Gluten and Celiac Intolerance Symptoms and Testing

Last Updated on August 30, 2024

Celiac disease and gluten intolerance are often interchanged with one another even though they refer to different conditions with their own underlying causes, symptoms, and treatment strategies. Understanding the differences and similarities between these two is crucial for proper diagnosis and treatment. Taking a closer look at the similarities and differences between gluten intolerance and celiac disease will help to clarify what your next steps should be.

What is Gluten Intolerance?

Gluten intolerance is more commonly referred to as non-celiac gluten sensitivity. It is a condition in which individuals have symptoms caused by the consumption of gluten, a protein that is found in many types of grain such as barley, wheat, and rye.

Symptoms of Gluten Intolerance

There are several common symptoms associated with gluten intolerance including:

• Bloating
• Gas
• Diarrhea
• Constipation
• Headaches
• Fatigue
• Joint Pain
• Rashes and Eczema

The effects of gluten intolerance can vary from individual to individual. In some individuals, these symptoms may appear a few hours after consumption, while in others it might take a few days.

Prevalence and Demographics

The prevalence of gluten intolerance is unclear, but many physicians estimate that the condition affects a significant portion of the world’s population. Gluten intolerance is more common in adults than it is in children, and it generally affects both genders in equal amounts.

What is Celiac Disease?

Celiac disease, on the other hand, is an autoimmune disorder that is triggered by the ingestion of gluten. When someone who is genetically predisposed to celiac disease consumes gluten, their immune system attacks the small intestine, which leads to inflation and damage to the villi. These tiny villi are responsible for absorbing the nutrients that pass through the intestines.

Symptoms of Celiac Disease

Although similar to gluten intolerance, celiac disease symptoms tend to be more severe and varied:

• Chronic Diarrhea
• Chronic Constipation
• Abdominal Pain
• Bloating
• Weight Loss
• Fatigue or Weakness
• Anemia Caused by Iron Deficiency
• Osteoporosis
• Peripheral Neuropathy
• Ataxia

Prevalence and Demographics

It is estimated that celiac disease affects approximately 1% of the entire world population. It can develop in predisposed individuals at any age but is generally diagnosed in older children and younger adults. Unlike gluten intolerance, more women than men suffer from celiac disease.

Pathophysiology of Celiac Disease

For those suffering from celiac disease, the long-term effects can be extremely dangerous. When someone is predisposed to celiac disease ingests gluten, sometimes through cross-contamination, their immune system responds by damaging the small intestines. In doing so, the villi are attacked which prevents the body from absorbing the nutrients it needs. If left untreated, this can lead to malnutrition, iron deficiency, and a wide array of other complications.

Similarities Between Gluten Intolerance and Celiac Disease

There are many similarities between gluten intolerance and celiac disease, and knowing what the similarities and differences are, can help you make better decisions regarding your health and well-being.

Common Symptoms

Both celiac disease and gluten intolerance share several symptoms, which makes it difficult to distinguish one another simply based on symptoms. These include gastrointestinal issues, fatigue, headaches, and migraines, as well as diarrhea or constipation.

Dietary Restrictions

Regardless of whether you are suffering from gluten intolerance or celiac disease, the dietary restrictions are the same, the removal of gluten from the diet. This gives the body time to heal and recover from any damage caused by the ingestion of gluten.

Overlapping Triggers and Lifestyle Changes

Because the main trigger for both celiac disease and gluten intolerance is the consumption of gluten, both conditions require individuals to avoid gluten altogether. This means that you will need to pay close attention to the labels on all of your food products, to ensure that it is gluten-free. You may even need to change a significant part of your lifestyle as well.

Differences Between Gluten Intolerance and Celiac Disease

Although the two are very similar, celiac disease and gluten intolerance are completely separate conditions.

Pathophysiology

Let us start by taking a look at the pathophysiology of these two conditions:

Celiac Disease:

Celiac disease is an autoimmune response that causes inflammation and damage to the small intestine. More specifically the body’s autoimmune system attacks the villi in the small intestine, causing inflammation and a reduction in nutrient absorption.

