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celiac-versus-gluten-intolerance-1The terms “gluten intolerance” and “gluten sensitivity” are often used interchangeably, and sometimes they are even used interchangeably with “celiac disease.” So what’s the deal with these different terms that are used for people who are unable to digest gluten? Does it matter which term you use?

And, most importantly, do the nutritional concerns of a person with biopsy-confirmed celiac disease vary from the nutritional concerns of someone with serious non-celiac gluten sensitivity?

Let’s take a look at what these terms mean, and why using the right one can improve your health.


Know the Difference Between Celiac Disease and Gluten Intolerance


Celiac disease: An autoimmune disease also known as celiac sprue or gluten-sensitive enteropathy. Gluten consumption contributes to intestinal villi damage, causing malabsorption. Even the smallest amounts of gluten can cause villi damage and contribute to risk factors for osteoporosis, certain cancers and other maladies. Celiac disease is related to specific genes that are inherited, and it is estimated to affect about 1% of the population.

Non-celiac gluten intolerance or gluten sensitivity: An adverse reaction to the ingestion of gluten that is not autoimmune in nature and is not celiac disease. It is diagnosed only in the absence of celiac disease. Reactions may range from gastrointestinal to neurological, but do not include any damage to the intestinal villi and no malabsorption is noted. There is no known genetic component but it does appear to run in families. Incidence is not known but is estimated to be as high as 6% of the general population.


Why Does It Matter?


Knowing whether you have celiac disease or non-celiac gluten intolerance / sensitivity matters for several reasons. First, people with celiac disease are at risk for a number of diseases and disorders that are serious and potentially life-threatening if they don’t stick to a gluten-free diet for life.

There is no room for “cheating” for someone with celiac disease, whether or not they are symptomatic. Even after going gluten-free, celiacs should be followed by a physician to ensure their bone density is normal and they are not suffering from continued malabsorption.

People with non-celiac gluten intolerance, on the other hand, may in some cases find they can ingest small quantities of gluten without ill effect. Even if they do feel badly after ingesting gluten, there is not yet any proof that serious damage is occurring to their bodies. This means that they may not need to be as cautious about cross-contamination as a celiacs needs to be.

They should also rule out the presence of IBS, GERD or colitis, since gluten can trigger flares of these conditions in some people. (The key words here are “may" or "may not". Individuals with gluten intolerance are at very different parts of the sensitivity spectrum – some are very sensitive to gluten and others are not so sensitive, so it's important to keep in mind that everyone reacts differently.)


Is a Gluten-Free Diet the Answer for Celiacs and Gluten Intolerant Folks?


If you have celiac disease, you must be 100% gluten-free for life to avoid complications of untreated celiac disease.

If you don’t have celiac disease but experience fatigue, intestinal discomfort, diarrhea, constipation, heartburn, headaches, neurological symptoms, etc. after gluten ingestion, then a gluten-free diet is a good thing to try.

However, not so fast!

Before you go gluten-free you need to rule out celiac disease, which can only be tested for if you’re currently ingesting gluten. So get a celiac blood test (and, if possible, biopsy) before embarking on a gluten-free lifestyle. Once you’ve ruled out celiac disease, a gluten-free diet may help you improve your health and wellbeing.


Other Nutritional Considerations for Celiac Disease Versus Gluten Intolerance


For people with celiac disease:

  • Take a bone density supplement, such as a supplement combining calcium, magnesium and vitamin D3.
  • Consider iron and B12 supplementation, as celiacs are often low in both nutrients.
  • Take a multivitamin to guard against deficiencies.

For people with non-celiac gluten sensitivity:

  • Take a high quality probiotic to help alleviate intestinal discomfort.
  • Consider fish oil to reduce general inflammation in the body.
  • Supplement with B vitamins and possibly iron in order to replace the nutrients that are normally added to fortified wheat flour that’s found in pasta, cereal, and bread.

While new research on celiac disease is coming out all the time, we’ve noticed a lack of research on non-celiac gluten intolerance, and we hope to see more in the future. So many non-celiacs are benefiting from a gluten-free diet, and there is still no conclusive evidence about why some people who are not celiac are unable to digest the gliadin and glutenin proteins found in wheat, barley, and rye.

In the meantime, the gluten-free market is growing so there is no shortage of gluten-free food for anyone who needs or prefers it. Just make sure you know what your diagnosis is so you can ensure that you are meeting your nutritional requirements.




