunological response that occurs in celiac disease. Individuals with gluten tolerance do not show any signs of intestinal damage or increased permeability.

Symptoms

Celiac disease can indicate both intestinal symptoms and extra-intestinal manifestations.

Intestinal symptoms: Diarrhea, pale-foul smelling stools, abdominal pain, loss of weight and appetite, constipation, acid reflux and heartburn

Extra-intestinal manifestations: Headache, itching, rashes, anemia, osteoporosis, fatigue and joint pains

Gluten intolerance symptoms include mental fatigue (brain fog), physical fatigue, bloated feeling in the abdomen and headache.

Diagnosis

Both these conditions are triggered by the consumption of Gluten, however,

Celiac disease is diagnosed by a duodenal biopsy and serological screening

Gluten intolerance will be diagnosed by excluding possible causes of wheat allergy and underlying celiac disease.

Treatment

Both conditions will strictly be followed by a gluten-free diet.

“Coeliac path” By Samir at the English language Wikipedia (CC BY-SA 3.0) via Commons Wikimedia

About the Author: Embogama

Embogama is a passionate freelance writer for several years. Her areas of interest include general medicine, clinical medicine, health and fitness, Ayurveda medicine, psychology, counseling and piano music

There is often a lot of confusion on what the difference between celiac disease and gluten intolerance is. I’m frequently asked “I have the symptoms of both celiac and gluten intolerance – how do I know which one I have”. First, I want to say – I am not a doctor and I can’t diagnose you. Second, as you’ll learn further in this post, the only way to know which one you have is to be tested by your doctor. If you are concerned about having gluten intolerance or celiac disease, get help from a trusted doctor. With that said, hopefully this post can help clear up some of the confusion.

What is Celiac Disease?

Celiac disease is an autoimmune disease where the body essentially attacks itself when you eat gluten. More specifically, the body attacks the small intestine which can cause serious damage and trigger serious symptoms.

How to Understand Celiac Disease and Gluten Intolerance

What are the symptoms of Celiac Disease?

There are over 300 reported symptoms of celiac disease. From diarrhea to brain fog, celiac disease can impact many parts of the body. Some more commonly recognized symptoms of celiac disease are:

  • Pain
  • Bloating
  • Constipation
  • Heartburn
  • GI Distress
  • Fatigue
  • Stomach ache
  • Vomiting
  • Headaches/Migraines
  • Depression
  • Anxiety

How do you get a Celiac Diagnosis?

Getting diagnosed with celiac disease involves a series of tests. Every doctor is different but the gold standard is to be tested for inflammatory blood markers and then to confirm the diagnosis through an endoscopy of the small intestine. Beyond celiac has a very well-written description of celiac disease testing here, if you want to know more!

What’s the treatment for Celiac Disease?

The ONLY treatment right now for celiac disease is a life-long gluten-free diet. Or in other words, a strict gluten-free lifestyle. This disease is lifelong and there are no other treatment options or cures.

What is Gluten Intolerance?

Gluten intolerance, better known and referred to as non-celiac gluten sensitivity, is when you don’t have celiac or an allergy to the protein gluten, but find yourself reacting poorly to eating foods with gluten in it.

What are the symptoms of Gluten Intolerance?

The symptoms of gluten intolerance are the same as the symptoms of celiac disease aside from the characteristic small intestinal damage. The main difference is that those with celiac have small intestinal damage and the majority of people with gluten intolerance don’t (though there are a few who do experience it according to new studies).

How do get a Gluten Intolerance Diagnosis?

It is difficult for people to clinically separate gluten intolerance from IBS and there aren’t many good tests specifically designed for diagnosing gluten intolerance. Often, many people who have gluten intolerance are self-diagnosed or receive this diagnosis following negative test results for celiac disease.

What is the treatment for Gluten Intolerance?

A gluten-free lifestyle is a treatment for gluten intolerance. Though it should be noted that sometimes food intolerances, like gluten intolerance, can be grown out of, unlike celiac disease. So a gluten-free lifestyle is not always lifelong for people with gluten intolerance.

How to Understand Celiac Disease and Gluten Intolerance

Ultimately, what’s the difference between Celiac Disease and Gluten Intolerance?

Since celiac disease and gluten intolerance share so many symptoms, it can be hard to understand what the difference is – and ultimately, how to know which one you have.

The key differences? Celiac disease always involves an autoimmune reaction and damage in the small intestine and celiac disease is always lifelong. There is no cure and there is no growing out of celiac disease. This is different from gluten intolerance because in some cases, intolerance can be grown out of and foods can be reintroduced later on in life. Additionally, damage in the small intestine is only reported in a very small group of people.

So how do you know which one you have? Unfortunately, the only way know which one you have is to be tested for celiac disease. Self-diagnosis is not an option. There is no way of knowing if you have celiac or gluten intolerance without being tested. If you’re concerned you have either, talk to your doctor about it. They are your best resource when it comes to diagnosis.

Have any more questions? Drop them in the comments!

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    What is celiac disease?
    Celiac disease is an autoimmune disorder that results from the response of the immune system to the ingestion of gluten, which is a protein found in wheat, barley, and rye. This immune response causes inflammation and damage to the small intestine that can ultimately lead to malnutrition and poor health. Celiac disease can be diagnosed at any age, starting in early childhood.

    The genes responsible for the development of celiac disease are inherited; therefore it occurs at a significantly higher rate among first-degree relatives (parents, children, and siblings) of those who have the condition. The only treatment for celiac disease is lifelong adherence to a gluten-free diet. The removal of gluten from the diet is a highly effective treatment that allows the small intestine to heal, leading to normal absorption of nutrients.

    Childhood is a crucial time for the overall growth and development of all body systems. If undiagnosed or untreated, celiac disease can cause malnutrition in children that may lead to inability to develop optimal bone mass, short stature, failure to thrive, anemia and delayed puberty, among other problems. It is important that when celiac disease is present, it be diagnosed as soon as possible, so that these potential health issues can be reversed or avoided through following a gluten-free diet.

    Nutrients of concern:
    Nutritional inadequacies may exist among children with celiac disease and can occur for a number of reasons. Primary causes are the inability to absorb certain nutrients due to damage of the small intestine (until the intestine has had a chance to heal), lower micronutrient content of some gluten-free grains, and lack of enriched grain products consumed on a gluten-free diet. Talk to your doctor or registered dietitian if you are concerned about potential nutritional deficiencies in your child. A dietitian can provide suggestions on gluten-free foods which contain nutrients of concern. If supplements are recommended, be sure to confirm that they are gluten-free.

    For more information about the gluten-free diet, go to the Resources section of the GIG website, www.gluten.org.

