What the Heck Is Celiac Disease, Anyway?
Spoiler alert: It's autoimmune, not an allergy.
One of the most common questions I get asked by friends and family about celiac disease is a basic one: What is it, exactly? And, is it the same — or different — from a gluten intolerance or allergy?
The TLDR answer: Celiac disease is an autoimmune disorder, which is, indeed, different from a gluten intolerance or allergy in the way it affects your body — although many people (including some in the celiac community) use the terms interchangeably.
The fact that these terms are often used interchangeably (and, in many cases, incorrectly) can make things really confusing. And being confused can cause stress and make it harder to know how to confidently manage your celiac disease.
So, I put together the following explainer about what celiac disease is and how it differs from a gluten intolerance or allergy. Whether you were recently diagnosed with celiac disease but not really sure what that means or are looking to educate people in your life who are curious about your condition, hopefully this guide will help!
What’s the difference between celiac disease, gluten intolerance, and wheat allergy?
Celiac disease
What is it: Celiac disease is an autoimmune disorder. ICYMI, an autoimmune disease is a genetic disorder that causes your immune system to mistakenly attack healthy cells. In the case of celiac disease, when you ingest gluten, this triggers your body to launch an immune response, which damages your villi (the cells that line your small intestine).
Villi are responsible for absorbing nutrients and transporting them through your bloodstream. When your villi are damaged, your body can’t absorb nutrients properly and you’re likely to develop vitamin and mineral deficiencies.
You may also experience digestive symtpoms like constipation, diarrhea, and bloating. But it turns out there are more than 250 symptoms that can be associated with celiac disease, many of which aren’t related to digestion at all. (I used to bruise very easily and get terrible nighttime leg cramps, both of which are celiac symptoms — who knew?)
How it’s diagnosed: Celiac disease can be diagnosed through a blood test and biopsy of your small intestine (which is done via endoscopy). The blood test measures levels of certain antibodies that are typically higher in people with celiac disease. It can also be used to test for nutritional deficiences (which are common in people with celiac disease).
Because it’s genetic, you can also take a test to find out if you have one of the celiac genes. Just because you have the gene doesn’t mean you have celiac disease, though. Something needs to trigger the gene to “turn on.” This could happen at any point in your life. If you do end up being diagnosed, then doctors recommend having your immediate family get tested as well since it’s a genetic disease.
How it’s treated: Currently, there aren’t any medications available for celiac disease (although there are a few in the works!). The only way to “treat” it at the moment is to adhere to a strict gluten-free diet.
That means not only do you have to make sure the food you’re eating is, in fact, gluten-free, but you have to make sure that it’s prepared in such a way that it doesn’t come into contact with any gluten during the cooking process. Consuming even the tiniest amount of gluten can cause damage to your villi, even if it doesn’t make you feel sick.
When left untreated, celiac disease can lead to serious long-term complications like osteoperosis, infertility, and intestinal cancer. Plus, when you have an autoimmune disease, you’re also at higher risk of developing another autoimmine disease.
For example, about 6% of people with type 1 diabetes also have celiac disease. Because the complications can be so serious, you really do have to be vigilant when it comes to eating gluten-free and visiting your doctor for follow-up testing.
Gluten intolerance (non-celiac gluten sensitivity)
What is it: Broadly, a food intolerance, or sensitivity, occurs when you have trouble digesting a certain type of food — and it has nothing to do with your immune system. If you have lactose intolerance, for instance, you lack enough of the lactase enzyme to digest the sugar in milk.
You can have a sensitivity to gluten and experience many of the same digestive symptoms as celiac disease, like bloating, gas, and constipation. The medical name for this is non-celiac gluten sensitivity. However, non-celiac gluten sensitivity doesn’t cause damage to the small intestine like celiac does because it’s not an autoimmune condition.
How it’s diagnosed: There’s no clear-cut test to be diagnosed with non-celiac gluten sensitivity specifically. Your doctor will have to rule out all other possibilities, like celiac disease and wheat allergy, first. You’ll also need to try eating gluten-free to see if that makes you feel better.
How it’s treated: As with celiac disease, the “treatment” for non-celiac gluten sensitivity is sticking to a gluten-free diet. You don’t have to be as concerned with avoiding cross-contact, though, because in this case, gluten won’t damage your small intestine or lead to long-term health complications.
Wheat allergy
What is it: A food allergy is an immune response that happens after eating a certain food. You can’t technically be allergic to gluten (which is a protein) — but you can be allergic to a food derived from gluten, such as wheat.
With a wheat allergy, you may experience symptoms similar to that of celiac disease or gluten intolerance — but you may also experience the typical signs of an allergic reaction, including hives, swelling of the lips and face, and trouble breathing.
How it’s diagnosed: Wheat allergy can be diagnosed through a skin prick test or blood test. Going on an elimination diet may also help your doctor determine whether you have a wheat allergy.
How it’s treated: Regardless of your allergy, you’ll want to avoid eating that food. Similarly to celiac disease, preventing cross-contact while preparing food is also key. Depending on the severity of your allergy, you may be able to treat an allergic reaction with a prescribed antihistamine. For more severe cases, you may need to use an EpiPen or head to the ER for an emergency injection.
Products I’m loving right now
Every newsletter, I’ll share (at least) three products that are currently part of my celiac self-care routine, from food to beauty to wellness. Halloween candy is already on store shelves, so now is as good a time as ever to reveal my favorite gluten-free candy alternatives, right?
Unreal Dark Chocolate Almond Butter Cups: If you’re looking for an elevated take on the peanut butter cup, then look no further than this dark chocolate almond butter variety. It’s made with Fair Trade dark chocolate, high-quality almond butter, and contains less sugar than other leading brands.
Trupo Treats Vegan Crispy Wafer Chocolate Bars: These crispy wafer bars aren’t only gluten-free — they’re vegan too. IMO, they’re an excellent replacement for Kit Kat bars, which sadly aren’t gluten-free.
Smart Sweets Red Twists: I was a tiny bit devastated when I learned that Twizzlers had gluten in them. Enter these better-for-you gluten-free red twists that are plant-based and have no added sugar.
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