Is it gluten intolerance, celiac disease or something else?

From the grocery store to the coffee shop, gluten-free products are often sought and chosen. Attending brunch or dinner with friends? There’s often someone at the table asking about gluten-free items on the menu.

But how can you determine whether you or your loved ones have a gluten intolerance or might even have celiac disease?

According to Dr. Arthur Yan, a board-certified gastroenterologist with Sharp Community Medical Group, gluten is a protein found in many grains, including wheat, barley and rye, but it provides no essential nutrients. It's common in foods such as bread, pasta, pizza and cereal.

A reaction to eating gluten can cause many symptoms, including hives, skin rashes, nausea, stomach cramps, indigestion, vomiting or diarrhea, and even a stuffy or runny nose. But having a gluten intolerance — or in rare cases, a gluten allergy — differs from having celiac disease.

The truth about celiac disease

The National Institute of Diabetes and Digestive and Kidney Issues (NIDDK) defines celiac disease as a chronic digestive and immune disorder that damages the small intestine. Triggered by eating foods containing gluten, the disease can cause long-lasting digestive problems and restrict absorption of necessary nutrients.

It is estimated just 1% of people in the world have celiac disease. However, people with a close relative — such as a parent or sibling — with celiac disease have a 1 in 10 risk of developing it.

Symptoms of celiac disease include:

• Diarrhea

• Poor absorption of nutrients, or malabsorption

• Flatulence

• Abdominal pain

• Complications from vitamin deficiencies, such as osteoporosis

"Outside of celiac disease, I don't generally recommend people avoid gluten, as there is nothing inherently negative about consuming gluten,” Dr. Yan says. “There are patients with nonceliac gluten sensitivity or diarrhea-predominant irritable bowel syndrome, known as IBS-D, that report feeling better with avoidance of gluten. But studies have shown this is more due to a reduction in FODMAPs, fermentable short-chain carbohydrate that can cause bloating and diarrhea in some people, as foods with gluten also tend to contain FODMAPs."

Additionally, Dr. Yan says those who go on a gluten-free diet may also be reducing their consumption of processed foods and sugars and substituting them with healthier alternatives, such as fruits, vegetables and nuts. “This is an indirect way that helps people feel better, but they may falsely attribute the improvement to avoiding gluten,” he says.

Is it a gluten allergy — or intolerance?

Some people believe they have what they call a "gluten allergy." However, Dr. Yan reports this is not usually an accurate diagnosis. “Most — if not all — patients I see with alleged ‘gluten allergy’ are not having a true allergy to gluten but more of an insensitivity due to IBS or FODMAP intolerance," he says.

While people with celiac disease, IBS and sensitivity to FODMAPs can frequently have bloating, abdominal pain and diarrhea, allergic reactions to gluten differ and include:

• Hives

• Rashes

• Swelling

Anaphylaxis, a severe allergic reaction that can include coughing, wheezing and chest tightness

Dr. Yan encourages you to talk with your doctor if you are experiencing signs of a gluten intolerance, celiac disease or food allergies. Diet changes are usually effective for treating each.

Screening for celiac disease involves a blood test. However, Dr. Yan recommends you get tested before eliminating gluten from your diet. “Otherwise, the test can come back as a false-negative, as a gluten-free diet essentially treats celiac disease,” he says.

Additionally, during an upper endoscopy — a procedure to diagnose and treat gastrointestinal issues — duodenal biopsies, which are tissue samples considered the “gold standard” for celiac disease diagnosis, can be obtained to confirm a diagnosis of celiac disease. There are also genetic tests that help determine a risk for celiac disease. However, these tests alone cannot confirm or rule out celiac disease.

Treating celiac disease

The NIDDK advises those with celiac disease to follow a gluten-free diet. Symptoms can improve within days or weeks of eliminating gluten from your diet and damage in the small intestine can heal.

If diagnosed with celiac disease, you may be advised to work with a registered dietitian who specializes in the disease. The dietitian can teach you how to avoid gluten while following a healthy diet and recommend substitutes for foods that contain gluten.

In addition to following a gluten-free diet, you are also advised to watch for hidden sources of gluten. This can include ingredients found in:

• Supplements

• Medications

• Cosmetics

• Skin and hair products

• Toothpaste and mouthwash

About 20% of people with celiac disease may continue to have symptoms even when following a gluten-free diet due to the consumption of small amounts of gluten or other health issues. Talk with your doctor about your concerns. According to Dr. Yan, most care providers will recommend keeping a food and product journal to find potential hidden sources of gluten and suggest further testing to check for other causes.

Learn more about nutrition; get the latest health and wellness news, trends and patient stories from Sharp Health News; and subscribe to our weekly newsletter by clicking the "Sign up" link below.