    Take realistic steps for your family:

    • Educate yourself, your child, and the entire family about what it means to have celiac disease, and about the importance of a gluten-free diet as the treatment.
    • Be sure everyone in the household is knowledgeable about sources of gluten: wheat, barley, rye, contaminated oats*, and the by-products and hybrids of these grains. Remember that gluten may be found in unexpected foods such as licorice, energy bars and processed meats.
    • If some members of your household are continuing to eat gluten-containing foods, remember that cross-contamination is a common way that gluten finds its way into food. Even the smallest amount of gluten can cause damage to the small intestine without causing visible symptoms, so it is imperative to prevent cross-contamination.
      • Designate a separate area for gluten-free ingredients on an upper-shelf in the pantry and refrigerator.
      • If possible, assign one counter area to be used only for gluten-free food preparation.
      • Thoroughly clean cookware, cutting boards, plates, bowls, and utensils.
      • Buy separate condiments or put them in squeeze bottles so utensils do not cross-contaminate them.
    • Reach out to national organizations that offer local support groups for kids and families, such as the Gluten Intolerance Group (GIG) at www.gluten.org. GIG’s Generation GF program is geared specifically to kids and offers support groups as well as a magazine just for kids: www.gluten.org/community/kids/

    Can my child still enjoy a socially active life?
    Aside from the need to maintain a gluten-free diet, children with celiac disease are able to participate in traditional events as usual such as sports, band, academic clubs, and other hobbies. Always communicate with coaches, club sponsors, teachers and other parents about your child’s need to avoid gluten. Consider exploring whether other children are gluten-free so both the kids and parents can have an informal support system.

    What should I do about school lunches?
    Communicate! Whether you choose to pack your child’s meals or buy them at school, alert the principal, school nurse, and teachers about the importance of a gluten-free diet for your child. This will also come in handy if there is a special occasion, such as a birthday party where you will need to be alerted ahead of time if you need to provide an alternative dessert for your child.

    If you would like to purchase meals from school, you will want to contact the cafeteria manager and/or the School District (Nutrition Services Department) to inquire further about the availability of a gluten-free menu. Some school cafeterias are equipped for allergen-free cooking and can provide daily options, whereas others have limited resources and will not be able to accommodate your child.

    To have the most assurance that your child enjoys gluten-free meals while at school, preparing lunches at home is a good option. This can be an excellent hands-on opportunity to educate your child about eating gluten-free. Once they are familiar with the guidelines, let them try to plan their own menu. This will empower them, give them some freedom, and help them not to feel so restricted by their diet.

    Kid-friendly gluten-free (GF) meal and snack ideas*:

    Breakfast:

    • Yogurt with fruit and nuts
    • Cold or hot cereal (made from puffed rice, quinoa, millet, amaranth, teff, or other GF grains) with banana, cooked apples, cinnamon, maple syrup, etc.
    • Eggs, potatoes, and GF toast
    • Smoothies: yogurt, cow/almond/soy/rice milk, nut butter, berries, banana, mango, or any fruit your child likes!
    • GF pancakes, waffles, or French toast

    Lunch/Dinner:

    • Sandwiches made with GF bread or wrapped in lettuce (green leaf, red leaf, butter lettuce work best)
    • GF pasta and favorite sauce or chilled GF pasta salad
    • GF burrito with sweet potato, black beans, and brown rice
    • Tacos, nachos, or quesadillas made with corn tortillas and favorite fixings
    • Baked fish/chicken with GF macaroni and cheese

    Snacks:

    • Applesauce, pudding, fresh fruit, GF muffin
    • Hard-boiled egg, cheese stick, yogurt, cottage cheese
    • Homemade trail mix with dried fruit, nuts and seeds
    • Veggies: carrot, celery, jicama, red pepper, broccoli, and cauliflower
    • Dipping ideas: nut butter (peanut, almond, cashew), hummus, ranch-flavored yogurt, cream cheese, salsa, guacamole, and bean dip

    *oats are inherently gluten-free, but are often cross-contaminated with wheat or barley during harvesting or processing. Only certified gluten-free oats should be consumed on a GF diet, and only after consultation with your physician or dietitian.

    What is Lactose Intolerance?

    Lactose intolerance is the inability to digest or absorb lactose, which is a type of sugar found in milk and other dairy products. Common symptoms of lactose intolerance include stomach ache, gas, bloating and diarrhea. These symptoms occur when people eat or drink dairy products, and the degree of toleration varies from person to person. This means that some people are affected by a small amount of lactose, while others can consume quite a lot before they are affected. It is important to note that lactose intolerance is not an allergy, as people with a milk allergy can react to even the smallest amount of dairy foods.

    What is the Connection between Lactose Intolerance and Celiac Disease?

    • In newly diagnosed celiac disease patients, secondary lactose intolerance is common due to the loss of lactase, an enzyme that digests milk sugar along the lining of the small intestine
    • The damage that gluten causes in the small intestine is the main factor in the lack of lactase for people with celiac disease
    • While following a strict gluten-free diet, the gut is able to heal, making lactose intolerance temporary in most celiac disease patients
    • It is important to make sure that those with lactose intolerance still consume adequate amounts of calcium. Low lactose foods that are generally well tolerated include aged cheese (cheddar, Swiss, etc.), some yogurts and lactose-removed products (lactose-free milk). Nondairy sources of calcium include salmon (with the bones), broccoli and spinach.

    Gluten and Lactose Intolerance

    A 2015 study showed that some with a celiac disease diagnosis that went on a gluten-free diet were actually doing so in reaction to symptoms caused by lactose intolerance rather than a non-celiac gluten sensitivity (mistakenly referred to as gluten intolerance).

    Additionally, research suggests that gluten alone may not be responsible for the symptoms produced by the condition currently called gluten sensitivity. Instead, it is showing that perhaps FODMAPs, a group of poorly digested carbohydrates, may be the cause of the symptoms instead. It is also important to note that wheat, barley and rye — gluten-containing grains — are all high in FODMAPs.

    Celiac Disease and Dairy

    Lactose intolerance is often a symptom of celiac disease. It usually resolves itself after following a strict gluten-free diet.

    Learn more about gluten and dairy:

    Where Can I Learn More?

    • U.S. National Library of Medicine
    • Celiac Disease Symptoms Checklist

    Do you or a family member suffer from lactose intolerance? You may have celiac disease. Find out now. Take our Celiac Disease Symptoms Checklist.

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    How to Understand Celiac Disease and Gluten Intolerance

    What exactly is the difference between Celiac disease and gluten intolerance?

    How to Understand Celiac Disease and Gluten Intolerance

    I was at a restaurant in Oslo, Norway a few months ago enjoying some spicy gluten free noodles. As I took a breath in between mouthfuls, a young French girl walked over to me and asked me what I was eating.

    “Gluten Free noodles” I politely replied.

    “Oh, I can’t eat gluten either” she enthusiastically told me.

    10 minutes later I paid my bill, thanked the owner and headed to the door. As I nodded goodbye to the French girl, I couldn’t help but notice the huge pita bread kebab she was holding.

    “hey, I thought you said you couldn’t eat gluten?” I jokingly asked.

    “Oh, I shouldn’t, but I do sometimes. I’m gluten intolerant.” she laughed.

    I spent the walk back to my hostel pondering why someone with an autoimmune disease would purposely make themselves so sick.

    I couldn’t understand it.

    Anyway, fast-forward half a year and I now know that celiac disease and gluten intolerance are completely different.

    Shame on me for being so judgmental!

    But, life is a learning curve, right?

    So, what exactly is the difference?

