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Celiac disease vs non-celiac gluten sensitivity

Posted On: February 28, 2021 By Amanda Kotze
28 Feb

Celiac disease vs non-celiac gluten sensitivity

Celiac disease: is an immune-mediated disease in which people cannot eat gluten. If you have celiac disease, and you eat gluten, your immune system responds by damaging the small intestine. It results in the flattening of the finger-like villi in the small intestine resulting in maldigestion and malabsorption of nutrients.

Gluten is a protein found in wheat, rye, and barley.

Prevalence and onset and clinical manifestation:

In contrast to the dramatic classical presentation noted typically in younger children, many patients with celiac disease present at a later age with subtle symptoms, and the diagnosis of celiac disease may be delayed [1]. Onset and first occurrences of symptoms may appear any time from infancy to adulthood but the peak diagnoses accurse after forty [2]. The disease may become apparent when an infant begins eating gluten-containing cereals or only in adulthood when it may be triggered by surgery, stress, pregnancy, or a viral infection. 

The clinical manifestations of celiac disease that have been identified are extensive and varied and are no longer isolated to the gastrointestinal tract. Celiac disease has been associated with other autoimmune conditions such as autoimmune thyroid disease and type 1 diabetes [1]. 

Celiac disease manifestation can be asymptomatic (silent) to full-blown celiac disease [2]. Patients may present with a variety of symptoms ranging from fatigue, weight loss, diarrhoea, constipation, vitamin or mineral deficiencies, skin rashes, abdominal bloating or -pain, infertility, and miscarriage, joint pain, and stiffness. 

Gluten sensitivity or non-celiac gluten sensitivity is a term used to describe persons with nonspecific symptoms without intestinal damage [3]. It also refers to a state of increased immunological responsiveness due to exposure to the gliadin component in gluten in genetically susceptible people. Non-celiac gluten sensitivity can affect many organ systems such as the brain and nervous system.

A study by Harvard’s, Dr. Fasano published in 2015 explained that gliadin also triggers the production of another protein called zonulin which breaks down the gut lining and increases permeability. Substances leak from the gut into the bloodstream and incite inflammation. Fasano’s study concluded: “Gliadin exposure induces an increase in intestinal permeability in all individuals, regardless of whether or not they have celiac disease” [4]. Gluten sensitivity also increases the production of inflammatory cytokines, and these cytokines are pivotal players in neurodegenerative diseases. 

Dietary implications:

Lifelong adherence to a strict gluten-free diet is the only known treatment for celiac disease. If adhering to the diet the intestinal mucosa usually reverts to normal or near normal. Clinical symptoms can improve in 2 to 8 weeks of starting the gluten-free diet. 

All wheat, rye, barley, spelt, semolina, and bulgar should be excluded from the diet. Lactose and fructose intolerances sometimes occur secondary to celiac disease and sugar alcohols are not well absorbed [4]. Patients need to read labels of food for hidden gluten in bakery products and packaged food. A registered dietitian will be able to support a newly diagnosed patient in making healthy food choices, avoiding gluten and gluten-containing products, and monitor possible nutrient deficiencies. 

If consistent non-specific symptoms with underlying inflammation occur (and celiac is excluded) it is worthwhile to look into the possibility of non-celiac gluten sensitivity. A six-week trial excluding all gluten is suggested with guidance from a dietitian. 


  1. Barker JM, Liu E. Celiac disease: Pathophysiology, clinical manifestations, and associated autoimmune conditions. Adv Pediatr. 2008;55:349-346.
  2. Holtmeier W, Caspary WF. Celiac disease. Orphanet journal of rare diseases. 2006;1:3.
  3. Mahan LK, Raymond JL. Krause’s food, and the nutrition care process. 14th ed. St Louis, Missouri: Elsevier; 2017.
  4. Hollen J. et al. Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Nutrients. 2015;7(3):1565-1576.
Amanda Kotze
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