Celiac Disease vs. Gluten Intolerance: What’s the Difference?

For most people, there’s no reason to give up gluten for good.

But that’s not so easy for folks with two gluten-related medical conditions: celiac disease and gluten intolerance, according to Dr. Sarmed Sami, a gastroenterologist at Mayo Clinic Healthcare in London.

He offers some details about this protein and the two health conditions.

Gluten is a protein found in grains including wheat, barley and rye.

In people with celiac disease, eating it triggers an autoimmune reaction that causes cell damage to the small intestine. That reaction can cause diarrhea, fatigue, weight loss, bloating, anemia and lead to serious complications, Sami said.

Gluten intolerance is more common, he added.

“In gluten intolerance, there is no cell damage or inflammation. It’s more of a sensitivity: ‘Gluten doesn’t agree with me,'” Sami said in a clinic news release. “If you eat gluten and have an immediate reaction, such as diarrhea, that’s more likely to be gluten intolerance than celiac disease, which is a slow process that you don’t tend to feel immediately.”

A sign of gluten intolerance or celiac disease is having one or more gastrointestinal symptoms such as diarrhea, bloating or heartburn that diminish or disappear if gluten is removed from the diet. These symptoms then return if the person begins eating gluten again.

It is important to be tested in case you have the more serious celiac disease, Sami said.

Those who have gluten intolerance may be able to cut back on gluten-containing foods rather than having to eliminate them completely, Sami said.

“It depends on the intolerance level. Some people may be fine by halving the gluten intake, while others may need to cut down more,” he said. “It’s different from celiac disease, where you have to be strictly, completely gluten-free.”

To diagnose celiac disease, doctors start with a blood test to determine whether the body views gluten as an invader and reacts by generating high levels of antibodies. After a positive blood test, an endoscopy can take biopsies to check for damage in the small intestine.

“We typically recommend that people should not be on a gluten-free diet if they are being tested for celiac disease, because that can create false negative results on the blood test,” Sami said.

For most patients who have celiac disease, eliminating gluten keeps it under control, he said. Without a celiac diagnosis, there is no reason to eliminate gluten, he said.

“There’s no evidence that a gluten-free diet by itself is healthier,” Sami said. “It’s not about the gluten. Take a biscuit, for example: It’s more about the fat and the sugar in the biscuit, rather than the gluten.”

More information

The Celiac Disease Foundation has more on celiac disease.

SOURCE: Mayo Clinic, news release, Sept. 26, 2023