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What’s the difference between celiac disease and gluten sensitivity?

The question: I thought I had celiac disease but my doctor told me that I may have gluten sensitivity instead. What's the difference?

The answer: Both gluten sensitivity and celiac disease share similar symptoms that are triggered by exposure to gluten, but the potential implications of each condition are different.

Gluten is a protein that is found in foods such as wheat, barley and rye. Celiac disease is an autoimmune condition where the body attacks itself at the site of gluten absorption – the small intestine. This response causes inflammation and damage to the intestinal wall, making it leaky and unable to absorb nutrients, which can lead to symptoms of pain, diarrhea and bloating.

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Celiac disease can be diagnosed through a blood test, but it is often confirmed through a biopsy of the small bowel. It can also be associated with other autoimmune conditions such as thyroid disease and diabetes.

Treatment for celiac disease involves the complete removal of gluten-containing foods from the diet. If gluten continues to be consumed, people experience significant negative effects on their health that are related to the malabsorption of essential nutrients and vitamins in their diet. Over time, the loss of these nutrients can lead to conditions such as anemia, lowered bone density and in children, growth delay. If untreated, the chronic inflammation in the lining of the intestine can also increase the risk of cancer. If gluten is avoided however, the inflammatory response stops, the intestinal lining will heal and the complications can be avoided.

Those who experience the symptoms of celiac disease – yet have negative celiac testing – may suffer from something known as non-celiac gluten sensitivity. This response seems to be immune mediated but at this time it is unclear why the sensitivity occurs and what the body is reacting to. Beyond the gastrointestinal symptoms, people who seem to be sensitive to gluten often also expericne headaches, rashes and fatigue.

Many people self-diagnose gluten sensitivity which is fair if avoiding gluten helps ease symptoms. There is research that suggests that it may in fact be other proteins or sugar in wheat (other than gluten) that may be triggering the reaction, so with further understanding a more targeted treatment plan can be advised. In these individuals, there does not seem to be any inflammation or damage to the intestinal lining as in celiac disease.

The bottom line: While celiac disease is a well recognized and understood condition, further research needs to be done to explore the phenomenon of gluten sensitivity and its potential implications on health.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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