    Celiac Disease and Gluten Intolerance

    Celiac Disease

    Celiac Disease is a digestive and autoimmune disorder that causes damage to the small intestine. The small intestine is vital for absorbing key nutrients, so any damage can cause malnutrition. This in itself can result in hundreds of possible symptoms.

    Gluten Intolerance

    Many symptoms of gluten intolerance, such as diarrhea, fatigue and vomiting are similar to celiac disease. However, there is no damage to the intestine and any blood tests for gluten sensitivity will be normal.

    A lot of people with celiac disease are…well.. dicks to people with gluten intolerance. They have a “my disease or worse than yours” attitude.

    I have complete sympathy for those with celiac disease and gluten intolerance. Only together can we raise awareness for the gluten free lifestyle, and help others get correctly diagnosed.

    Who develops celiac disease (CD) and why? Three factors are involved: 1) a person must have the pre-disposing genes (

    33% of the population have the genes, but only 1% develop CD); 2) A person must be consuming gluten; and 3) a person must experience some type of environmental triggering event or circumstance, which could include childhood antibiotic exposure, stressful events like surgery or pregnancy, make-up of the bacteria in the gut, and others factors (research is ongoing on factors which could be involved). The existence of any of the 3 factors necessary for development of celiac disease could theoretically vary and be influenced by race/ethnicity.

    Also relevant is the fact that among individuals with celiac disease, many (likely at least half) remain undiagnosed. The likelihood of being diagnosed (access to medical care, lack of referral bias, and other factors) could also be influenced by race/ethnicity.

    Based on the available data, the African American community in the U.S. needs more attention from the celiac community. This would include additional social support, improved medical attention, and additional research.

    Following are summary points of some of the currently available relevant research

    • Although in the past celiac disease was thought to affect predominantly Caucasian populations, a major systematic review published in 2018 which looked at data from 1991-2016 on 275,000 individuals with celiac disease (CD) concluded that CD is a major public health problem worldwide. (https://pubmed.ncbi.nlm.nih.gov/29551598/)
    • There are differences in prevalence in different parts of the world and among different ethnic groups, but it is acknowledged by experts in the field that CD can and does exist among all groups. In this study prevalence of biopsy-confirmed celiac disease was found to be 0.5% in both Africa and North America.
    • A study done in 2006 ( https://pubmed.ncbi.nlm.nih.gov/16642428/) which looked at 700 cases of CD (biopsy proven) found that although African-Americans made up 12% of the U.S. population, only 1% of the patients with celiac disease seen in this study group were African American.
      • These authors noted:
        • 1) The low rate of diagnosis among African Americans could be due to referral bias (less likelihood of being referred to a specialist), or to socio-economic factors that affect access to health care.
    • Large scale study published in 2015. ( https://pubmed.ncbi.nlm.nih.gov/25577269/)

    Included 14,000 participants. Looked for positive serology (tTG and EMA antibodies) only; biopsies not involved. In this study, it was found that prevalence of CD autoimmunity was 4 times higher among non-Hispanic whites (1.08%) than in non-Hispanic blacks (.22%).

    While these results seem to indicate a lower likelihood of CD among African Americans, a commentary article (“Celiac Disease and the Forgotten 10%: the ‘Silent Minority’” https://pubmed.ncbi.nlm.nih.gov/25875755/) points out issues with this assumption:

    • The tTG threshold levels could be lower in minorities, i.e. lower levels that were considered “normal” in this study could be indicative of CD in some minority individuals. Also, there are some cases of “sero-negative” CD, and these cases would have been missed. The “gold standard” of intestinal biopsy for diagnosing CD was not used.
    • Under-diagnosis in a certain group can occur if it is assumed that there is lower prevalence – a sort of vicious cycle. If CD is still considered to be a Caucasian disease (or mostly Caucasian), then it will be under-diagnosed among other groups because it is not looked for.

    With regard to racial disparities in CD generally, this author also points out:

    • Research which found that among patients undergoing upper endoscopy for iron deficiency, anemia, diarrhea, and weight loss (all potential symptoms of CD), only 43% underwent duodenal biopsy, and that biopsy was less likely to be performed in black or Hispanic patients.
    • Undiagnosed patients are self-prescribing a gluten-free diet (GFD), and are not always being highly compliant. (If an individual is not receiving adequate work-up for diagnosis, the patient may self-prescribe a GFD, and not be as concerned about being strictly GF since no official diagnosis has been made.)
    • Author’s conclusion: “It behooves us to send a clear message: CD is common, potentially serious, and is present in Caucasians as well as non-Caucasians.”

    Another study similar to the previous listing, also published in 2015. “Trends and Racial/Ethnic Disparities in Gluten-Sensitive Problems in the United States: Findings From the National Health and Nutrition Examination Surveys From 1988 to 2012.” (https://pubmed.ncbi.nlm.nih.gov/25665935)

    • This research looked at racial disparities in the prevalence of celiac disease (CD) and in the number of people without CD avoiding gluten (“PWAG”). The prevalence of CD was found to be significantly higher among non-Hispanic whites than non-Hispanic blacks, whereas the prevalence of PWAG was significantly higher in blacks (1.2%) as compared with whites (0.7%) and Hispanics (0.5%).
    • The points noted above made in the commentary article could similarly apply to these findings.

    __________________________________________________________________________________

    2012 study. “Gender and Racial Disparities in Duodenal Biopsy to Evaluate For Celiac Disease” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445758/

    Gastroenterologists use endoscopies to look inside the small intestine; based on what they see, they may decide to take tissue samples for biopsy, which is the basis for a CD diagnosis. Biopsies were less likely to be done on African Americans, so CD may have been missed.

    The majority of people with celiac disease have not been diagnosed and are unaware that their physical condition may be linked to the food they eat.

    With one in 133 Americans suffering from its effects, it seems like you can’t pick up a paper or magazine today without seeing an article about gluten or Celiac Disease. Is this a major problem or just another food fad? Even major grocery store chains are increasingly adding gluten-free foods to their market selections. So what is gluten? Gluten is the protein in wheat, barley and rye that gives the grain its elasticity. But for many Americans, gluten is a food substance causing life-long damaging nutritional deficits and symptoms resulting in a disease that can not be cured.

    Celiac disease is an auto-immune disease. When adults or children with celiac eat gluten, the protein damages the villi in the small intestine causing a flattening of the villi. Villi are the finger like protrubences that absorb nutrients from the food we eat. With flattened villi, we lose the ability to absorb these nutrients leading to malnutrition affecting virtually every organ in the body.

    Symptoms of gluten intolerance or celiac include:

    • Anemia
    • Skin problems (eczema/psoriasis)
    • Fatigue and/or memory loss
    • Digestive problems such as bloating, diarrhea or constipation

    What should you do if you suspect that you have gluten intolerance? Try avoiding foods containing gluten for several weeks and see if your symptoms improve. Common foods containing gluten include:

    • Anything made from wheat, rye or barley including flours, bread, pasta, crackers, cereal and desserts
    • Processed meats including luncheon meat and imitation bacon
    • Breading mixes

    Reading food labels will help you determine if a food contains gluten. But remember that “wheat free” does not mean gluten free as rye and barley also contain gluten. Some common ingredients containing gluten that you may not have thought of include:

    • Soy sauce and Worcestershire sauce
    • Spice and herb mixtures
    • Marinades and salad dressings

    After a week or two, if symptoms are less severe you might conclude that you have an intolerance and continue eating this way for the rest of your life. You might also try reintroducing gluten and see if your symptoms return or worsen. But for a definitive diagnosis or if symptoms don’t improve, contact your physician for an appointment to get tested for Celiac disease. By becoming your own health advocate, you can learn to live a healthy life free of sypmtoms while still enjoying the food you love.

