It’s easy to feel confused when you hear the terms: celiac disease, non-celiac wheat sensitivity, wheat allergy. What do they mean? What are the differences between them?

A lot, it turns out. But the one thing they do have in common is they are medical issues that can be treated through diet. Whether it’s an eating plan that eliminates gluten or wheat will differ by diagnosis. Here’s a guide to help you better understand the differences between these conditions.

Dietary Problems with Gluten and Wheat

• Celiac Disease

  Approximately 1 out of 100 people have the genetic autoimmune condition known as celiac disease. There is currently no cure. A lifelong avoidance of any foods containing gluten must be strictly adhered to, as the body’s reaction to any ingested gluten causes a flattening of the cells lining the small intestine. This in turn leads to nutrient malabsorption and other serious health issues. Gluten is a protein found in wheat, barley, and rye, as well as any products or hybrids made from these grains.

  There are more than 300 identified symptoms associated with this disease, including behavioral changes, stunted growth, anemia, infertility, and gastrointestinal issues (bloating, abdominal pain, diarrhea, and constipation). With such a large number of associated symptoms, diagnosing this disease can be challenging—combined with the fact that a significant amount of those with the disease may have few or no symptoms.

  According to the Celiac Disease Center at Columbia University Medical Center, “Anyone who suffers from an unexplained, stubborn illness for several months should consider celiac disease a possible cause and be properly screened for it.” Approximately 83 percent of those with celiac disease remain undiagnosed.  

• Non-Celiac Wheat Sensitivity

  Neither an allergy nor an autoimmune reaction, non-celiac wheat sensitivity (NCWS) is a not-well-understood condition in which a person experiences intestinal and extra-intestinal symptoms triggered by gluten ingestion.

  In 2012, an internationally recognized group of celiac disease experts classified the condition as being separate from celiac disease. Some studies indicate that wheat components other than gluten may cause symptoms, so the term non-celiac wheat sensitivity has been suggested as opposed to non-celiac gluten sensitivity.

  Depression, bloating, abdominal pain, diarrhea, constipation, headaches, chronic fatigue, and bone or joint pain are symptoms of both celiac disease and NCWS. Symptoms generally appear hours or even days after gluten has been consumed for those with NCWS. When gluten is removed from the diet, the person improves and symptoms resolve.

  Although many of the symptoms are similar to those of celiac disease, individuals with NCWS do not test positive for celiac. There are no biomarkers or tests to identify NCWS. Celiac disease, wheat allergy, and any other possible reasons for symptoms are first ruled out. A gluten-free diet is then followed and if improvement is observed, gluten sensitivity may be the diagnosis.

  It was once believed that those with NCWS did not experience intestinal damage. However, in July 2016, researchers at Columbia University Medical Center published a study confirming that wheat exposure for those with NCWS triggered a systemic immune reaction and accompanying intestinal cell damage. It’s believed that the number of people affected by this condition is equal to or may even exceed the number of those with celiac disease.

• Wheat Allergy

  An immune reaction to any of the multitude of proteins found in wheat, a wheat allergy occurs when the body’s T-cells deliver immunoglobulin E (IgE) antibodies to “attack” any ingested wheat. The rest of the body receives an alert that there is an issue. Symptoms ensue within minutes to hours, and can include nausea, abdominal pain, itching, swelling of the lips and tongue, breathing issues, hives, or anaphylaxis—a life-threatening reaction.

  Those with a wheat allergy must eliminate all forms of wheat from their diet. They can, however, eat gluten from nonwheat sources.

  A diagnosis for wheat allergy is conducted through skin prick tests, a food elimination diet, and a wheat-specific IgE blood test. A child diagnosed with a wheat allergy may outgrow it, but an adult with the allergy tends to have it for life.

Most of us who care about eating healthfully know to look for the words “whole wheat” on product labels, but there’s a growing movement—and not just among people with gluten allergies—to cut back on or cut out wheat entirely.

Cut out wheat? But people have been eating wheat for centuries! Do we really need to avoid it to stay healthy?

Well, say some experts, yes . . . and no.

The bad news

Americans consume 55 pounds of wheat flour each year, writes physician and author Mark Hyman, MD. And, he adds, “this is not the wheat your great-grandmother used to bake her bread. It is FrankenWheat—a scientifically engineered food product developed in the last 50 years.”

