When Gluten Gets You Down

Gluten intolerance and true celiac disease can cause a variety of symptoms

/ Author:  / Reviewed by: Dominique Brooks, M.D Beth Bolt, RPh

Wheat allergy, gluten intolerance, celiac disease — one and the same, right? Well, no, not really.

Although people sometimes use the terms interchangeably, a wheat allergy is an actual allergic reaction that can cause hives, itching, swelling and trouble breathing.

Celiac disease is a genetic intolerance to gluten that can cause severe gastrointestinal symptoms and even malnutrition. One of a group of other autoimmune diseases like rheumatoid arthritis, celiac disease causes the body to form antibodies that attack body structures in the same way they would normally attack bacteria or viruses.

Gluten intolerance — sometimes called gluten allergy or non-celiac gluten sensitivity — is a condition in which the patient has symptoms similar to those of celiac disease but does not have intestinal damage or produce antibodies.

Gluten sensitivity can lead to celiac disease, according to David Winter, MD. Dr. Winter, the chief clinical officer, president and chairman of the board of Baylor Health Care's HealthTexas Provider Network (HTPN), told dailyRx News, "A lot of folks have gluten allergy — a lot of folks think they have one but really don't."

The only way to find out if you are gluten-sensitive, Dr. Winter said, is to be tested. You must be on a diet that includes gluten, or the test results may not be valid because the gluten makes your blood produce the antibodies you're being tested for.

Read on for a breakdown of gluten, allergies and celiac disease.

Wheat Allergy

A wheat allergy can cause severe, sometimes deadly symptoms that must be treated immediately with medications like adrenalin and antihistamines. People who have a wheat allergy must avoid not only gluten but wheat in any form.

People with a wheat allergy may be able to eat other grains. However, wheat allergies are most likely to occur in children, according to the Food Allergy Research and Education (FARE) website. About 20 percent of children with a wheat allergy also react to grains like barley or rye, according to FARE. Many children outgrow wheat allergies — some as early as age 3.

Celiac Disease

Celiac disease, also called celiac sprue or just sprue, is a relatively common autoimmune disorder, according to the National Institute of Diabetes and Digestive and Kidney Diseases. The disease causes damage to structures in the intestines called villi. Celiac disease, Dr. Winter said, "can cause your intestines to atrophy. It can cause lots of symptoms — cramping, bloating, even malnutrition."

In a healthy person, nutrients are absorbed through the villi. Once the villi become damaged, the person cannot absorb nutrients and becomes malnourished. People with celiac disease cannot tolerate gluten, which can be found not only in wheat but in other grains like rye and barley.

People with genetic disorders like Down syndrome may also have celiac disease. In infants, symptoms common to celiac disease include abdominal bloating and pain, chronic diarrhea or constipation, vomiting, irritability and weight loss.

Adults are less likely to have digestive symptoms, but they may have fatigue, bone or joint pain, depression, anxiety, seizures or iron deficiency anemia that cannot be explained. Women with celiac disease may have menstrual problems, miscarriages or fertility problems.

Gluten Sensitivity

Gluten sensitivity is very similar to celiac disease in symptoms. The primary difference is that people with gluten sensitivity don’t have antibodies in the blood and don’t experience intestinal damage.

Gluten sensitivity does not cause intestinal damage or malnutrition. Symptoms often improve on a gluten-free diet.

Making a Diagnosis

It can take a while to determine whether a person has any of these conditions. The symptoms may be subtle and can mimic other diseases. Only testing can provide a conclusive diagnosis of gluten sensitivity or celiac disease, Dr. Winter said.

A doctor can diagnose wheat allergy with blood or skin tests.

Celiac disease can also be diagnosed with a different blood test or an intestinal biopsy. In an intestinal biopsy, the doctor removes small pieces of the patient’s intestines and examines them for damage. Since celiac disease is a hereditary condition, the doctor may also recommend testing relatives like children, brothers or sisters.

Gluten sensitivity, however, cannot be diagnosed with blood or other diagnostic tests. The patient must still undergo the diagnostic testing for celiac disease to rule that out. If the test is negative and the patient has symptoms that would otherwise indicate celiac disease, the doctor will often recommend a gluten-free diet. If the patient’s symptoms improve, gluten sensitivity is usually the problem.

A Gluten-Free Diet

If you are gluten-sensitive or have celiac disease, you must avoid gluten, which means avoiding not only wheat but also rye and barley. Wheat is found in a wide variety of foods and may also be found in products like children’s play dough.

Wheat gluten is sometimes used in medications or cosmetics like lipstick. Anyone with a wheat allergy must avoid all such products.

"A gluten-free diet is a fine diet," Dr. Winter said. "If you don't have the allergies, the antibodies, you don't need to be on it, but you can be on it if you want to."


Review Date: 
April 9, 2015