    For more information visit the Celiac Disease Foundation website.

    This article was published by Michigan State University Extension. For more information, visit https://extension.msu.edu. To have a digest of information delivered straight to your email inbox, visit https://extension.msu.edu/newsletters. To contact an expert in your area, visit https://extension.msu.edu/experts, or call 888-MSUE4MI (888-678-3464).

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    If your doctor suspects that you have celiac disease or gluten intolerance, he or she may use blood tests — also called serological tests — to look for antibodies that the body produces when someone with a sensitivity or celiac disease eats gluten.

    You have to be eating gluten for an extended length of time before blood testing. If you don’t eat gluten, or haven’t eaten it for long enough, your body may not produce enough antibodies to show up on the tests, and the results will seem to show that you’re “normal” — or “negative” for gluten sensitivity or celiac disease.

    No one knows for sure exactly how much gluten you need to be eating, but if you eat the equivalent of about one or two pieces of gluten-containing bread a day for at least three months, you should have enough gluten in your system to provide a measurable response. If you have severe symptoms during that time, consult your physician to see whether you should continue to eat gluten.

    The most comprehensive panel of blood tests for gluten sensitivity and celiac disease includes five tests for antibodies:

    tTG (anti-tissue transglutaminase)-IgA: This test is very specific to celiac disease, meaning that if you have a positive tTG, it’s very likely that you have celiac disease and not another condition.

    EMA (anti-endomysial antibodies)-IgA: This test is also specific to celiac disease. When it’s positive, especially if tTG is positive too, it’s extremely likely that you have celiac disease.

    AGA (antigliadin antibodies)-IgA: The antigliadin tests are less specific for celiac disease, and these antibodies sometimes show up in other diseases (including gluten sensitivity). AGA-IgA is useful when testing young children, who don’t always produce enough tTG or EMA for diagnostic purposes.

    AGA-IgA is also useful for monitoring compliance on the gluten-free diet (if it’s still elevated after you’ve been gluten-free for several months, gluten may be sneaking into your diet). Some people feel that a positive AGA-IgA indicates gluten sensitivity.

    AGA (antigliadin antibodies)-IgG: This is another antigliadin test (like the preceding one) and is less specific to celiac disease, but it may be useful in detecting gluten sensitivity or leaky gut syndrome.

    Also, if the IgG levels are highly positive and all the other tests are negative, that may signal that the patient is IgA-deficient, in which case the results of the other tests are erroneous.

    Total serum IgA (total serum, immunoglobulin A): A significant portion of the population is IgA-deficient, meaning their IgA production is always lower than normal. Three of the four tests above are IgA-based (the only one that isn’t IgA-based is antigliadin IgG), so in someone who’s IgA-deficient, results of those three tests would be falsely low.

    By measuring total serum IgA, doctors can determine whether a patient is IgA-deficient and can compensate when reading the results of the three IgA-based tests.

    Any lab can draw the blood, as long as you have an order from a health care practitioner allowed to order blood draws.

    Celiac disease and gluten sensitivity can be triggered at any age, so just because you went to the doctor and tested negative once doesn’t mean you’re “out of the woods” forever.

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    Celiacs at higher risk for COPD before and after diagnosis

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    Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.

    Emmy Ludwig, MD, is board-certified in gastroenterology and hepatology. She is an associate attending physician at Memorial Sloan-Kettering Cancer Center and an associate professor at Weill Cornell Medicine in New York City.

    How to Understand Celiac Disease and Gluten Intolerance

    • Overview
    • Symptoms
    • Causes
    • Diagnosis
    • Treatment
    • Coping
    • Caregiving

    How to Understand Celiac Disease and Gluten Intolerance

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    It’s not infrequent to find someone with celiac disease who also has asthma. But it also appears that people with celiac disease may be at moderately increased risk for another respiratory disorder: chronic obstructive pulmonary disease (COPD).

    COPD, a lung disease, progressively makes it harder for you to breathe as your airways lose their elasticity and their walls thicken, becoming inflamed and clogged with mucus.

    Most COPD cases involve current or former smokers. In addition, the condition can affect people who have had long-term exposure to other airborne lung irritants, including pollution and secondhand smoke.

    And, it appears that people with celiac may develop COPD more frequently than the general population.

    Emphysema and Chronic Bronchitis Forms of COPD

    The National Institutes of Health recognizes two forms of COPD: emphysema and chronic bronchitis.

    In emphysema, the walls that separate the air sacs in your lungs become damaged over time. Eventually, they lose their shape and may even break down, leaving fewer, larger air sacs that don’t work as well to allow oxygen exchange from your lungs into your bloodstream.

    In chronic bronchitis, meanwhile, you have chronic inflammation and irritation in your airways, which causes their linings to thicken. In addition, too much mucus fills the tiny passages, making it more difficult for you to breathe.

    Most people are diagnosed with COPD in middle age or in their senior years. The condition progresses slowly, but eventually many people need supplemental oxygen. COPD represents the third-leading cause of death in the United States, behind only heart disease and cancer.

    Study Shows Increased COPD Risk for Celiacs

    There are few medical studies on COPD risk in celiac disease, but the available research indicates there is an increased risk.

    A team of researchers in Sweden used that country’s excellent national health database to identify all people with a biopsy-proven celiac disease who had been diagnosed between 1987 and 2008. They found 10,990 individuals and matched them with 54,129 control subjects without celiac. They then looked to see how many had been diagnosed with COPD.

    A total of 3.5% of individuals with celiac disease also had been diagnosed with COPD, compared with 2.6% of the control subjects, indicating about a 25% increase in risk for COPD if you have celiac disease.

    The risk dropped somewhat after people were diagnosed with celiac disease but still remained higher than normal in the five years following their celiac disease diagnoses.

    Heightened Risk Could Relate to Inflammation and Nutritional Status

    It’s not clear why people with celiac disease might have an increased risk for COPD.

    The authors of the Swedish study noted that chronic inflammation plus poor nutritional status can influence the development of chronic obstructive pulmonary disease. Since celiac disease “is characterized both by dysregulated inflammation and malnutrition,” they said, they decided to investigate if there was an association.

    Other researchers, citing case reports, also have noted a possible association between the two conditions.

    Does celiac disease cause COPD? No, most people develop COPD because they smoked or were exposed to secondhand smoke. However, having celiac disease, whether it’s diagnosed or not, might increase your chances of developing COPD as you get older, especially if you have other risk factors.

