Gluten-Free, Celiac Disease, and Gluten-Sensitivity
As we have already observed in the articles “What is Gluten” and “How is Gluten Digested,” some people do not wish to consume gluten. The question which generally arises is then, “Why would you ever do that?”
In response, there are two broad categories of gluten-free: those who have clinical celiac disease, and those who are gluten-sensitive.
Celiac Disease is an autoimmune disease. This means, the body mounts an immune response against itself (1).
In celiac disease, the body produces antibodies against the enzyme, named tissue transglutaminase (2), in the small intestine that digests gliadin, a component of gluten (see our article: “What is Gliadin?”).
This response creates inflammation primarily localized in the small intestine. The initial inflammation in the small intestine causes large scale systemic inflammation, which leads to the other broad, non-specific symptoms of celiac disease (3).
The key marker for Celiac Disease is abnormal small intestine villa formation, which leads to a “leaky gut (4).”
About 1% of the world’s population has diagnosed celiac disease (8, 9), which accounts for at least 70 million people (10), and is highest in Northern Europe with an average of 6.2% of the population frequency (9).
Gluten-sensitivity, on the other hand, is a less severe inflammatory response than Celiac Disease. It is sometimes called sub-clinical celiac, silent celiac disease, or gluten-intolerance (5), but occurs very similarly to Celiac Disease. In fact, it seems to be a continuum with Celiac Disease, and just a predecessor of something more severe.
Generally, in a gluten-sensitive individual, the normal digestive protein enzymes are unable to keep up with the amount of difficult to digest gliadin in the gut, and this imbalance creates inflammation. Gluten-sensitivity is frequently masked as other inflammatory symptoms (11).
So, what is the difference between Celiac Disease and Gluten Sensitivity? Celiac Disease has been diagnosed through a small intestine biopsy and has observed villi atrophy. On the other hand, gluten sensitive individuals have not had clincal confirmation of villi atrophy but still have symptom relief through a gluten-free diet.