Celiac vs. Non-Celiac Gluten Sensitivity: Both Can Cause Immune Response and Damage

B.S. Dietetics, Dietitian, Health Professional
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In the United States, approximately one in every 133 people, or 2 million people in total, have Celiac disease (CD). CD is a condition in which the immune system reacts to the ingestion of the protein gluten. Left untreated, CD can cause permanent damage in the gastrointestinal (GI) tract, so it is important that people with CD follow a diet that strictly avoids foods containing gluten.

Some people may have all of the symptoms of CD and feel better when removing foods containing gluten, and yet they don’t test positive for CD or for wheat allergy when screened by their physician. This condition is known as non-Celiac gluten sensitivity (NCGS).

According to the Celiac Disease Foundation, some symptoms of NCGS include “brain fog, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue,” but most clinicians did not believe that NCGS caused actual immune response or damage to the intestine.

However, a 2016 study by researchers at Columbia University and published in Gut shows otherwise. Close study of people with NCGS showed increased levels of soluble CD14, lipopolysaccharide-binding protein, antibody reaction to microbial antigens, and elevated levels of fatty acid-binding protein 2. These markers indicate that systemic immune activation is present, along with compromised intestinal epithelial barrier integrity.

In another study based on the analysis of 1,312 adults across 10 controlled studies of gluten-challenge trials, researchers found that most of the people with NCGS experienced increased symptoms when unknowingly ingesting gluten. What this new research means practically speaking is that people who are found to have NCGS may also need to be just as careful as people with CD when it comes to avoiding gluten.

One of the main barriers to following a diet that is strictly gluten-free is the cost of gluten-free foods. Here are a few of my favorite tips for staying gluten free without breaking the bank!

  • Stick to foods that are naturally gluten-free. Potatoes, rice, quinoa, fruits, vegetables, and many other whole foods are great choices.

  • Avoid buying gluten-free pre-packaged foods. For example, my gluten-free girl wanted yogurt covered pretzels, but a two-serving bag was over $5 — twice what regular pretzels cost! That can really add up.

  • Only buy gluten-free foods for the person who needs them. If, for example, we are having spaghetti, I will cook regular noodles in one pot and a single serving of gluten-free noodles in a separate pot for my gluten-free girl. This prevents me from having to buy gluten-free food for all five people in our family.

  • Pick one day a week to plan your meals and do the prep work (like chopping veggies), so that you are less inclined to eat out. Eating out gluten-free can be expensive, and you also run the risk of cross-contamination.

Whether you have CD or NCGS, diet is key to feeling better.

If you continue to experience symptoms even when following a gluten-free diet, it is important to talk with your physician. They can rule out other conditions or assess damage that may have occurred in your digestive tract.

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