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    How to Understand Celiac Disease and Gluten Intolerance

    Gluten is a protein compound that is found in wheat, and any foods made from wheat. It is used in foods because it makes dough elastic and helps it rise during baking. Gluten is also found in barley, rye, and sometimes in oats. In addition, it is also found in things like vegetarian meat-like foods, such as vegetarian chicken, cold cuts, and hot dogs.

    For most people, consuming gluten doesn’t cause a problem, but for others it can wreak havoc on their digestive systems. Some of these people have celiac disease, which is a situation where the intestines can not absorb nutrients properly because they can not tolerate gluten. The reason behind this is that when you suffer from celiac disease, the consumption of gluten causes your immune system to over react, and it responds by releasing antibodies that destroy the villi areas of the stomach and small intestines. The villi are little projections, similar to a very plush carpet, that assist in nutrient absorption.

    Common celiac disease symptoms include abdominal pain, occasional diarrhea, and severe bloating. If it progresses it can lead to muscle cramps, joint pain, and mouth sores. With time it can lead to malnutrition because the digestive system can’t do its job properly. Regardless of how much a person eats, if this disease is serious enough, they will not be able to absorb the necessary nutrients.

    Note that gluten intolerance is different than celiac disease. Gluten intolerance is a situation where it causes uncomfortable abdominal pain when gluten is ingested, but there is no damage to the digestive system.

    If you are experiencing any of these symptoms a proper diagnosis is the first step. Be aware that sometimes celiac disease is sometimes confused with other diseases, so be sure to seek a specialist. If celiac disease is confirmed the best treatment is to avoid the consumption of gluten. A few years ago this may have been a problem, but with greater awareness these days there are many types of foods now that are gluten free.

    These are other signs that celiac disease may be present:

    • Low albumin
    • High levels of alkaline phosphatase, which is also related to bone loss
    • Clotting factor abnormalities
    • Low cholesterol (although this may be a good thing if it is not caused by a disease).
    • Anemia

    If celiac disease is suspected then a biopsy of the small intestine will be taken to see if there is a flattening of the villi. This can be repeated over time to see if the person is responding to treatment.

    If you suspect that you have celiac disease, do not alter your diet until you have been diagnosed. The reason being, if you alter your diet first, then the physician can’t monitor any progress that has been made since they he (or she) didn’t examine you before beginning treatment.

    Although there is no cure for celiac disease, a gluten free diet will allow the villi to regenerate. However, the more gluten you consume the worse it will become.

    Other facts about celiac disease:

    • Women are more likely to suffer celiac disease
    • There is no known cause, but there is genetic predisposition
    • It can occur at any age
    • People with celiac disease are more likely to also have other problems such as:
      • Other types of autoimmune disorders
      • Down syndrome
      • Intestinal cancer and lymphoma
      • Lactose intolerance
      • Type 1 diabetes

    How to Understand Celiac Disease and Gluten Intolerance

    It’s common to be unsure whether symptoms that come from eating a potential food allergen are a result of a food allergy or from a different cause, such as an intolerance. This confusion can come into play with reactions to wheat. While all three involve symptoms as a reaction to eating wheat, a wheat allergy, gluten intolerance and celiac disease are distinct from one another. Let’s take a look at the differences.

    Wheat Allergy

    Wheat allergy is the only reaction to wheat that is actually an allergy. If a child has a wheat allergy, specific proteins in wheat cause their body to produce antibodies in response. If this happens, the child can experience symptoms of allergy soon after eating a food with wheat in it, such as bread, cereal, pasta or pastries. The timeframe can range from minutes to hours after eating the allergen.

    Symptoms of wheat allergy can include trouble breathing, headache and nasal congestion. Your child could experience symptoms affecting the skin, including swelling, hives or an itchy rash. The mouth and throat can itch, swell and experience irritation. Also, your child could have digestive symptoms including cramps, nausea, vomiting or diarrhea.

    Finally, a wheat allergy can bring the severe symptom of anaphylaxis, which can include throat tightness or swelling, severe difficulty breathing, difficulty swallowing, chest tightness or pain, blue-tinged skin color, dizziness or fainting. Get immediate medical care if you notice signs of anaphylaxis, as it is a life-threatening condition. If you have access to an epinephrine auto-injector, such as EpiPen, use it and then seek medical attention.

    Gluten Intolerance

    Gluten intolerance is also known as non-celiac gluten sensitivity. While similar to another reaction to gluten called celiac disease, it is not as severe. It is also distinct from a wheat allergy. The mechanisms of gluten sensitivity are not entirely understood.

    Nonetheless, the symptoms are connected to eating foods with gluten, showing up soon after ingestion. Gluten is found in wheat, wheat derivatives like spelt and certain other grains such as barley and rye.

    Symptoms of gluten intolerance can vary and come in different combinations. Nonetheless, commonly reported symptoms include consistent constipation and diarrhea, abdominal pain, bloating, nausea, headaches and fatigue.

    Celiac Disease

    Celiac disease also involves a reaction to gluten, so your child would react to similar foods as with a gluten intolerance. However, celiac disease is more severe. This is a genetic immune disease. If your child eats gluten, their immune system has the unhealthy reaction of damaging the small intestine.

    Symptoms of celiac disease often take place in the digestive system, yet they can impact other systems. Symptoms can vary in each person. In children, irritability is a common symptom of celiac disease. This disease may also show itself in the form of abdominal pain, diarrhea or depression. Instead, it’s possible not to experience symptoms.

    If your child shows symptoms after consuming wheat or foods that contain wheat or gluten, they could have a wheat allergy, gluten intolerance or celiac disease. You may get an idea of which one would be most likely depending on the symptoms your child experiences. Nonetheless, it’s important to get an official diagnosis from a medical professional. This will help you understand specifically what is causing the problem and how to go about managing it.

    Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.

    Emmy Ludwig, MD, is board-certified in gastroenterology and hepatology. She practices at the Memorial Sloan-Kettering Cancer Center in New York.

    • Overview
    • Symptoms
    • Causes
    • Diagnosis
    • Treatment
    • Living With
    • In Children

    How to Understand Celiac Disease and Gluten Intolerance

    Parents have said for years that diet appears to play a role in their children’s symptoms of ADHD, and many have removed food dyes and additives, along with sugar, from their children’s plates in an effort to manage the condition. However, recent research is pointing to a new potential culprit for ADHD symptoms: gluten.

    When you have attention deficit hyperactivity disorder (ADHD), you often behave impulsively and are easily distracted, and you probably have difficulty concentrating and focusing on important tasks. These problems can take a toll on everyday life — if you’re a child with ADHD, your grades probably suffer, and if you’re an adult, you may find it difficult to perform well at work or sustain a healthy relationship.

    Up to 5 percent of preschoolers and school-age children suffer from ADHD. For many of them, symptoms will continue into adulthood. It’s not clear exactly what causes ADHD; researchers believe it may involve a chemical imbalance in the brain or possibly even physical differences in brain structure.

    It is clear that it runs in families: If you have a close relative with ADHD, your chances of developing it yourself are up to five times greater than the regular population.

    Celiac Disease and ADHD Linked in Studies

    The evidence for an association between ADHD and celiac disease is fairly strong: children and adults with the undiagnosed celiac disease do seem to have a higher risk of ADHD than the general population.