0 # sharon 2012-11-19 15:27
I am non-celiac gluten intolerant and have severe malabsorption, but maybe it's better now that I am off gluten 100%. I have two genes, one from each parent that has caused this condition. I was tested at Entero Labs. Your information above is incorrect. People with my genes and gluten sensitivity quite frequently have immune and auto-immune issues. There are some estimates that this group of people represents 30% or more of the population. To do your research, go to and to Both types of gluten-intolerant people require the same diet with 100% adherence. is a new lab offering accurate testing--and they don't even distinguish btwn the two types--they analyze the effect of gluten on the body through bloodwork. The point is, vills atrophy is the only difference; seriousness of the symptoms and the required diet are the same.
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0 # Katrina 2012-11-19 17:45
Thankyou Sharon, for pointing out this misinformation your absolutely correct. I have Celiac but work as a health coach with many people who has gluten intolerance ,leaky gut and autoimune issues.
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0 # Cathy 2012-11-20 12:17
Quoting Katrina:
Thankyou Sharon, for pointing out this misinformation your absolutely correct. I have Celiac but work as a health coach with many people who has gluten intolerance ,leaky gut and autoimune issues.

I agree with Sharon. I was not tested at Entero Labs for gluten intolerance, but from getting DH. I was gene tested for celiac and I didn't inherit either celiac gene. (and blood test negative for cillia damage)However - I had immune and autoimmune, malabsorption and neurological issues. And from what I understand without either gene I STILL have a chance of damage to the villi. (although less than 1%) Gluten sensitive people should also be off gluten totally. There is Research (see Dr Rodney Ford) that gluten inflames the autonomic nervous system for gluten sensitive, NCGI, and Celiacs alike, which turns on whatever autoimmune gene you have. Please do not encourage gluten sensitive people to ingest gluten.
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0 # New Zealander 2012-11-19 15:58
I live in New Zealand and am a diagnosed Coeliac however I believe that there is a lot of mis-information about Coeliac Disease and Gluten Intolerance even amongst medical professionals. While damage to the intestinal villi demonstrates that a person has Coeliac Disease it is something that may take a while to appear. To coin a phrase I would call this a pre coeliac condition. The question is then whether to exclude gluten in which case a definitive diagnosis may never be known or to test regularly for changes. Ultimately what is needed is more knowledge on the subject and improved testing methods to catch the condition before it evolves into Coeliac Disease.
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0 # Katy 2012-11-20 13:42
I also believe that your information is incorrect. Although I have never had any digestive involvement, I had many other symptoms during my entire life. In testing, I showed a high anti-gliadin antibody level. My doctor has told me that the anti-gliadin antibody is definitive proof that I have a life-long autoimmune response to glutin and that I must eliminate glutin from my diet for the rest of my life.

As well, in my experience helping friends and family diagnosed with gluten problems, the only way to manage the diet and to get better is to 100% eliminate gluten from your diet. "Sort of" going gluten free is not a viable solution. I think you are very incorrect to claim that less than full compliance to a gluten-free diet will help patients get better.
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0 # Leslie 2012-11-20 15:30
I had the blood test done and according to the results was not Celiac, so when I finally landed in the hospital for a week unable to even absorb water through my intestines, my DR did a biopsy, & said the villi were so damaged they were completely flattened out out smooth. Worst Celiac Sprue he'd seen. The blood tests apparently give false negatives all too often.
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+1 # Melisa 2012-11-20 16:04
My blood test was negative for celiac but I'm not sure I trust it. I have malabsorption of nutrients and calling what I feel after accidently ingesting even the tiniest amount of gluten should not be called just "intestinal discomfort." I am in real pain, sometimes for days. There is no room for cheating, as I would never willingly subject myself to such illness. Suggesting that it is ok for gluten intolerant people to "cheat" seems irresponsible and makes the condition seem less serious than it is.
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0 # Nancy 2012-11-20 16:21
I think over time they will find that there are other genes involved in CD. My gene test came back showing DR1 / DQ5 which I've been told is severe gluten intolerance, I had negative anti-gliadin antibody tests, but had a POSITIVE biopsy, showing blunted villi. I have been GF for 5 1/2 years, showed improvement within 1 week of going GF, I have asthma, terrible neuropathy pain in my leg, an auto-immune disease I had is gone now, since going GF, diagnosed with osteopenia, and lost 3 babies (not miscarriages - they were never able to tell me why) I now know it was the CD/gluten intolerance that caused me to lose them. If I accidentally ingest gluten now, I go thru the typical "gastro" related issues, but then suffer with joint problems and headaches for months after. Ingesting even a microscopic speck of gluten, in my eyes, would cause a suffering that I wouldn't wish on an enemy!!
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0 # Cathy 2013-04-18 16:01
Your definition of glten intolerance or sensitivity not being genetic I believe is false. The Dr. I see said he is not a celiac but carries the gene, he passed it to his son. My mother is not a celiac and yet she passed it to me and I am a celiac. I passed it to my children who have yet to be tested for celiac but have tested positive for gluten sensitivity. I believe it is a genetic trait.
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