Celiac Disease Involves Autoimmune Reaction to Gluten
Celiac disease occurs when gluten makes your immune system attack the lining of your small intestine. The resulting intestinal damage, known as villous atrophy, can cause malnutrition and conditions such as osteoporosis. In rare cases, it can actually lead to cancer.
This condition is autoimmune in nature, which means gluten doesn’t cause the damage itself; instead, your immune system’s reaction to the gluten protein makes your white blood cells mistakenly attack the lining of your small intestine. Celiac disease is also associated with other autoimmune conditions such as type 1 diabetes and autoimmune thyroid disease.
Celiac disease affects 1 in every 133 people, or close to 1% of the population. However, very few people, actually know that they have the condition.
Gluten Sensitivity Stems from Different Immune System Reaction
Gluten sensitivity, also known as non-celiac gluten sensitivity or gluten intolerance, has only been recently acknowledged as a stand-alone condition, and there’s still a lot of controversy surrounding it. Not all doctors agree that it exists, and little research has been carried out on its causes, effects, and symptoms.
A team of researchers from the University of Maryland Center for Celiac Research put forth a yet-to-be-confirmed hypothesis that gluten insensitivity involves a different immune system reaction than celiac disease. The team, led by center director Dr. Alessio Fasano, hypothesizes that a person who has gluten sensitivity experiences a direct reaction to gluten – i.e., your body views the protein as an invader and fights it with inflammation both inside and outside your digestive tracts. On the other hand, with celiac disease, your immune system doesn’t mount a direct attack against gluten; instead, the gluten triggers your own immune system to attack your own intestinal lining.
At the moment, it is unsure whether gluten sensitivity raises your risk for other conditions, such as autoimmune conditions – some researchers say it does, while others say it does not. It’s also not clear whether it damages your organs or other tissue, or whether it simply causes symptoms with causing damage.
It’s also unclear how many people suffer from gluten sensitivity. Dr. Fasano’s team estimates that this condition affects 6-7% of the population (around 1 in 5), but other researchers suggest a much higher figure – perhaps as high as 50% of the population.
Determining Whether You Have Gluten Sensitivity or Celiac Disease
Since not all doctors agree that gluten sensitivity exists, there not yet a consensus on how to test for it. However, in a study published back in 2012, Dr. Fasano and his research team recommended a diagnostic algorithm that can determine if you have one or the other.
According to this algorithm, you and your doctor would first rule out celiac disease by taking a few blood tests. If those come back negative, then you would participate in a gluten challenge, first eliminating gluten from your diet to see if your symptoms cleared up, and then adding it again to see if your symptoms return.
In theory, if you experience symptoms when you have gluten in your diet, but those symptoms clear up when it’s removed, you would be diagnosed with gluten sensitivity.