    In one study, researchers tested 67 people with ADHD for celiac disease. Study participants ranged in age from 7 to 42. A total of 15 percent tested positive for celiac disease. That’s far higher than the incidence of celiac in the general population, which is about 1 percent.

    Once they started on a gluten-free diet, the patients or their parents reported significant improvements in their behavior and functioning, and these improvements were backed up by ratings on a checklist physicians use to monitor the severity of ADHD symptoms.

    Another study investigated the incidence of ADHD symptoms in people newly diagnosed with celiac disease. It looked at 132 participants, ranging from toddlers to adults, and reported that “ADHD symptomatology is markedly overrepresented among untreated celiac disease patients.” Again, a gluten-free diet improved symptoms quickly and substantially—six months after starting the diet, most people had vastly improved ADHD symptoms.

    Not all studies have found a link between celiac and ADHD. A 2013 study from Turkey, for example, found similar rates of celiac disease in children ages 5 to 15 with ADHD, and in control subjects.

    Evidence Less Clear for ADHD and Gluten Sensitivity

    Not everyone who has a problem with gluten has celiac disease—recent research has identified markers for non-celiac gluten sensitivity, a poorly understood condition that seems to involve a reaction to gluten but not the intestinal damage that characterizes the celiac disease.

    Gluten sensitivity may affect up to 8 percent of the population by some estimates. For people with gluten sensitivity, studies show it’s possible that gluten plays a role in ADHD symptoms, but it’s less clear how large a role it plays.

    In one large study, researchers looked at the effects of the gluten-free, casein-free (GFCF) diet on people with various autism spectrum disorders. They reported a positive effect on ADHD symptoms but noted that they couldn’t say for certain that it came from the GFCF diet. They also couldn’t say if the effect might have stemmed from removing gluten or from removing casein from the participants’ diets.

    Anecdotally, parents of children with ADHD have reported improvements in behavior (some quite significant) when they placed their children on special diets, including a gluten-free diet. However, it’s difficult to correlate those improvements with the dietary changes.

    Currently, there’s no accepted test to detect gluten sensitivity; the only way to know if you have it is if your symptoms (which usually involve digestive problems but also can involve neurological issues such as headaches and brain fog) clear up when you go gluten-free.

    The Bottom Line

    If you suspect gluten may be contributing to your or your child’s ADHD symptoms, what should you do?

    First, you should consider testing for celiac disease, especially if you or your child shows other celiac-related symptoms. Remember, not all symptoms involve your digestive system; celiac symptoms in children may involve something more subtle, such as short stature or failure to thrive.

    In most cases, your physician will use a blood test to screen for celiac disease, followed by endoscopy if the blood test is positive.

    If the tests are negative for celiac disease (or if you decide not to pursue testing), you may want to discuss dropping gluten from your diet or your child’s diet for a month or so to see if symptoms improve. To do this test properly, you’ll need to avoid gluten completely, not just cut back on it. If the symptoms are influenced by gluten ingestion, you should notice a change within that month.

    Last Updated: September 27, 2020 References Approved

    This article was co-authored by Marsha Durkin, RN. Marsha Durkin is a Registered Nurse and Laboratory Information Specialist for Mercy Hospital and Medical Center in Illinois. She received her Associates Degree in Nursing from Olney Central College in 1987.

    There are 32 references cited in this article, which can be found at the bottom of the page.

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    Gluten is a type of protein found in certain grains, including wheat, barley, and rye. It’s what gives bread its distinctive, chewy texture. For people with celiac disease, gluten triggers an immune system reaction that damages the intestine. But you don’t have to have celiac disease to be sensitive to gluten. Doctors estimate that 1% of the U.S. population has celiac disease, while up to 6% may have a less severe condition called non-celiac gluten sensitivity. [1] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source It can be scary and frustrating to deal with a gluten intolerance. But once you know what’s causing your symptoms, you can take control of your diet and start on the path to healing and feeling good again!

    Gluten Cheat Sheets

    How to Understand Celiac Disease and Gluten Intolerance

    Amy Chow. Registered Dietician Expert Interview. 16 September 2020. Bloating and stomach cramps are some of the most common symptoms of gluten sensitivity. [3] X Research source They’re also a major component of celiac disease. [4] X Trustworthy Source Mayo Clinic Educational website from one of the world’s leading hospitals Go to source If you feel gassy, bloated, and just plain icky after eating a meal, think back to what you ate and whether it had gluten in it.

    • Some people may also experience symptoms such as diarrhea, constipation, nausea, vomiting, or heartburn.
    • If you often have these kinds of symptoms, start keeping a diary to track them. Write down what you ate and how soon after your meal the symptoms began.
    • There are a lot of reasons you might get an occasional upset stomach after a meal, and most of them aren’t serious. It could be something as simple as eating too much, too fast or overdoing the hot sauce. [5] X Research source But if you get bellyaches frequently after eating, it’s a good idea to get it checked out.

    Summary

    • Non-Celiac Gluten Sensitivity can present with intestinal and extra-intestinal symptoms
    • There are no biomarkers for diagnosis
    • Autoantibodies (TTG, EMA, DGP) are absent
    • There is no villous atrophy
    • Diagnosis requires excluding celiac disease by serological tests
    • A gluten-free diet should not be started before ruling out celiac disease
    • The gluten-free diet is complicated and expensive
    • Patients should be referred to a dietitian with expertise in the gluten-free diet.

    The spectrum of gluten-related disorders includes celiac disease, dermatitis herpetiformis, gluten ataxia, wheat allergy and non-celiac gluten sensitivity. The term non-celiac gluten sensitivity (NCGS) is used to describe the clinical state of individuals who develop symptoms when they consume gluten-containing foods and feel better on a gluten-free (GF) diet but do NOT have celiac disease.

    Celiac Disease

    Celiac disease is a multi-system autoimmune disorder that is triggered by ingestion of gluten (a protein in wheat, rye and barley) in genetically susceptible individuals. A common disorder, affecting about 1% of the population, patients can present with a variety of intestinal and non-intestinal symptoms. Autoantibodies such as tissue transglutaminase antibody (TTG), endomysial antibody (EMA) and deamidated gliadin peptide (DGP) are produced in the body and form the basis of serological tests used for screening. The diagnosis of celiac disease is confirmed by a small intestinal biopsy and treatment consists of a strict GF diet for life. Adherence to the GF diet results in the resolution of symptoms and intestinal inflammation, with the autoantibodies becoming negative over time. Celiac disease is a serious disorder with patients being at risk for nutritional deficiencies and development of other autoimmune disorders and rarely malignancies such as small intestinal lymphoma.

    Non-Celiac Gluten Sensitivity

    Non-celiac gluten sensitivity (NCGS) is frequently a self-diagnosis; hence the true prevalence is difficult to establish. There are currently no biomarkers for this disorder. In a survey of 1,002 people from the United Kingdom, 13% reported having gluten sensitivity, with 3.7% claiming to be on a GF diet. In a large study from Italy of 12,255 individuals, NCGS was found to be only slightly more common than celiac disease. Data from the National Health and Nutrition Examination Survey in the United States found that 0.55 to 0.63% of people followed a GF diet in the absence of celiac disease. This prevalence is similar to that of combined diagnosed and undiagnosed cases of celiac disease.