Gluten Intolerance:

Gluten intolerance on the other hand, although not as well understood, does not include any form of autoimmune response. As there is no autoimmune response, there is also no intestinal damage caused by consuming gluten.

Diagnostic Criteria and Processes

Due to the differences between celiac disease and gluten intolerance, the manners of diagnosis are quite different:

Celiac Disease:

Celiac disease, is commonly diagnosed through genetic tests, blood tests, as well as intestinal biopsies. It’s important to remember that people are predisposed to having celiac disease, which is why genetic testing is an excellent way of determining whether you may have celiac disease rather than gluten intolerance.

Gluten Intolerance:

Gluten intolerance, on the other hand, is diagnosed simply through the exclusion of gluten from the diet. Since the mechanism that causes gluten intolerance is not quite known, the most common practice of diagnosing it is simply by excluding it from the diet. If the symptoms improve on a gluten-free diet, then gluten intolerance is usually the culprit.

Long-term Health Implications

Both celiac disease and gluten intolerance cause issues with your body, but only one has long-term health implications:

Celiac Disease

Celiac disease can be a severe and debilitating condition if left untreated. Since the body’s autoimmune system attacks the small intestine, celiac disease can lead to malnutrition, and an increased risk of certain cancers. Those who are predisposed to celiac disease may also suffer from osteoporosis and a wide array of neurological disorders.

Gluten Intolerance

Gluten intolerance, however, does not have any long-term complications so long as you reduce your gluten intake. This condition, although uncomfortable, can be treated simply by shifting to a gluten-free diet.

Genetic Factors and Risk Profiles

Perhaps one of the biggest differences between gluten intolerance and celiac disease comes down to genetic factors:

Celiac Disease

Celiac disease is strongly associated with genetic predisposition. Studies have found that two specific genes are involved in determining whether somebody is predisposed to the condition. These two genes are the HLA-DQ2 and HLA-DQ8 genes.

Gluten Intolerance

To date, there are no specific genetic markers associated with gluten intolerance. Very little information has been discovered as to what mechanism causes the intolerance to occur in the first place.

Testing for Gluten Intolerance

Let us take a look at how gluten intolerance is diagnosed:

Current Testing Methods

The testing procedure for diagnosing gluten intolerance simply involves the ruling out of other conditions. Most physicians will first determine whether you have a wheat allergy or are predisposed to celiac disease. If both of these conditions are ruled out, then the physician will simply ask you to go on a gluten-free diet to see if the symptoms improve.

Symptom-based Diagnosis

In general, gluten intolerance has a symptom-based diagnosis. Once a physician has ruled out other possible conditions, they will ask you to follow a gluten-free diet and monitor the symptoms. If there is an improvement, then gluten is reintroduced to the diet to see if those symptoms come back.

Drawbacks of Conventional Testing

Because it is difficult to diagnose gluten intolerance, there are many drawbacks to the conventional forms of testing:

Subjectivity and Variability in Symptoms

The symptoms of gluten intolerance vary from individual to individual, which makes diagnosing an individual with this form of intolerance, a difficult process.

Lack of Biomarkers

Moreover, because there are no specific biomarkers associated with gluten intolerance, physicians must rely solely on symptom observation and patient reporting.

Testing for Celiac Disease

Testing for celiac disease, on the other hand, can be done through several different methods:

Current Testing Methods

As a general rule, physicians will use a combination of genetic testing, blood tests, and biopsies to diagnose you with celiac disease.

Blood Tests

There are two major blood tests that can be performed to identify whether someone is suffering from celiac disease:

tTG-IgA (Tissue Transglutaminase Antibodies):

The most common and accurate blood test for celiac disease is the tTG-IgA. Most physicians will perform this test first.

EMA (Endomysial Antibodies):

Only after someone has tested positive for celiac disease through the tTG-IgA test, will a physician have them undergo the EMA testing. This second form of blood test is used to confirm the results of the first test.

