Celiac Disease vs. Gluten Sensitivity vs. Wheat Allergy

How can you tell the dif­fer­ence – and how can you man­age the gluten-free lifestyle?

That lit­tle “(GF)” next to menu items, the gluten-free prod­ucts lin­ing the gro­cery store shelves, the celebri­ties who swear that cut­ting out gluten has helped them lose weight … we’re con­stant­ly hear­ing the term gluten-free.”

If you can eat gluten – a pro­tein found in grains like wheat, rye, and bar­ley – with­out prob­lem, gluten-free diets might seem like a fad. But for peo­ple who can­not eat gluten, these diets can be lifesaving. 

Sev­er­al med­ical con­di­tions can make some­one unable to eat gluten, includ­ing celi­ac dis­ease, gluten sen­si­tiv­i­ty (also called gluten intol­er­ance” or non-celi­ac gluten sen­si­tiv­i­ty”), and wheat allergies. 

So, what are the differences? 

Celi­ac Dis­ease vs. Gluten Sensitivity

Let’s start with the big two play­ers in the gluten-free game: celi­ac dis­ease and gluten sensitivity. 

The symp­toms of celi­ac dis­ease and gluten sen­si­tiv­i­ty are prac­ti­cal­ly identical: 

  • Nau­sea and diarrhea 
  • Bloat­ing, con­sti­pa­tion, and gas 
  • Fatigue
  • Headaches and brain fog 
  • Joint pain
  • Depres­sion

How­ev­er, the two con­di­tions aren’t exact­ly the same.

Celi­ac dis­ease is an autoim­mune dis­or­der. When gluten enters your diges­tive sys­tem, it trig­gers your immune sys­tem to cre­ate anti­bod­ies (pro­teins that fight for­eign sub­stances like virus­es or bac­te­ria). These anti­bod­ies dam­age the lin­ing of your small intes­tine, inter­fer­ing with the intestine’s abil­i­ty to absorb nutrients. 

Gluten sen­si­tiv­i­ty is when you have a bad reac­tion to gluten but don’t test pos­i­tive for celi­ac dis­ease or a wheat aller­gy. It doesn’t cause the same type of intesti­nal dam­age as celi­ac dis­ease. The exact cause of gluten sen­si­tiv­i­ty isn’t well understood. 

Also read: Gas­troin­testi­nal Symp­toms You Should Not Ignore 

Wheat Aller­gies and the Myth of the Gluten Allergy 

Some peo­ple say they have a gluten aller­gy, but it’s not pos­si­ble to be aller­gic to gluten. It’s like­ly that they are aller­gic to wheat – which con­tains gluten – and they are mis­tak­en­ly attribut­ing their symp­toms to gluten. 

There are sev­er­al dif­fer­ences between wheat aller­gies, celi­ac dis­ease, and gluten sensitivity: 

  • You can grow out of a wheat aller­gy and may be able to grow out of gluten sen­si­tiv­i­ty, but you can­not out­grow celi­ac disease. 
  • Aller­gic reac­tions can hap­pen in min­utes up to an hour. Symp­toms of celi­ac dis­ease or gluten sen­si­tiv­i­ty typ­i­cal­ly start with­in a few hours or days. 
  • Wheat aller­gies can cause some of the same symp­toms, but they can also bring on reac­tions like hives, swelling in your mouth or throat, or even life-threat­en­ing ana­phy­lac­tic shock. 

Also read: Food Aller­gy 

Which One Is It – and What Hap­pens Next?

This can get a lit­tle tricky. There are tests to diag­nose celi­ac dis­ease and wheat aller­gies, but there Isn’t cur­rent­ly a test for gluten sen­si­tiv­i­ty. It’s diag­nosed if you have symp­toms after eat­ing gluten and don’t test pos­i­tive for celi­ac dis­ease or a wheat allergy. 

The only treat­ment for both celi­ac dis­ease and gluten sen­si­tiv­i­ty is a gluten-free diet – but there’s a catch. If you have celi­ac dis­ease, you must go gluten-free per­ma­nent­ly. How­ev­er, if you have non-celi­ac gluten sen­si­tiv­i­ty, you may only need to avoid gluten tem­porar­i­ly. Experts rec­om­mend fol­low­ing a gluten-free diet for about 1 to 2 years before get­ting test­ed again. 