    The symptoms of NCGS are highly variable. These include bloating, abdominal pain and diarrhea; symptoms mimicking irritable bowel syndrome. Other intestinal manifestations include nausea, acid reflux, mouth ulcers and constipation. Individuals may have non-intestinal symptoms such as feeling generally unwell, fatigue, headaches, foggy mind, numbness, joint pains, or skin rash. An individual may have one or more symptoms.

    The clinical symptoms of NCGS and celiac disease overlap making it difficult to distinguish the two disorders on the basis of symptoms alone. In one study of adults, patients with celiac disease were more likely to have a positive family history, personal history of other autoimmune disorders and nutrient deficiencies compared to those with NCGS. It is important to note that in NCGS, the TTG, EMA and DGP antibodies are absent and there is no villous atrophy (damage to small intestine) on biopsy. Therefore, the diagnosis of NCGS can only be established by excluding celiac disease.

    Non-celiac gluten sensitivity was first reported in the 1970’s. However, over the last decade an increasing number of people are following a GF diet for perceived health benefits. This has renewed both interest and concern whether these individuals have a true gluten-related disorder. There is a real possibility that some of those who go on a GF diet on their own could, in fact, have celiac disease. These individuals may not get diagnosed or receive adequate nutritional counseling from a dietitian and appropriate follow-up from their physicians. As a result, this may put them at risk for long-term complications of celiac disease. Since the small intestinal damage resolves and the TTG (and other antibodies) normalize after starting a GF diet, the true diagnosis of celiac disease becomes difficult to establish.

    Most clinical trials investigating the phenomenon of gluten sensitivity gave study subjects gluten-containing grains such as wheat, rye and barley in their diet rather than pure gluten. Therefore, it has been postulated that individuals with NCGS may be reacting to other components in wheat rather than gluten. FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are types of carbohydrates that some people cannot digest very well. The bacteria in the colon ferment these carbohydrates resulting in gas, bloating, abdominal pain and diarrhea. Wheat, barley and rye are high in FODMAP, which may be a contributing factor to these symptoms. Furthermore, wheat contains other proteins called amylase/trypsin inhibitors (ATI) that in laboratory studies have shown to cause intestinal inflammation.

    The GF diet can be very challenging to follow, as it is complicated and expensive. In addition, there are concerns about the nutritional adequacy of GF products as they can be high in fat and sugar, and often low in fiber, iron and B vitamins. For these reasons, patients requiring a GF diet should be referred to a registered dietitian with expertise in this diet.

    Currently, a lot remains unknown about NCGS. What is its exact pathophysiology? Is the sensitivity/intolerance to gluten a dose-related phenomenon? Is it a transient or a permanent problem? Do some individuals outgrow this condition over time? Are there specific diagnostic tests that can confirm the diagnosis? Clearly, more research is needed to clarify these issues.

    Take Home Message

    What is most important for the public and health care professionals to know is that the diagnosis of non-celiac gluten sensitivity should not be made without excluding celiac disease. A gluten-free diet should NOT be initiated without a proper clinical assessment that includes serological testing with IgA-tissue transglutaminase antibody while the individual is on a regular gluten-containing diet.

    Celiac Disease and Thyroid Disease: The Connection

    Researchers have found autoimmune thyroid diseases to be more common in people with celiac disease than in the general population.

    The reasons for this relationship are not entirely clear, but these are the known facts:

    • There is a genetic link among many autoimmune diseases.
    • It is likely that celiac disease and thyroid disease will occur together because they are both common autoimmune diseases.
    • There is evidence that celiac disease may predispose individuals to develop other autoimmune diseases, such as thyroid disease.
    • Thyroid disease is often diagnosed before celiac disease; physicians may test for thyroid disease more than celiac disease because it is more common.

    What does the thyroid gland do?

    The thyroid is a small gland just below your Adam’s apple. This gland produces thyroid hormones whose main job is to regulate metabolism. These hormones affect every system in the body and help to control its functions, for example, temperature regulation.

    Thyroid Disease

    • If the thyroid gland stops producing adequate amounts of hormones, this causes body processes to slow down. This is called hypothyroidism.
    • If the thyroid begins to over-produce hormones it causes the body’s metabolism to significantly increase. This is called hyperthyroidism.
    • Hashimoto’s disease and Grave’s Disease are two common causes of hypothyroidism and hyperthyroidism (respectively). Both are autoimmune diseases.

    Hashimoto’s Disease (Also called Chronic Lymphocytic Thyroiditis)

    • The body’s immune system attacks the thyroid and causes a decrease in production of thyroid hormone (hypothyroidism).
    • Hypothyroidism can exist for years with no symptoms appearing until the body becomes over-stressed, e.g. after a pregnancy or a traumatic illness.
    • Symptoms can be very subtle and non-specific, mimicking other illnesses, so it is important to consult with your physician about having a TSH thyroid test if you experience the following symptoms:
      • Tiredness
      • Weight gain
      • Dry skin
      • Often feeling cold and low body temperature
      • Coarse, dry hair or hair loss
      • Enlarged thyroid gland in the neck
      • High cholesterol
      • Dizziness
      • Depression
      • Muscle cramps
      • Constipation
      • Decreased ability to concentrate or difficulty remembering things
      • Slowed heartbeat
      • Yellowish skin
      • Nausea
      • Lack of coordination

    Grave’s Disease

    • The body’s immune system attacks the thyroid and causes it to produce too much thyroid hormone (hyperthyroidism).
    • Hyperthyroidism is not as common as hypothyroidism.
    • Common Symptoms:
      • Weight Loss
      • Rapid pulse
      • Protruding eyes
      • Feeling too warm
      • Nervousness
      • Insomnia
      • Irritability
      • Heart palpitations
      • Diarrhea
      • Muscle weakness

    Testing for Thyroid Function

    • Initial testing is done by measuring TSH (thyroid stimulating hormone).This is currently the best screening test for thyroid function. After reviewing these results, a doctor may want to do more specific thyroid tests to determine whether any problem is of autoimmune origin.

    Treatment

    • If a person is diagnosed with hypothyroidism, the doctor will generally prescribe a thyroid hormone replacement. There are different strengths of hormone replacement, so finding the right dosage may take some time.
    • Treatment for hyperthyroidism is more complex. It usually is treated with anti-thyroid drugs, but if the condition persists, radioactive iodine or surgery may be needed.
    • If you do not respond positively to any thyroid hormone treatment, discuss testing for celiac disease with your doctor, as you may be mal-absorbing the medication.

    Hypothyroidism and the Gluten-Free Diet (GF)

    • Some patients with celiac disease have reported a lower need for thyroid hormone replacement after being on the gluten-free diet for a period of time. One reason is that being on a gluten-free diet allows the small intestine to heal, and therefore thyroid medication may be better absorbed. The gluten-free diet may also cause a lower inflammatory response and reduce the inflammation of the thyroid gland.

    This article has been assessed and approved by a Registered Dietitian Nutritionist.

    Immune system plays a part in different ways

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    Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.