Genetic Testing

Next, physicians may require you to undergo genetic testing.

HLA-DQ2 and HLA-DQ8: 

Since celiac disease is caused by a genetic predisposition, it can be diagnosed partially through the determination of whether a person has the HLA-DQ2 and HLA-DQ8 genes. However, the simple presence of these genes does not necessarily indicate the presence of celiac disease. Someone can have the genes, without ever developing the condition.

Intestinal Biopsy

Lastly, physicians will want to conduct an intestinal biopsy. After a patient has tested positive through the blood tests, and it has been determined that they have the predisposed genetic markers, then a physician will conduct a biopsy on the small intestine to look for villi damage.

Drawbacks of Conventional Testing

When it comes to diagnosing celiac disease, there are many drawbacks associated with the conventional forms of testing:

False Negatives/Positives

If a patient is currently on a gluten-free diet, there is a possibility that the blood test can yield a false negative.

Invasive Procedures

Undergoing an intestinal biopsy is an invasive process, which requires an endoscopic procedure.

Need for Gluten Consumption Before Testing

To ensure that the tests are conducted properly, patients must consume gluten before they undergo any testing. A patient must therefore undergo significant discomfort just to ensure that the results are more accurate.

Genetic Factors and DNA Testing

Let’s take a closer look at the genetic factors associated with DNA testing:

Role of HLA-DQ2 and HLA-DQ8 Genes

It is already well known that both the HLA-DQ2 and HLA-DQ8 genes are strongly associated with the predisposition of celiac disease. In fact, most people with celiac disease carry at least one of these genes. However, it is important to point out that having one or both of these genes does not necessarily signify that a person will develop celiac disease.

Importance and Benefits of Genetic Testing

Nevertheless, there are many important benefits associated with genetic testing:

Identifying Risk Factors

For starters, genetic testing can help to identify individuals at risk for celiac disease. If it is determined that you have one or both of the genes associated with the disease, then it can help guide you as you start taking the necessary preventative measures.

Guiding Diagnosis and Prevention Strategies

If you have a family history of celiac disease, genetic testing can also aid in the early diagnosis of the condition, as well as its long-term management.

Limitations of Genetic Testing

However, there are also some limitations to the genetic testing:

Not Definitive for Gluten Intolerance

The biggest limitation of genetic testing is that it is not definitive for the diagnosis of a gluten intolerance. In fact, there are no specific genetic markers associated with the intolerance. The genetic testing can only identify the HLA-DQ2 and HLA-DQ8 celiac genes.

Associated Medical Conditions

Now, let us take a closer look at the different medical conditions that are commonly associated with celiac disease.

Autoimmune Disorders

There are several different autoimmune disorders associated with celiac disease:

Type 1 Diabetes

At the top of the list is type I diabetes. Type I diabetes is an autoimmune condition where the body’s immune system attacks and destroys insulin-producing cells located within the pancreas. This results in high blood sugar levels.

Autoimmune Thyroid Disease (Hashimoto’s Thyroiditis, Graves’ Disease)

Next, we have autoimmune thyroid diseases such as Hashimoto’s thyroiditis and Graves’ disease. Hashimoto’s thyroiditis is a condition in which the immune system attacks the thyroid gland and causes hypothyroidism. With Graves’ disease, on the other hand, the immune system stimulates the thyroid causing hyperthyroidism.

Autoimmune Hepatitis

It is also possible to develop autoimmune hepatitis. This form of hepatitis is a chronic condition in which the immune system attacks the liver. It can cause inflammation and potential damage or cirrhosis of the liver.

Neurological Conditions

Some neurological conditions are commonly associated with celiac disease including:

Gluten Ataxia

In rare occasions, celiac disease can cause gluten ataxia which affects the body’s coordination and movement.

Peripheral Neuropathy

There is also the possibility of developing peripheral neuropathy which is the numbing and tingling of the extremities.

