Differences Between Celiac Disease and Gluten Sensitivity

Immune system plays a part in different ways

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.

Gluten free pasta in a bowl surrounded by it's ingredients
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Celiac Disease

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.

Celiac disease is believed to affect as many as 3.2 million Americans. Of those, an estimated 2.5 million remain undiagnosed, according to the Celiac Disease Foundation.

Celiac disease 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.

Non-Celiac Gluten Sensitivity

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. As such, your body views the protein as an invader and fights it with inflammation both inside and outside of your digestive tract.

With celiac disease, your immune system doesn't mount a direct attack against gluten. Instead, the ingestion of gluten triggers your immune system to attack it own tissues, namely those of the intestines.

It is 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.

Differentiating the Diseases

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.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Sapone A, Bai JC, Ciacci C, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10:13. doi:10.1186/1741-7015-10-13

  2. Raithel M, Kluger AK, Dietz B, Hetterich U. [Non-allergic gluten sensitivity. A controversial disease - or not yet sufficiently explored?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59(7):821-6. doi:10.1007/s00103-016-2366-z

  3. Sapone A, Lammers KM, Casolaro V, et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 2011;9:23. doi:10.1186/1741-7015-9-23

Additional Reading

By Jane Anderson
Jane Anderson is a medical journalist and an expert in celiac disease, gluten sensitivity, and the gluten-free diet.