If you experience digestive or full-body symptoms after eating bread, pasta, or desserts, you may have one of a few gluten-related disorders—two of which are gluten intolerance and celiac disease. The conditions can cause similar symptoms, and the terms are often used interchangeably, but they are not the same. So, how do you know which one you may have?
This article explores everything you need to know about the differences, their signs and symptoms, and more.
Illustration by Michela Buttignol for Verywell Health
A gluten intolerance, also called non-celiac gluten or wheat sensitivity (NCGS/NCWS), is when an individual is sensitive to gluten (a protein found in wheat, rye, and barley), but does not test positive for celiac disease or a wheat allergy. Gluten intolerance involves the digestive tract and can cause digestive problems.
Symptoms of gluten intolerance that involve the digestive tract include:
Other symptoms may include:
Both gluten intolerance and celiac disease result from the effects of gluten, but they are not the same thing. Celiac disease is an autoimmune disease that causes damage to the small intestine when people with the condition consume gluten. It’s estimated to affect 1 in 100 people globally.
When people with celiac disease eat gluten, their bodies react with an immune response that attacks the villi (small fingerlike projections that promote nutrient absorption) along the wall of the small intestine.
Celiac disease can affect people differently, making it difficult to identify. Some people have no symptoms, while others have many. Children and infants tend to have more digestive symptoms compared to adults.
Common symptoms in children with celiac disease include:
Common symptoms in adults with celiac disease include:
It can be difficult to tell the difference between gluten intolerance and celiac disease based on symptoms alone, as there is some crossover between symptoms. If you are experiencing symptoms related to either condition or suspect you have one or the other, contact a healthcare provider for further evaluation.
Both celiac disease and gluten intolerance involve gluten and the digestive tract. People with both conditions may experience gastrointestinal (GI) symptoms, such as abdominal pain, bloating, gas, diarrhea, and/or constipation.
Testing is required to tell the difference between celiac disease and a gluten intolerance. If you do not test positive on the blood test for celiac disease and do not have small intestine damage but still have symptoms, you may have a gluten intolerance.
Many people use the terms “gluten intolerance” and “gluten sensitivity” to describe the same condition. The medically correct terms are “gluten sensitivity,” “non-celiac gluten sensitivity,” or “non-celiac wheat sensitivity.”
However, “gluten intolerance” and “gluten sensitivity” are often used interchangeably and usually refer to the same thing.
Celiac disease runs in families and can develop at any age after someone starts consuming gluten. People with a first-degree relative (parent, sibling, or child) with the condition have a 1 in 10 chance of developing it, too.
Typically, to develop celiac disease, an individual must have at least one of two celiac genes, be consuming gluten, and have triggers for a celiac-related immune response. Celiac disease can develop at any time across the lifespan.
If someone with gluten intolerance is not genetically predisposed to celiac disease (meaning they do not have the genes for celiac disease), there is a very low risk of their developing the condition.
There isn’t a single test that can diagnose gluten intolerance. Gluten intolerance is typically diagnosed after ruling out other conditions. If you don’t test positive for any of the conditions tested for, you may have a gluten intolerance.
Some conditions a healthcare provider may test you for prior to a gluten intolerance diagnosis are celiac disease or a wheat allergy.
The first step in testing for celiac disease is usually a blood test that looks for certain antibodies that people with celiac disease have increased rates of in their blood. For the testing to be accurate, you need to be including gluten in your diet. Your healthcare provider may order additional blood tests.
An endoscopy and/or intestinal biopsy may be needed. These tests allow your healthcare provider to see into your GI tract with a tiny camera to look for inflammation and intestinal damage, as well as take some tissue samples to confirm celiac disease. As with the blood tests, you need to be following a gluten-containing diet at the time of testing for the results to be accurate.
Genetic testing is also available for relatives of people diagnosed with celiac disease since it tends to run in families. If a family member tests positive for one of the celiac disease genes, they will be recommended for celiac disease testing. If negative for celiac disease, the family member should then repeat the test every three to five years.
Several at-home antibody tests are available for celiac disease. These tests can offer a convenient first step in identifying what might be causing your symptoms. However, they are not meant to be diagnostic.
If you have taken an at-home test for celiac disease, take your results to a trusted healthcare provider for follow-up to determine if you have celiac disease. They can help provide any additional testing and, if needed, set out a care plan.
A gluten-free diet is the main treatment for both gluten intolerance and celiac disease. This diet includes avoiding all foods and beverages that contain wheat, barley, and rye grains.
Gluten may also be in other foods, supplements, and products such as cosmetics or toothpaste, so it’s important to check labels for gluten-containing ingredients.
You might be referred to a registered dietitian, who can teach you how to follow a balanced, nutrient-rich diet while staying gluten-free.
Avoiding cross-contamination at home and in restaurants may also be necessary to prevent accidentally ingesting gluten.
Some people with gluten intolerance may benefit from avoiding foods high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). These are short-chain carbohydrates that can cause symptoms in people with irritable bowel syndrome (IBS).
Talk with a healthcare provider or a registered dietitian before starting a low-FODMAP diet, as avoiding these can be unnecessarily restrictive if unnecessary.
People with celiac disease may also need to supplement with certain vitamins, minerals, or other dietary supplements. Talk with your healthcare provider to determine if you need to take in additional nutrients or dietary supplements.
You can trial a gluten-free diet at home before being tested for gluten intolerance or celiac disease. However, for most tests to be accurate, you need to include gluten in your diet while being tested.
If you have been diagnosed with either gluten intolerance or celiac disease, follow a gluten-free diet is recommended to help resolve symptoms. Symptoms typically improve within days to weeks after starting a gluten-free diet.
If you or your child is experiencing symptoms of either gluten intolerance or celiac disease that are not resolving with other treatment, contact a healthcare provider for further evaluation.
Gluten intolerance (also called gluten sensitivity) and celiac disease are two different conditions that both involve gluten. Both conditions can present with gastrointestinal (GI) symptoms, such as abdominal pain, gas, bloating, diarrhea, and/or constipation. There may also be non-GI symptoms present.
Celiac disease is an autoimmune condition that causes inflammation and damages villi on the lining of the small intestine. People with celiac disease typically have certain genes that predispose them to the condition and higher levels of certain antibodies in their blood.
People with gluten intolerance do not test positive for celiac disease but still have symptoms when consuming gluten. Testing for celiac disease usually involves blood tests, an endoscopy, and intestinal biopsy.
Following a gluten-free diet can treat both conditions. A healthcare provider can help determine if your symptoms are caused by a gluten intolerance or celiac disease.
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