Gastrointestinal Conditions

Gastrointestinal conditions are the most commonly associated medical conditions:

Irritable Bowel Syndrome (IBS)

Of all of the possible medical conditions associated with celiac disease, IBS, or irritable bowel syndrome is the most common. This gastrointestinal disorder includes symptoms such as abdominal pain, altered bowel habits, and of course bloating.

Lactose Intolerance

Those suffering from celiac disease may also develop a lactose intolerance. Lactose intolerance is the inability to digest the sugar lactose, which is found in most milk and dairy products. As a result of celiac disease and the damage to the intestines, the body produces less lactase which leads to an intolerance of lactose.

Nutrient Deficiencies

Naturally, celiac disease causes damage to the villi which prohibits the body from absorbing nutrients as they pass through the intestines:

Iron Deficiency Anemia

At the top of the list, is iron deficiency anemia. When the body does not absorb enough iron, it is unable to produce the number of red blood cells it needs which results in weakness, fatigue, and other health-related issues.

Calcium and Vitamin D Deficiency

There is also the possibility of vitamin D and calcium deficiencies. Both of these nutrients are vital to the body’s skeletal system, and deficiencies related to their absorption can result in osteoporosis which causes the bones to become fragile and brittle.

Management and Treatment

There are many different strategies for managing and treating both gluten intolerance and celiac disease.

Strategies for Managing Gluten Intolerance

When it comes to dealing with gluten intolerance, the most common strategy is focused on dietary changes and symptom monitoring and management:

Dietary Changes

It’s important to adopt a gluten-free diet as the number one form of treatment for gluten intolerance. This requires that you avoid any food that contains wheat, rye, or barley.

Symptom Management

By adjusting your dietary intake, and reducing any food that can trigger the gluten intolerance symptoms, you can successfully manage the condition.

Monitoring and Follow-up

However, it is important to remember to monitor changes related to intake and symptoms and report that back to your healthcare provider regularly. They will be able to work with you to help adjust your diet as needed.

Strategies for Managing Celiac Disease

Managing celiac disease can be a little bit more difficult, but it is not impossible:

Strict Gluten-Free Diet

Just like managing gluten intolerance, it is essential that you completely avoid any and all gluten-containing foods.

Nutritional Support

Due to the reduced absorption of nutrients, most people suffering from celiac disease will also need to take vitamins and supplements to address these deficiencies. This is especially important during the early stages of treatment when the body is most vulnerable.

Regular Medical Follow-ups

Those suffering from celiac disease will have to undergo regular checkups and monitoring for possible complications associated with the condition. Medical professionals will be able to aid you in adhering to your gluten-free diet throughout the process.

Addressing Associated Conditions

More importantly, is the management of co-occurring conditions associated with celiac disease. Those who are suffering from the disease will also have to undergo regular checkups and testing for thyroid disorders and diabetes.

Advances and Future Directions in Research

There is hope in the future as many advancements have been made in researching celiac disease:

Emerging Diagnostic Tools and Methods

Research is ongoing to develop a less invasive and more accurate form of diagnosis for both gluten intolerance as well as celiac disease. Since an intestinal biopsy is the most effective way of diagnosing celiac disease, it is important to find something that’s less invasive.

Potential Therapies and Treatments

At the same time, several different therapies and treatments are being studied:

Enzyme Supplements

The most important of these studies is enzyme supplements. Researchers are looking into using enzyme supplements that can help the body break down gluten in the digestive system before it causes any damage.

Gut Microbiome Research

Lastly, researchers are looking into the role that gut bacteria have in the control and maintenance of gluten intolerance in those suffering from both conditions. By understanding the role that gut bacteria plays in the process, researchers hope to find new ways to treat the conditions.

Role of Personalized Medicine

Depending on individual genetic and environmental factors, your physician may be able to personalize medicine that is tailored specifically to your treatment plan.

By understanding the differences between celiac disease and gluten intolerance, we can focus on treating both conditions effectively. Physicians must be able to accurately diagnose both conditions accurately, and effectively manage the symptoms and associated conditions as they manifest themselves. Remember, early diagnosis is important for making the necessary lifestyle changes to properly manage these conditions.