Gluten intolerance vs. celiac disease: understanding the difference

Medically reviewed on August 1, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• Signs vs. Symptoms
• What is celiac disease?
• What is gluten intolerance?
• Treatment for gluten intolerance and celiac disease
• Gluten intolerance vs celiac disease
• Testing for gluten intolerance and celiac disease
• Take back control of your health with at-home tests

If you experience digestive or full-body symptoms after eating bread, pasta, or desserts, you may be suffering from one of a few gluten-related disorders (GRDs)—two of which are gluten intolerance and celiac disease. [1]

Keep in mind, gluten intolerance and celiac disease aren’t the same. While both illnesses are caused by an inappropriate immune system response to gluten—a protein found in wheat, rye, and barley—the conditions have different physical or GI symptoms and differ in severity,

In this guide, we’ll explore everything you need to know about the differences between gluten intolerance vs celiac disease. We’ll define each condition, discuss their signs and symptoms, discuss treatment options, compare and contrast them, and discuss diagnosis options.

Signs vs. Symptoms

Before we get into the nitty-gritty of gluten intolerance vs. celiac disease, let’s define two crucial key terms that will help you navigate this article—signs and symptoms: [2]

• Signs are verifiable, objective markers of a medical condition. Healthcare providers use them to diagnose patients. Professionals identify signs via testable, quantitative data. Patients may be aware of some signs of an illness, but since many signs manifest internally, providers are generally more equipped to diagnose a condition based on signs.
• Symptoms are subjective, patient-reported health complaints. Providers sometimes use symptoms as a diagnostic tool, but symptoms are generally not used as a primary indicator of a condition.

Let’s explore an example. Imagine that you fall off of your bike, and you experience severe leg pain as a result. When you go to a hospital, you’ll likely present the following symptoms:

• Severe, acute pain
• Trouble walking
• Acute leg swelling

But, a healthcare provider will test for signs via:

• X-ray, where they’ll investigate potential internal damage
• Tactile testing, or touching the affected area and feeling for injuries

While your symptoms (and your description of the circumstances) may suggest to your provider that your leg is broken, they’ll depend on objective signs (like X-ray results) to diagnose you with a broken leg and develop a treatment plan.

What is celiac disease?

Celiac disease is a digestive and immune disorder that’s triggered when you eat gluten containing food, a protein found in a number of products like breads, beer, and even beauty supplies. [3]

Celiac disease can significantly impact the body, potentially causing: [3]

• Long-term small intestine damage
• Malnutrition
• Bone and blood complications like osteoporosis and anemia, respectively

Experts estimate that, while many people with celiac disease haven’t been diagnosed, approximately 2 million people in the US have the disease—0.6% of the US population—and about 1% of the global population has it. [4]

Celiac disease is genetic. Approximately 30% of people in the US have one of two normal gene variants (DQ2 or DQ8) that can cause celiac disease, but only 3% of this population develops the disease. [5] The condition is more common in:

• People of European descent
• Females
• People with chromosomal disorders, including, Down syndrome, Turner syndrome, and Williams syndrome

Celiac disease is often comorbid (occurring at the same time) with other conditions, such as:

• Type 1 diabetes
• Selective immunoglobulin A (IgA) deficiency
• Liver diseases like autoimmune hepatitis
• Thyroid-related diseases, including: Addison’s disease, primary hyperparathyroidism, Hashimoto's disease, and Graves’ disease

Signs and symptoms of celiac disease

Celiac disease presents with a variety of symptoms.

Digestive symptoms are the most commonly associated with the disease, and include: [5]

• Chronic diarrhea
• Constipation
• Gas
• Bloating
• Lactose intolerance
• Abdominal pain
• Nausea and vomiting
• Greasy, large, or loose stools

But, symptoms of celiac disease can present elsewhere in the body. People with the condition may also experience:

• Chronic fatigue
• Anxiety
• Bone and joint pain
• Female reproductive issues, such as infertility, miscarriages, and delayed or missed menstrual periods
• Oral maladies like dry mouth, canker sores, or a smooth, red, and shiny tongue
• Nervous system issues, including headaches, seizures, balance difficulties, and peripheral neuropathy
• Dermatitis herpetiformis, a blistering and itchy rash

Celiac disease is usually diagnosed in adults, but children with the disorder may experience specific symptoms, like:

• Tooth enamel damage
• Failure to thrive (which typically presents as difficulty gaining weight)
• Mood swings
• Slow growth and short stature
• Delayed puberty

But, it’s important to remember that many of these symptoms overlap with other conditions. So, you should confirm these symptoms with your healthcare provider, who will seek objective signs of celiac disease via testing. Some tests for celiac disease include:

• Genetic testing for the DQ2 or DQ8 genes (performed with blood tests or cheek swabs)
• Blood tests to identify:
  • Antibodies common in celiac patients
  • Celiac-related health issues, like anemia
• Skin biopsies to search for signs of dermatitis herpetiformis
• Small intestine biopsies via endoscopy

What is gluten intolerance?

Gluten related disorder (GRD), gluten intolerance—or non celiac gluten sensitivity (NCGS)—is a condition triggered by gluten consumption. [1]

Population studies of gluten intolerance haven’t been published yet, so it’s difficult to estimate how many people in the US have the condition. Gluten intolerance is typically identified after healthcare providers have ruled out any wheat allergy and celiac disease (two other GRDs).

