Gluten Sensitivity vs. Celiac Disease

What's the difference between the two conditions?

Woman eating pasta
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Celiac disease and non-celiac gluten sensitivity involve two different responses to the gluten protein, which is found in the grains wheat, barley, and rye. However, the symptoms of both conditions are very similar or even nearly identical, which makes it close to impossible to determine which one you might have (if either one) without the use of medical tests.

Celiac Disease Involves Autoimmune Reaction to Gluten

Celiac disease occurs when gluten spurs your immune system to attack the lining of your small intestine.

The resulting intestinal damage, called villous atrophy, can cause malnutrition and conditions such as osteoporosis. It also potentially can lead to cancer in rare cases.

The condition is autoimmune in nature, which means gluten doesn't cause the damage directly; instead, your immune system's reaction to the gluten protein spurs your white blood cells to mistakenly attack your small intestinal lining. Celiac disease is also associated with other autoimmune conditions, including autoimmune thyroid disease and type 1 diabetes.

Celiac disease affects about one in 133 people or close to 1 percent of the population. However, few people – some estimates are as few as 5 percent of the total – know they have the condition.

Gluten Sensitivity Stems From Different Immune System Reaction

Gluten sensitivity, also known as non-celiac gluten sensitivity or sometimes gluten intolerance, has only been recently recognized as a stand-alone condition by the medical community, and there's still plenty of controversy surrounding it.

Not all physicians agree it exists, and little research has been done on its causes, symptoms, and effects.

A team of researchers at the University of Maryland Center for Celiac Research put forth a yet-to-be-confirmed hypothesis in 2011 that gluten sensitivity involves a different immune system reaction than celiac disease.

The team, led by center director Dr. Alessio Fasano, hypothesizes that a person with 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 tract.

In celiac disease, meanwhile, your immune system doesn't mount a direct attack against gluten; instead, gluten ingestion triggers your immune system to attack your own tissue, in the form of your intestinal lining.

It's not clear yet whether gluten sensitivity raises your risk for other conditions, including autoimmune conditions – some researchers believe that it does, and others say it does not. It's also not clear whether it physically damages your organs or other tissue, or whether it simply causes symptoms without incurring damage.

It's also not clear yet how many people may have gluten sensitivity. Dr. Fasano's team estimates the condition affects 6 percent to 7 percent of the population (around one in five people), but other researchers (and advocates) place the number far higher – perhaps as high as 50 percent of the population.

Determining Whether You Have Gluten Sensitivity or Celiac Disease

Since not all physicians agree that gluten sensitivity exists, there's no consensus yet on how to test for it.

However, in a study published in February 2012, Dr. Fasano and his team recommended a diagnostic algorithm that can determine if you have one or the other.

Specifically, according to their suggested algorithm, you and your physician would first rule out celiac disease through celiac disease blood tests. If those are negative, then you would participate in a gluten challenge, first eliminating gluten from your diet to see if your symptoms cleared up, and then "challenging" it, or reinstating it in your diet, to see if symptoms return.

In theory, if you experience symptoms when your diet contains gluten, but those symptoms clear up when you're following the gluten-free diet, you would be diagnosed with gluten sensitivity, according to Dr. Fasano.


Fasano A. et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Medicine. 2011.

Fasano A. et. al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13. 2012.