BATON ROUGE, La. (BRPROUD) — When eating out with a large group of friends or family, it isn’t uncommon for at least one person in the party to order a specially prepared gluten-free meal.
They may explain to the wait staff that they have either celiac disease, a wheat allergy, or gluten intolerance.
Anyone overhearing the exchange may wonder if there’s any difference between the three diagnoses.
The simple answer is, yes.
So, what is it that makes gluten intolerance, celiac, and an allergy to wheat so different?
What exactly is gluten?
First of all, it helps to understand a bit about the culprit in two of the conditions mentioned above.
Gluten, known to many bakers as the magical ingredient that makes desserts fluffy and delicious, is a bit of an enemy to people with celiac and gluten intolerance.
Essentially, gluten is a protein found in wheat, barely, rye, and other grains. It’s a component in countless food products and beverages such as pasta, breads, beers, and even seasonings. It’s also used in a number of non-edible items like lotions and cosmetics.
Defining gluten intolerance
Nearly six percent of the U.S. population is considered gluten intolerant, according to the Cleveland Clinic.
This means after ingesting gluten, the person gets sick. They might feel tired, nauseous, or bloated.
That said, their symptoms are not the result of an allergy or an autoimmune response.
Therefore, gluten intolerance is neither an autoimmune disorder such as celiac disease, nor is it a wheat allergy.
In fact, researchers aren’t quite sure what causes most gluten intolerance. There are two popular theories on the matter. One suggests that people may not be sensitive to gluten itself, but to a particular carbohydrate found in many foods. This carb stays in their gut and ferments, which is what makes them sick.
The other theory is lifted from research that suggests people with gluten intolerance may have a weakened stomach lining, which has been affected by wheat. Healthy stomach lining keeps bacteria from leaking out of the intestines. But these individuals have lining that doesn’t work as well as it should and allows bacteria into their blood or liver, which triggers inflammation.
While these may be reasons for gluten intolerance, experts are still investigating the issue.
In any case, people with gluten intolerance are advised to avoid consuming foods with gluten.
What is a wheat allergy?
A wheat allergy is a type of food allergy, which develops when the body’s immune system becomes sensitized and overreacts after eating a certain type of food.
So when someone with a wheat allergy eats a bowl of pasta or a piece of bread, they may experience hives, nausea, vomiting, headache, anaphylaxis, or shortness of breath.
To properly diagnose the allergy, a doctor will likely perform a blood test or a skin-prick test.
The skin-prick test involves placing a small amount of a liquid containing wheat protein on the back or forearm and then pricking the skin with a small, sterile probe to let the liquid to seep into the skin. If a raised, reddish spot forms within 15 to 20 minutes, this is likely an indication of a wheat allergy.
A wheat allergy can be managed by avoiding any foods and products that contain wheat, by controlling symptoms with antihistamines and corticosteroids, and when necessary, by using a prescribed epinephrine to reverse anaphylactic symptoms.
Understanding celiac disease
Celiac disease is a hereditary autoimmune disease marked by the body’s extreme response to gluten.
When someone with celiac consumes gluten, their body’s immune system attacks their small intestine, which damages the gut’s villi.
This is very bad because villi are important. These tiny, fingerlike projections line the small intestine and help the body take in nutrients.
In celiac patients, the villi becomes damaged, which means nutrients can’t be properly absorbed.
The longer someone with celiac continues to eat gluten, the more likely they are to develop other autoimmune disorders such as type 1 diabetes, multiple sclerosis, and other conditions like dermatitis herpetiformis, anemia, osteoporosis, infertility and miscarriage, heart disease, and intestinal cancer.
The National Institute of Diabetes and Digestive and Kidney Diseases estimates that about 2 million people in the U.S. have celiac disease.
It adds that many with the illness have yet to be properly diagnosed.
Emily Lyons, a woman who’d experienced symptoms of celiac for years, wasn’t diagnosed until she was 30.
Lyons told Women’s Health, “I used to eat a ton of food everyday without ever gaining weight—pizza, bread, cookies—and always hovered around 104 pounds. I battled stomach problems daily, always caught colds or the flu, and was constantly exhausted. I could sleep 12 hours and still have to drag myself out of bed. The majority of my friends and family, and even my doctor, thought I was making a lot of it up or that it was mental, which spiraled me into a depression.”
Sadly, Lyons’ experience is not uncommon.
As is the case with many chronic illnesses, when patients bring their physical symptoms to doctors, their concerns are often dismissed or they’re told that what they’re experiencing is in their head.
Studies indicate this tends to happen to female patients more than it happens to male patients.
According to an article in Today, the average woman’s immune system is more robust than the average man’s, which is why women typically have many autoimmune conditions.
Along those lines, experts say a celiac disease diagnosis is more common in women than in men.
Despite this, the article points out that, “more than 40 percent of women eventually diagnosed with a serious autoimmune disease had at one point been told by a doctor they were ‘just too concerned with their health or they’re a hypochondriac,’ said Virginia Ladd, founder of the American Autoimmune Related Diseases Association.”
Some of the symptoms that a person with celiac may experience after consuming gluten include diarrhea, constipation, bloating, excessive gas, extreme fatigue, weight loss, nausea and vomiting, anemia, itchy skin rashes, mouth ulcers, headaches, tingling in feet and hands, joint pain, and reduced functioning of the spleen.
To be diagnosed, most patients undergo two blood tests (Serology testing and Genetic testing) as well as an endoscopy, which allows a doctor to view the patient’s small intestine and take a small tissue sample to analyze for damage to the villi.
Lyons, mentioned above, was eventually able to find a medical team that provided her with a proper diagnosis and guide her along in the management of the disease.
Management of celiac typically involves first and foremost, a strict life-long gluten free diet. This often means working with a dietitian to plan healthy, gluten-free meals and taking care to avoid other products and medications that contain gluten.
Some patients who have severe damage to their small intestine or refractory celiac disease, might be treated with steroids or other drugs like azathioprine or budesonide to control inflammation.
Differences aside, there is one conclusion
While celiac disease is an autoimmune disorder, wheat allergy is a food allergy, and gluten intolerance is a yet to be fully understood reaction to gluten, the three issues have one thing in common.
People who suffer from any of these conditions should avoid products with wheat.
Additionally, individuals who’ve been diagnosed with gluten intolerance and celiac should avoid any form of gluten.
In any case, for the people with the diagnoses above, avoiding wheat and/or gluten is more than a food trend, it’s a decision that can be life-saving.