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Excerpt from the Living Gluten-Free Answer Book
What is gluten-intolerance and celiac disease?
Defining gluten-intolerance and celiac disease begins with understanding one basic human function: digestion. A miraculous process of design, the process of digestion takes the foods and beverages we consume, breaks them down, extracts the nutrients, and makes them transportable to nourish our bodies. But like any other process of the human body, digestion can malfunction.
Celiac disease is an autoimmune digestive disorder that causes an inability to digest a specific protein known as gluten. Gluten is found in the cereal grain families of wheat, barley, and rye. This inability to process is due mostly to a fragment of gluten known as gliadin and begins in the small intestine, the place responsible for much of the digestive and absorption process of foods. Celiac disease is considered to be full-blown gluten-intolerance.
The body is naturally designed to defend itself from foreign or "non-self" invaders to keep healthy. But an autoimmune disease is a condition where the body is tricked into attacking itself, thinking that protein and tissues of the body are "anti-self." In the case of celiac disease, the small intestinal wall lined with villi becomes the victim of the body's self-attack and is visibly damaged.
To illustrate, envision a healthy small intestinal wall lined with little, protruding, fingerlike hairs known as villi. Healthy villi act as the body's welcoming committee for food, granting the entry of necessary nutrients to the rest of the body for survival. But for a body that views gluten as an "anti-self" or foreign substance, the body, or specifically the intestinal wall, turns against itself. The villi respond by refusing entry of gluten through the small intestine. This continual mode of attack on gluten, each time it's consumed, causes inflammation of the villi. With continued consumption of gluten, the villi "flatten," making the surface area of the small intestinal wall abnormally smooth and no longer able to properly digest and absorb all of the valuable nutrients from food as it was designed to do. As a result, the body suffers from a state of malabsorption, and it can experience a multi-faceted range of physically uncomfortable symptoms and long-term complications. This state of intestinal distress is known as celiac disease.
Can you be gluten-intolerant and not celiac?
Yes. While celiac disease is gluten-intolerance to the fullest extent, gluten-intolerance is not necessarily celiac disease. Only a small portion of those who are gluten-intolerant have celiac disease. To accurately define and understand your individual relationship with gluten, it's important to grasp the important distinction between celiac disease, gluten-intolerance, and gluten-sensitivity because they are three different, though similar, conditions.
If you have celiac disease, you are gluten-intolerant. Celiac disease is full-blown gluten-intolerance that usually manifests in physical damage of the small intestine (i.e., flattened villi). You can actually see celiac disease through a biopsy of the small intestine, which is typically considered to be the ultimate diagnosis for the disease. The intestinal wall appears smooth and lacks the bumpy, fingerlike protrusions known as healthy villi.
On the other hand, you can be gluten-intolerant-and therefore gluten-sensitive-but not have celiac disease. While nonceliac gluten-intolerance produces antibodies to gluten and results in many of the same physical symptoms and complications associated with celiac disease, it does not result in physical damage of the small intestinal villi. You can accurately label yourself as gluten-intolerant if you experience uncomfortable symptoms as a result of consuming gluten, and if your symptoms disappear when gluten is removed permanently from your diet. Nonceliac gluten-intolerance symptoms are no less painful or important to treat than celiac disease; your villi are simply not flattened (damaged) as a result of your nonceliac gluten-intolerance.
Then what is gluten sensitivity?
Gluten sensitivity is often used as an umbrella term for anyone who reacts negatively to gluten, including those with celiac disease. But gluten-sensitivity is the "soft" version, compared to the "hard" versions of celiac disease and gluten-intolerance. You can be sensitive to gluten, but not necessarily be gluten-intolerant. Unlike celiac disease and gluten-intolerance, with gluten-sensitivity you can experience fleeting gastrointestinal discomfort or other annoying symptoms, but there is no dramatic physical change when gluten is either consumed or removed from the diet. Dramatic is the operative word. Gluten-sensitivity may encourage you to eat less gluten in your diet to feel better, but your symptoms are not as full-blown as the symptoms associated with celiac disease and gluten-intolerance. With gluten-sensitivity, you may choose not to eliminate gluten entirely from your diet and merely accept the occasional discomfort. Gluten-sensitivity may not medically require the removal of gluten from the diet, whereas celiac disease and gluten-intolerance do.
What is dermatitis herpetiformis?
If you are diagnosed with dermatitis herpetiformis, you have a form of celiac disease, but your small intestine may not receive the damage. Where celiac disease damages the small intestine, dermatitis herpetiformis wreaks havoc with the skin. Characterized by a severe skin rash that is extremely itchy, dermatitis herpetiformis is distinguished from other rashes with its own brand of blisters and lesions often produced by the incessant scratching of the sufferer. The rash can occur anywhere on the body, but is most found on extremities like the elbows and knees. The condition is diagnosed through a skin biopsy using a sample from right next to a lesion, but not directly from the lesion itself.
As with celiac disease, dermatitis herpetiformis is an autoimmune disorder that erupts with the ingestion of gluten; even the smallest trace can produce a severe reaction in extremely sensitive individuals. Those with dermatitis herpetiformis are also more prone to bone disease, as well as the same host of autoimmune disorders that individuals with celiac disease can be predisposed to developing. While dermatitis herpetiformis results in extreme skin irritation, it is also possible to experience intestinal wall damage-a two-fold assault on the body.