However, providers can sometimes mistakenly diagnose irritable bowel syndrome (IBS) in patients with gluten intolerance because:

• A majority of the symptoms overlap
• Both conditions lack peer-reviewed diagnostic criteria
• Both are diagnosed via elimination

Signs and symptoms of gluten intolerance

Some symptoms of gluten insensitivity and celiac disease overlap, and both disorders can present both digestive and non-digestive symptoms. [1]

Some digestive impacts of gluten intolerance include:

• Bloating
• Abdominal pain
• Gas
• Chronic diarrhea

The most common celiac-like symptoms that aren’t related to digestion include:

• Chronic fatigue
• Headaches
• Anxiety

Because of symptom overlap, it’s important to consult with your healthcare provider if you suspect that you have gluten intolerance. They’ll search for more objective signs of the condition via testing, which could include:

• Genetic testing for the DQ2 or DQ8 genes (which are present in 50% of gluten intolerance cases)
• Blood testing to examine the IgA and IgG antibodies, which develop segments that bind to gliadin—a segment of the gluten protein—in 50% of gluten intolerance cases
• Small intestine biopsies to search for duodenal villi atrophy (damage to the walls of the small intestine)

Treatment for gluten intolerance and celiac disease

Currently, there is no cure for gluten intolerance or celiac disease, and there is only one peer-reviewed treatment option—an elimination diet. [6]

People with confirmed celiac or gluten intolerance diagnoses must completely avoid eating gluten or using products that include gluten (like some lip balms or nutrition supplements).

After confirming your diagnosis, a healthcare provider can help you:

• Establish an everyday, gluten-free meal plan
• Check product labels for gluten
• Identify non-food products that contain gluten, like some vitamin supplements, over-the-counter medications, cosmetics, and even toothpaste and mouthwash

Celiac disease or gluten intolerance patients must also take care to:

• Alert restaurants to their food allergy to prevent cross-contamination
• Prevent accidental hand-to-mouth gluten exposure. For example, Play-Doh contains gluten. Using Play-Doh without washing your hands afterward could lead to accidental gluten ingestion.

Gluten intolerance vs. celiac disease

Now that we’ve explored each disease, let’s compare and contrast some key elements of each.

Similarities

There are many similarities between gluten intolerance and celiac disease:

• Symptom overlap – Particularly in the digestive tract, celiac and gluten intolerance patients will often experience similar symptoms.
• DQ2 and DQ8 gene presence – 50% of gluten intolerance patients have the DQ2 or DQ8 gene, but nearly all celiac patients have one of the two.
• Diagnoses – Both diseases are diagnosed via blood test, cheek swab, endoscopy, or genetic testing. However, these tests are often done in gluten intolerance cases in order to rule out celiac disease.
• Treatment – Neither condition is curable, and both require complete elimination of gluten products from the diet.

Differences

Celiac disease and gluten intolerance and two distinct conditions, and healthcare providers discern between the two by investigating:

• Immune response – Celiac disease is an autoimmune disorder—the immune system incorrectly identifies gluten as a threat to the body, initiating a series of immune responses like antibody production and inflammation. Gluten intolerance is not an autoimmune disorder, but about 50% of patients will develop antibodies against a portion of the gluten protein. [7]
• Intestinal damage – One immune response, inflammation, is directly responsible for the small intestine damage that uniquely impacts celiac patients. However, even gluten intolerance patients that develop antibodies against gluten retain their non-specific immune response, so they don’t experience intestinal damage.
• Heredity – Celiac disease is more common in people who have a history of the disease in their families. While scientists are still studying gluten intolerance, no evidence currently suggests a link between family history and gluten intolerance.

Testing for gluten intolerance and celiac disease

If you suspect that you have a gluten-related disorder (GRD), you have a few options for testing:

• Elimination dieting– If you’re unsure how to test for celiac disease and other GRDs, consider eliminating gluten from your diet (be sure to talk with a healthcare provider first). Closely monitor and track your food intake and digestive symptoms. If your symptoms persist, you might have a separate condition that requires medical attention. If your digestive symptoms improve, you may have a GRD.
• Consulting with a medical provider – Your healthcare provider can perform a number of tests to determine a diagnosis.
• At-home testing – At-home test kits for celiac disease are available. With a simple finger prick, you can screen for celiac disease from the comfort of home.

Take back control of your health with at-home tests

Both celiac disease and gluten intolerance are significant medical conditions that require attention. But, they’re far from identical, and you should work together with your healthcare provider to determine your diagnosis and a treatment plan that works for your lifestyle.

With help from Everlywell, you can explore crucial information about your health without having to make an appointment or stand in line at the lab. Our at-home Celiac Disease Screening Test is simple—just collect your sample, mail it to the lab using prepaid postage, and await your digital, secure results.

Related content

How to test for celiac disease

What to do after a celiac disease diagnosis: Two experts share their tips on long term management, shopping gluten-free, and more

IBS vs. Celiac Disease vs. Gluten Sensitivity: Understanding the Differences

References

1. Non-Celiac Gluten Sensitivity: A Review. National Library of Medicine. URL. Accessed August 1, 2022.
2. Multiple Perspectives on Symptom Interpretation in Primary Care Research. National Library of Medicine. URL. Accessed August 1, 2022.
3. Definition & Facts for Celiac Disease. National Institute of Diabetes and Digestive and Kidney Diseases. URL. Accessed August 1, 2022.
4. US and World Population Clock. US Census Bureau. URL. Accessed August 1, 2022.
5. Symptoms & Causes of Celiac Disease. National Institute of Diabetes and Digestive and Kidney Diseases. URL. Accessed August 1, 2022.
6. Treatment for Celiac Disease. National Institute of Diabetes and Digestive and Kidney Diseases. URL. Accessed August 1, 2022.
7. Celiac Disease. Medline Plus. URL. Accessed August 1, 2022.