One of the main questions that I get from people with autoimmune diseases is whether or not they have celiac disease. Celiac is a common autoimmune disease and can run in families with a genetic predisposition to autoimmunity. But being intolerant to gluten does not mean that you have celiac disease. Here we will discuss the difference between the two and how to tell the difference. But first let’s talk about gluten.
What is Gluten?
Gluten is a group of proteins that are found in many different grains, but primarily wheat. The most common grains that have gluten in them are wheat, barley, rye and oats (from cross-contamination). Gluten is approximately 75 – 85% of the total protein found in these grains.
Gluten is what gives bread flours their sticky and elastic properties. If you have ever made bread, you know that once you yeast it, it can get stretchy, and the final product is chewy. This is from the gluten. One of the main complaints of gluten free breads are that they are crumbly or dense. This makes sense given that they don’t have gluten in them.
Gluten proteins are large proteins, and when broken down in the small intestine, they can cause inflammation. There are at least 50 spots on the gluten proteins that we know of that the immune system can bind to and cause gut-damaging reactions. Which is what makes gluten one of the most well known inflammatory proteins.
Gluten hypersensitivity is when the immune system reacts to gluten that someone eats. Our immune system is not supposed to react to any food that we eat. But sometimes, foods that we eat look foreign to the immune system, and that causes inflammation. This inflammation can be local in the small intestine, or it can be systemic – meaning it can cause inflammation other places besides the gut.
A lot of foods that are stimulating to the immune system are proteins. This is because proteins are large molecules. There are many spots on a protein that the immune system can bind to. If proteins don’t get broken down into smaller pieces, the immune system might recognize it as foreign which leads to inflammation.
Big proteins can also cause what is called molecular mimicry. This is when pieces of the protein in the food we eat looks similar to proteins in our own body. If the immune system recognizes a food particle as foreign, and then sees another protein elsewhere in the body that looks the same, it might attack that other protein as well. This is how it can cause inflammation in other parts of the body.
This is what often happens with gluten. It is a large protein, and therefore, if not broken down enough, it can stimulate the immune system. When this happens, it can cause symptoms in people that lead to stomach upset, diarrhea, constipation, headaches, brain fog, joint pain…etc. Every person that has gluten hypersensitivity will have different reactions depending on their immune system response.
Celiac disease is a very specific autoimmune reaction that occurs because of gluten hypersensitivity. In those with celiac disease, the immune system produces antibodies specific to the gluten proteins. When this happens, some of the antibodies produced are specifically targeted at the cells in the small intestine. Because of this cross reactivity, there is direct damage to the small intestinal lining in the presence of gluten.
There are a number of antibodies associated with celiac disease. The most common ones include anti-tissue transglutaminase, Anti-endomysial and anti-gliadin antibodies. These specific antibodies can be very detrimental to the small intestinal lining. If Celiac disease goes on too long, it can lead to improper absorption and nutrient loss.
Those with celiac disease may or may not have abdominal symptoms. Many people with celiac disease will have abdominal pain, gas, bloating or diarrhea when they eat gluten. Some people may have just an overall flu-like feeling when they eat gluten.
In order to be diagnosed with celiac disease, you can check the blood for antibodies to see if you have any of them. Additionally, you can get an endoscopy to look at the small intestine to check for damage. Either of these options is a good idea for those looking to get a diagnosis of celiac disease.
Difference in Treatment
Treatments for celiac disease vs gluten sensitivity are different. For those with celiac disease, a complete avoidance of gluten is necessary. This is because any small amount of gluten protein in the food can trigger a severe or destructive inflammatory process. Those with gluten hypersensitivity though do not need to be as strict, and some people may even be able to eat gluten on occasion or with certain enzymes to help break it down.
Those with celiac disease should avoid gluten as strictly as possible. It is advisable that you remove gluten from your house completely. This includes gluten that could be found in health and beauty supplies or supplements/medications. If you cannot remove gluten completely from your house, make sure that you do not share the same surfaces (countertops, ovens, toasters, cutting boards…) with someone that uses gluten. Even thorough cleaning cannot remove all of the gluten proteins.
In those with hypersensitivity, every gluten reaction is different. Some people can eat gluten on occasion (maybe 1x a week or every 2-3 days) and keep their inflammation low enough that it doesn’t cause problems. Some people also respond well to gluten enzymes – which are enzymes that break down gluten when you eat it. The breakdown of the protein helps reduce the inflammatory response.
If you are concerned you may have issues with gluten and want to be tested for celiac disease or gluten hypersensitivity, talk to your doctor. Additionally, if you would like more information about gluten and the immune system, you can contact on of our doctors for a free 15 min phone consult. Gluten enzymes can also be ordered on our online ordering system.
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