Is Gluten Sensitivity Worse Than Celiac Disease?
How many times have you read that celiac disease is the worst form of gluten intolerance? Or maybe you’ve heard that celiac disease is the potential end-stage of gluten intolerance? And I know that you’ve read that gluten sensitivity isn’t nearly as severe as celiac disease, right?
These statements sound fairly logical. But have you ever stopped to think about whether or not they are actually true?
If you ever thought that maybe this was an oversimplified view of the difference between celiac disease and gluten sensitivity, then you’re really going to enjoy reading this. It turns out that the issues are quite a bit more complicated than they first appear.
In order to begin to get an accurate handle on the differences between celiac disease and gluten sensitivity, the first thing we must do is revisit the definition of celiac disease. To be diagnosed with celiac disease, you need one thing: villous atrophy. To put it simply, villous atrophy is a very specific kind of damage that can occur in the small intestine.
If you don’t have villous atrophy, then you don’t have celiac disease. Period. There are various ways to test for celiac disease, but they all lead to the potential outcome of villous atrophy.
At this point, it is important to notice that no reference has been made to how the person feels. The diagnosis is not based on how sick you feel, how many symptoms you have, what type of symptoms you have, or how long you’ve had those symptoms. You simply must have villous atrophy.
So how does this damage occur in the small intestine? As you may already know, it is the result of an autoimmune reaction. “Autoimmune” means that the immune system is attacking the villi, the name given to microscopic finger-like extensions that line the small intestine. When this happens, it results in damage that we call villous atrophy.
Eating gluten triggers the autoimmune reaction in certain people who are genetically susceptible. But fortunately, we can stop the autoimmune reaction from occurring. When these people stop eating gluten, the autoimmune reaction resolves and the small intestine begins to heal. The small intestine heals because the trigger for the damage has been removed. Gluten is that trigger and celiac disease (villous atrophy) is the effect. Celiac disease is in fact a symptom of gluten intolerance.
But that is just one part of the story. What if you don’t have celiac disease? Can you still have a reaction to gluten? Of course. Many people who do not have celiac disease react to gluten. This is not a new problem, although it is only now beginning to be acknowledged by the general medical community. Fifteen years ago most doctors didn’t understand the importance of celiac disease. We are now at that same place with gluten sensitivity.
What symptoms do these non-celiac gluten intolerant (often called gluten sensitive) people have? Well, we know what they don’t have: villous atrophy. However, you may be shocked to learn that villous atrophy is about the only difference between celiac disease and gluten sensitivity.
Careful now. I know you’re thinking that this article has truly gone off the rails. That there is no way this could be correct. But let’s examine the facts, just like in CSI. (Actually, I prefer Sherlock.)
People who have celiac disease vary widely in their symptoms. Some have diarrhea, some have constipation, and some don’t have any digestive problems at all. In reality, few present with the classic symptoms once thought to be required in celiac disease. Some celiacs have headaches, and some have osteoporosis. Some have skin problems, and some only have fatigue. But a great many of them have no symptoms whatsoever.
That’s right. A very large percentage of people with celiac disease have no discernible symptoms, except for their villous atrophy. They don’t feel or look sick.
Several studies have shown this, but this information has been largely ignored, most likely because stories about very ill patients are far more compelling.
So what does that mean for us?
Well, if that’s the case, then it obviously means that celiac disease isn’t always severe. In reality, people with celiac disease cover the spectrum, from feeling reasonably well and living normal lives to being in the hospital.
That puts a hole in the “celiac disease is always worse than gluten sensitivity” theory. But celiac disease still has more potential to be worse, right?
Not quite sure about that anymore, are you? Now I’ve got you questioning what you’ve been told. Good!
Most people will tell you that we don’t know much about gluten sensitivity. However, after working with thousands of patients and assessing each and every one of them for gluten sensitivity, I’ve learned a few things.
Nowadays, more and more people are being tested for celiac disease. Many of my patients have already been tested for celiac disease before they ever get to me. Most of them don’t have celiac disease. But I’ve found that whether or not they have celiac disease or gluten sensitivity, it hasn’t made an ounce of difference in how sick they are or what kind of symptoms they have.
For example, I’ve seen numerous patients who have spent significant time in the hospital and had multiple ER visits, yet nothing abnormal was found. They had extreme abdominal pain, yet they did not have appendicitis, gallstones, cancer, or any other malady that can be diagnosed with a CT scan, MRI, ultrasound, colonoscopy, upper endoscopy, or any other diagnostic procedure used at a hospital.
They didn’t have celiac disease either. Most of them had been tested for it more than once.
These patients literally felt like they were dying.
But lo and behold, as we began to dig deeper, it turned out that they had gluten sensitivity. (And often reactions to other foods.) They removed the offending foods from their diet, began to heal, and now live completely normal lives. No pain, no discomfort, and no more symptoms.
These gluten sensitive people were just as sick as any celiac case that any doctor has ever seen.
Other gluten sensitive patients only had headaches. Some only had joint pain. Some had skin problems. Some were hypothyroid. Others were anemic. Some had diarrhea, others constipation. The list goes on and on, just as it does for celiac disease. And in each case the severity of the problem varied from relatively mild to extremely debilitating.
The main point is that it is impossible to predict whether or not someone has celiac disease based on their symptoms. It is also impossible to predict whether or not someone is otherwise gluten sensitive based on their symptoms. The only difference is the presence of villous atrophy.
Don’t let the names fool you, nor the celiac experts who’ve been focused on celiac disease, not gluten sensitivity.
Many assumptions have been made about celiac disease. Unfortunately, many assumptions continue to be made about celiac disease that are incorrect, but the facts speak for themselves.
Celiac disease is a symptom. It’s one potential manifestation of your reaction to gluten. It’s not the worst symptom, nor is it the end stage of a gluten reaction if you happen to be gluten sensitive.
This begs the final question: if you don’t have celiac disease but you are sensitive to gluten, then do you have to be just as careful about avoiding gluten?
I think that deep down you already know the answer to this question. Either way it’s bad for you. It’s just wishful thinking to believe that if you react to gluten but you don’t have celiac disease then it isn’t doing any harm to have just a little bit of gluten. If you truly want to optimize your health, then you should absolutely avoid all sources of gluten.
So there you have it. Celiac disease and gluten sensitivity aren’t all that different after all, and celiac disease is really just one of many possible symptoms of gluten sensitivity.
If you would like to learn more about this fascinating topic, check out Dr. Wangen’s book, Healthier Without Wheat, which explores this topic further and helps to explain why millions of people are choosing to go gluten-free.
Written by Dr. Stephen Wangen
As always, consult a medical professional before beginning any new protocol.