The first time 10-year old Cole Dickey threw up on his way out of the school lunchroom, his mother, Nichol Nelson, figured it was the flu. But when the random vomiting episodes dragged on for weeks, with no other symptoms, Nelson ruled out a virus and focused on a new culprit: gluten.
"I knew he was predisposed to Celiac because he's also a Type 1 diabetic," she says. "The doctors warned me there was a correlation." Blood tests and a biopsy confirmed the diagnosis, and Dickey now carries gluten-free sandwiches and snacks in his lunchbox.
Clearly, Dickey's symptoms aren't common for everyone who is sensitive to gluten. So what, exactly, is the difference between true Celiac disease and gluten sensitivity? Celiac causes lasting and long term intestinal damage, while gluten sensitivity does not.
Celiac disease is one of the most common autoimmune conditions around, affecting about 1 in 133 people. But considering that 80 percent of those with Celiac remain undiagnosed, we can assume that the number of people who suffer from Celiac is far higher.
While more and more people are aware that gluten might be the underlying cause of the upset stomach, indigestion, brain fog, and even depression they suffer with daily, some are perplexed to find their blood test for Celiac disease come back as negative. But that doesn't mean that gluten isn't the culprit.
Just as common, gluten-sensitivity has many of the same symptoms of Celiac disease—digestional issues and stomach pain, fatigue and brain fog—but doesn't cause any damage to the small intestine or gut. Read on for more about how to discern between these two conditions.
A chronic and genetic autoimmune digestive disorder, those with Celiac deal with painful inflammation that results in damage to the small intestine thanks to gluten protein. Found most often in wheat and grains, but also in many other processed and prepared foods, gluten can't be digested by those with Celiac.
The symptoms can vary, but typically diarrhea, bloating, and abdominal pain are warning signs that someone may have Celiac disease. It's not just digestion that's affected by Celiac; many people with the disease also deal with weight loss, malnutrition, liver dysfunction, and fatigue because their small intestine is unable to absorb nutrients.
A doctor can perform a blood test and biopsy the small intestine to confirm the diagnosis, and the only cure for Celiac is to abstain from foods that contain gluten.
If Celiac disease is ignored, or is misdiagnosed, it can cause serious long-term health problems. The damage that occurs in the small intestine can be somewhat reversed after gluten has been eliminated from the diet, but if someone with Celiac continues to eat foods with gluten, not only will they feel awful, but too much damage will be created in the walls of the small intestine. It can take up to two years to repair damage, and about 60 percent of adults diagnosed with Celiac never fully recover.
For adults that suffer without treatment for many years, the irreparable damage caused to the gut means that 56 percent of patients have poor nutrient and vitamin intake—meaning that their bodies can't absorb nutrition through digestion.
Non-celiac gluten-sensitivity (NCGS) is Celiac's mysterious, less dangerous cousin—those with NCGS will have many of the same symptoms as those with Celiac, but without the damage to the small intestine. Gluten-sensitivity is a bit enigmatic and affects six percent of the population; it's been studied at great length by researchers and doctors but it's still unclear why when some people eat gluten they have and allergic response but not the same inflammation and damage of Celiac.
The digestive symptoms of gluten-sensitivity are similar to Celiac disease: diarrhea, bloating, and abdominal pain are the most common. But those with NCGS have additional extra-intestinal issues like brain fog, joint pain, neurological disorders, and fatigue.
Unfortunately, there isn't a definitive test that indicates a patient has gluten-sensitivity—unlike Celiac disease, your doctor can't test for antibodies in the blood, so the only way to designate that you have NCGS is to cut gluten from your diet and see if your symptoms dissipate.
Other than being really uncomfortable and sometimes affecting mental state, there are no serious long term effects of gluten-sensitivity that we know of. However, some researchers think that the irritation that NCGS sufferers deal with actually has less to do with an intolerance to gluten and more to do with a sensitivity to FODMAPS, a group of carbohydrates that is poorly digested by most people. Wheat and grains are also FODMAPS, along with legumes, dairy, and sugars. The link between a starting a low FODMAP diet and disappearance of gluten-sensitivity symptoms maybe be reason enough for those who are considering going gluten-free to make the switch.
Celiac or non-Celiac gluten-sensitivity diagnosis can sound pretty awful when you're sitting with your gastroenterologist, but the good news is that your life doesn't have to change as drastically as you might believe. There are so many tasty and affordable gluten-free products available, and many restaurants now offer gluten-free options.
Turns out when you go gluten-free you can have your cake, and eat it too!
Illustration by Foley Wu