Understanding the Differences Between Gluten Intolerance and Celiac Disease

Gluten-related disorders can manifest through symptoms such as nausea, bloating, and abdominal pain, but their underlying causes and health implications differ significantly. Two primary conditions associated with gluten are gluten intolerance, also known as non-celiac gluten sensitivity, and celiac disease, an autoimmune disorder.

Approximately 10% of Australians follow a gluten-free diet, primarily by avoiding foods like bread, pasta, and noodles that contain gluten—a protein found mainly in wheat, barley, and rye. While some individuals eliminate gluten to improve their wellbeing, not all have an underlying medical condition. Symptoms like nausea, bloating, and stomach discomfort after consuming gluten could suggest either gluten intolerance or celiac disease.

Celiac disease is an autoimmune condition affecting about 1 in 70 Australians, with only a fifth diagnosed. It causes the immune system to attack the small intestine's lining when gluten is ingested, leading to damage of the villi—tiny structures essential for nutrient absorption. This damage results in digestive issues such as diarrhea, bloating, and nausea, as well as non-digestive symptoms like headaches, dermatitis herpetiformis, joint pain, and fatigue. If untreated, celiac disease can cause malnutrition, reduced bone density, and neurological complications including epilepsy and dementia.

Diagnosis requires maintaining a diet containing gluten during testing. Blood tests assessing markers of immune response, followed by biopsies of the small intestine, confirm the diagnosis. Capsule endoscopy may also be used to observe intestinal damage.

In contrast, gluten intolerance involves similar symptoms but lacks the autoimmune response and intestinal damage characteristic of celiac disease. Often termed non-celiac gluten sensitivity, it affects an estimated 1% of Australians. Diagnosis involves ruling out celiac disease and wheat allergies, followed by a supervised gluten elimination trial to observe symptom improvement.

Individuals with diagnosed celiac disease must adhere to a strict, lifelong gluten-free diet to prevent intestinal damage. Even minimal gluten exposure, such as 50mg daily (about 1/100th of a slice of bread), can cause harm. Conversely, those with gluten intolerance generally do not suffer intestinal damage and may only experience temporary symptoms.

Choosing to avoid gluten without a confirmed diagnosis can lead to nutritional deficiencies, as gluten-containing grains are rich in fiber, vitamins, and minerals. Gluten-free products may also be more costly and lower in key nutrients.

If you experience symptoms like bloating, diarrhea, or stomach pain, consulting a healthcare professional is essential. Proper testing helps differentiate between celiac disease and gluten intolerance, guiding appropriate dietary choices to maintain health.