The wheat of today has been crossbred and hybridized to make it drought- and fungi-resistant, and to drastically increase yield per acre. The result? Wheat that contains 1) high levels of a starch called amylopectin A, which dramatically raises blood sugar levels and encourages overeating; 2) a “super gluten” that causes inflammation, which can trigger autoimmune diseases, obesity, diabetes, irritable bowel, cancer, and numerous other conditions; and 3) highly addictive polypeptides that keep you craving more and more wheat products.

“The prevailing notion that cutting fat and eating whole grains will make you healthy is not only wrong, it’s destructive,” cardiologist William Davis, author of Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health, said in an interview with Canadian magazine Maclean’s. Dr. Davis likens the choice of organic whole wheat bread over white bread to selecting filtered rather than nonfiltered cigarettes—it’s a matter of the lesser of two evils.

Gluten is a combination of proteins found in wheat, rye, and barley. For some Americans, possibly as many as 1 in 133, gluten is a problem.

The reason is a genetically based autoimmune condition called celiac disease. In this condition, the body reacts to proteins in gluten as though they were harmful. The immune responds by producing inflammation within the small intestine.

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Inflammation is normally a healthful mechanism for fighting off harmful invaders, but in the case of celiac disease, it is misdirected. The inflammation damages or destroys villi, the tiny, fingerlike protrusions lining the walls of the intestines. Without healthy villi to deliver nutrients into the bloodstream, malnourishment results—no matter how much food one eats.

The malnourishment caused by celiac disease can lead to diarrhea, gas, bloating, constipation, or any of more than 300 other symptoms—and possibly to more serious problems such as anemia, infertility, or cancer.

Getting Diagnosed

If your physician suspects you might have celiac disease, diagnosis typically takes place in three steps. The first is usually a blood analysis that tests for high levels of certain antibodies typical of celiac. If the blood test results warrant further examination, your doctor may recommend an intestinal biopsy, an outpatient procedure that removes a small amount of intestinal tissue for evaluation. Should the biopsy reveal damaged villi, then the last and conclusive test is undertaken: the gluten-free diet.

A celiac patient who follows a gluten-free diet—and stays away from wheat, rye, and barley in all their forms—stands an excellent chance of preventing further damage to the intestine wall. The villi will heal or grow back and nutritional deficiencies can be corrected.

Gluten Sensitivity

What if the diagnosis is negative, yet you still feel uncomfortable after eating bread, cereals, or pasta? As many as one person in seven experiences what’s called a wheat intolerance. Unlike celiac disease, the symptoms of wheat intolerance may not appear for two or three days after ingestion, and that makes the condition hard to diagnose.

Symptoms may include bloating, cramping, diarrhea, flatulence, or constipation. Skin rashes are a possibility, as well as food cravings, tiredness, chronic fatigue, or just feeling generally unwell. Even depression can stem from wheat intolerance.

But remember: Other food allergies can also produce uncomfortable symptoms. An elimination diet recommended by your doctor will help you sort out the possibilities.

Where to Start

If you decide to go gluten free, the best way to begin is to remove from your diet wheat, barley, rye, or hybrids of those grains. All other foods are safe, with the possible exception of oats. Unless they are processed in a gluten-free facility, oats can easily become cross-contaminated—with gluten finding its way into oats during harvesting, shipment, or processing. (For that reason, several producers of oats certify their products to be “Gluten Free.”)

But giving up wheat leaves lots of tasty alternatives that can be made into a host of delicious meals. Consider, for example, corn, millet, rice, sorghum, amaranth, quinoa, buckwheat, wild rice, and teff, a grain native to Ethiopia. (In this country, it’s possible to find teff in the form of either grain or flour.) Also give puffed rice, cream of rice, rice flakes, cornmeal, hominy, and grits a try.

Enjoy the ever-expanding variety of gluten-free foods now available. Be sure to take a look at the breads, bread crumbs, flours, cakes, cookies, cereals, pizza dough, and baking mixes labeled “Gluten Free” that are becoming ever more popular, even among those without a wheat sensitivity.

Many national brands are now carrying gluten-free products that make life easy for consumers wishing to take the gluten out of their diets.