    Emmy Ludwig, MD, is board-certified in gastroenterology and hepatology. She practices at the Memorial Sloan-Kettering Cancer Center in New York.

    How to Understand Celiac Disease and Gluten Intolerance

    • Overview
    • Symptoms
    • Causes
    • Diagnosis
    • Treatment

    How to Understand Celiac Disease and Gluten Intolerance

    Celiac disease and non-celiac gluten sensitivity involve two different responses to the gluten protein, which is found in the grains wheat, barley, and rye. However, the symptoms of both conditions are very similar or even nearly identical, which makes it close to impossible to determine which one you might have (if either one) without the use of medical tests.

    Celiac Disease

    Celiac disease occurs when gluten spurs your immune system to attack the lining of your small intestine. The resulting intestinal damage, called villous atrophy, can cause malnutrition and conditions such as osteoporosis. It also potentially can lead to cancer in rare cases.  

    Celiac disease is believed to affect as many as 3.2 million Americans. Of those, an estimated 2.5 million remain undiagnosed, according to the Celiac Disease Foundation.

    Celiac disease is autoimmune in nature, which means gluten doesn’t cause the damage directly; instead, your immune system’s reaction to the gluten protein spurs your white blood cells to mistakenly attack your small intestinal lining.

    Celiac disease is also associated with other autoimmune conditions, including autoimmune thyroid disease and type 1 diabetes.  

    Non-Celiac Gluten Sensitivity

    Gluten sensitivity, also known as non-celiac gluten sensitivity or sometimes gluten intolerance, has only been recently recognized as a stand-alone condition by the medical community, and there’s still plenty of controversy surrounding it. Not all physicians agree it exists, and little research has been done on its causes, symptoms, and effects.  

    A team of researchers at the University of Maryland Center for Celiac Research put forth a yet-to-be-confirmed hypothesis in 2011 that gluten sensitivity involves a different immune system reaction than celiac disease.  

    The team, led by center director Dr. Alessio Fasano, hypothesizes that a person with gluten sensitivity experiences a direct reaction to gluten. As such, your body views the protein as an invader and fights it with inflammation both inside and outside of your digestive tract.  

    With celiac disease, your immune system doesn’t mount a direct attack against gluten. Instead, the ingestion of gluten triggers your immune system to attack it own tissues, namely those of the intestines.

    It is not clear yet whether gluten sensitivity raises your risk for other conditions, including autoimmune conditions. Some researchers believe that it does, and others say it does not. It’s also not clear whether it physically damages your organs or other tissue, or whether it simply causes symptoms without incurring damage.

    It’s also not clear yet how many people may have gluten sensitivity. Dr. Fasano’s team estimates the condition affects 6 percent to 7 percent of the population (around one in five people), but other researchers (and advocates) place the number far higher – perhaps as high as 50 percent of the population.  

    Differentiating the Diseases

    Since not all physicians agree that gluten sensitivity exists, there’s no consensus yet on how to test for it. However, in a study published in February 2012, Dr. Fasano and his team recommended a diagnostic algorithm that can determine if you have one or the other.  

    Specifically, according to their suggested algorithm, you and your physician would first rule out celiac disease through celiac disease blood tests. If those are negative, then you would participate in a gluten challenge, first eliminating gluten from your diet to see if your symptoms cleared up, and then “challenging” it, or reinstating it in your diet, to see if symptoms return.

    In theory, if you experience symptoms when your diet contains gluten, but those symptoms clear up when you’re following the gluten-free diet, you would be diagnosed with gluten sensitivity, according to Dr. Fasano.  

    Chances of being diagnosed with eating disorder were higher in those with gluten intolerance

    HealthDay Reporter

    TUESDAY, April 4, 2017 (HealthDay News) — Young women with celiac disease may face a heightened risk of being diagnosed with anorexia, a new study suggests.

    The Swedish researchers found the increased risk for these women was present both before and after their celiac diagnosis. Celiac disease is a digestive disorder where a person cannot tolerate gluten, a component of wheat, barley and rye.

    The reasons for the link are not completely clear and the study, published online April 3 in the journal Pediatrics, did not prove that celiac disease causes anorexia. However, some U.S. doctors said they weren’t surprised by the findings.

    “I think a lot of us are aware there is a possibility of [celiac] patients developing an eating disorder,” said Dr. Hilary Jericho, an assistant professor of pediatrics at the University of Chicago’s School of Medicine. Jericho specializes in treating celiac disease.

    She explained that because the disease requires careful attention to diet, some patients may end up taking those eating restrictions “too far.”

    For example, Jericho said, they might fear their symptoms will come roaring back if they eat the wrong food, and become overly rigid about their diet.

    “It does happen,” agreed Dr. Neville Golden, chief of adolescent medicine at Stanford University School of Medicine. “That’s true not only with celiac disease, but with other diseases that require dietary restrictions, like type 1 diabetes.”

    Golden, who wrote an editorial published with the study, pointed to another likely explanation for the findings: Some women with celiac may initially be misdiagnosed with anorexia.

    Celiac disease is an autoimmune disorder, and people with celiac disease must follow a gluten-free diet, to prevent the immune system from attacking the small intestine.

    While celiac is far different from an eating disorder, it has certain symptoms in common with anorexia. Both can cause weight loss, fatigue, abdominal bloating and — in children — poor growth and delayed puberty.

    “Diagnosing anorexia is not always easy,” Golden said.

    That’s why the diagnosis should involve not only a mental health professional, he said, but also a pediatrician or other doctor who can help rule out physical health conditions.

    Continued

    Past research has pointed to connections between celiac disease and anorexia, but those studies have been small.

    So, the new study looked to Sweden’s system of national registries. Researchers were able to analyze records from nearly 18,000 women who’d had celiac disease definitively diagnosed through a biopsy of the small intestine.

    They then compared those women with over 89,000 others who’d never been diagnosed with celiac disease.

    The vast majority of women with celiac disease had no diagnosis of anorexia, the study found. Still, their risk was higher than the norm.

    Overall, women with celiac were twice as likely to be subsequently diagnosed with anorexia — even after factors like age and education levels were taken into account.

    They also had higher odds of being diagnosed with anorexia before their celiac disease was recognized.

    The link was strongest among women whose celiac disease was diagnosed before the age of 19: Their odds of having a previous anorexia diagnosis was 4.5 times higher than the comparison group of celiac-free women.

    According to Golden, “that implies an initial misdiagnosis.”

    Jericho agreed that’s a possibility. She made another point, though: The women in this study were diagnosed with celiac between 1969 and 2008. And years ago, there was little recognition of celiac disease.

    “There’s much more awareness of it now, and doctors are more likely to think of it,” Jericho said.

    Beyond that, she said, maintaining a gluten-free diet is more manageable now than years ago — with more options available at grocery stores and restaurants. That might lessen some of the stress and anxiety that can come with a celiac diagnosis, Jericho explained.

    She said she and her colleagues are currently studying anxiety and depression levels, as well as “coping skills,” among celiac patients.

    For now, Jericho suggested that if celiac patients — or their parents — feel like their dietary restrictions have become unhealthy, they should talk to their doctor.