Celiac Disease and Gluten Sensitivity
[Updated May 20, 2015]
There are no tests or biomarkers for conclusively diagnosing gluten sensitivity, says Alessio Fasano, MD, medical director of the University of Maryland Center for Celiac Research. The condition is typically determined by a positive response to the gluten-free diet.
Celiac disease and gluten sensitivity are subsets of gluten intolerance. Anyone who has celiac disease or gluten sensitivity is, by definition, gluten intolerant. Although gluten is the culprit for both, they're thought to be distinct entities. “From what we understand," Fasano says, "gluten sensitivity and celiac are two different conditions. The mechanisms that lead to celiac disease and gluten sensitivity are different. People don’t leap from one to the other."
Gluten sensitivity may be up to six to seven times more common than celiac disease, according to Fasano. Unlike celiac disease, gluten sensitivity causes no measurable intestinal damage. Classic symptoms are gastrointestinal discomfort, such as diarrhea, bloating or constipation, but symptoms can range from clumsiness, brain fog and depression to ADHD or autistic behaviors.
On the genetic front, “almost 100 percent of people with celiac disease have either the HLA DQ2 or DQ8 pattern,” says Fasano. Up to 40 percent of the general population have one of these markers. “Gluten-sensitive people are somewhere in the middle—half have HLA DQ2 or DQ8 and half don’t. So it’s possible to be gluten sensitive without having the HLA DQ2 or DQ8 pattern.”
Celiac experts strongly advise that patients be screened for celiac disease before embarking on a gluten-free diet.