For a wheat aller­gy, avoid wheat alto­geth­er and car­ry epi­neph­rine (emer­gency med­ica­tion for ana­phy­lac­tic shock) if you’re at risk for severe reactions. 

If you believe you might have celi­ac dis­ease or gluten sen­si­tiv­i­ty, make an appoint­ment with a Duly Health and Care gastroenterologist. 

Make sure that you go through the test­ing process and get a diag­no­sis from your provider before giv­ing up gluten on your own. Cut­ting out gluten when you don’t need to like­ly won’t improve your own health and can lead to prob­lems like: 

  • Decreased fiber intake, which can neg­a­tive­ly affect digestion 
  • Vit­a­min or min­er­al defi­cien­cies – unlike foods with gluten, gluten-free foods are often not for­ti­fied with nutri­ents like iron and folic acid 
  • Inac­cu­rate test results for celi­ac dis­ease if you get test­ed in the future 
  • Weight gain and obe­si­ty, since gluten-free foods tend to be high in fat and sugar 

Also read: Every­thing You Know About Start­ing a New Diet is Iffy (Well, Maybe)

Liv­ing a Gluten-Free Life 

Being gluten-free can make din­ing at restau­rants a bit dif­fi­cult or stress­ful. For­tu­nate­ly, it’s becom­ing a lot eas­i­er to find gluten-free prod­ucts and menu items. 

If you’re new to the world of gluten-free eat­ing, it can be over­whelm­ing at first. Here are some point­ers to get started: 

Be Restau­rant-Smart

Check out menus ahead of time to make sure there are gluten-free options. When you’re at the restaurant: 

  • Let the wait staff know – and make sure to clear­ly explain that any­thing with flour, bread­crumbs, or soy sauce will make you sick. 
  • Go for sim­ple dish­es that don’t have sauce or coating. 
  • Don’t assume that some­thing is gluten-free. For instance, some chefs add pan­cake bat­ter to omelets. 
  • Ask them if they use a clean or sep­a­rate prep space and if they clean the grill before cook­ing gluten-free food. 

Beware of Hid­den Gluten 

Gluten can be sneaky and make its way into foods you wouldn’t expect to find it in. It’s crit­i­cal to look for hid­den sources of gluten to make sure that you don’t acci­den­tal­ly ingest it. 

Know Your Labels 

If you can’t eat gluten, any pack­aged prod­uct that is reg­u­lat­ed by the US Food and Drug Admin­is­tra­tion (FDA) and labeled gluten-free” is con­sid­ered safe. 

Even if a food is labeled as gluten-free,” it’s a good idea to dou­ble-check the ingre­di­ents in case there was a label­ing or pack­ag­ing error. Avoid foods with any of these ingredients: 

  • Bar­ley
  • Brewer’s yeast
  • Durum
  • Einko­rn wheat 
  • Emmer
  • Fari­na
  • Far­ro
  • Gra­ham
  • KAMUT®
  • Kho­rasan wheat 
  • Malt
  • Rye
  • Semoli­na
  • Spelt
  • Trit­i­cale
  • Wheat
  • Wheat starch

Notice a warn­ing that says, may con­tain wheat” or processed on equip­ment that han­dles wheat” on some­thing that’s marked gluten-free?” If you have celi­ac dis­ease or gluten sen­si­tiv­i­ty, you’re in the clear – these warn­ings aren’t rel­e­vant to a product’s gluten con­tent. But if you have a wheat aller­gy, take these warn­ings seri­ous­ly to avoid the risk of eat­ing some­thing that was acci­den­tal­ly con­t­a­m­i­nat­ed with wheat. 

Whether you need to avoid gluten or just avoid wheat, it’s not always easy to live with a chron­ic con­di­tion that lim­its what you can eat. But by learn­ing how to quick­ly deter­mine which foods are safe and to be proac­tive when you’re going out to eat, you don’t need to let celi­ac dis­ease, gluten sen­si­tiv­i­ty, or wheat aller­gies stand in the way of liv­ing a healthy and nor­mal life. 

Health Topics:

  • It is an important part of my practice to pay thoughtful attention to the medical, emotional, and psychosocial aspects of each person’s care – as I often say to trainees working with me, “It is important to treat the whole person, not just parts of them.” I take pride in developing ongoing partnerships with patients and their loved ones as they work through each of these important aspects together.