Gluten Sensitivity Versus Celiac Disease
Approximately 18 million Americans have gluten sensitivity which is about 6 times the amount of people who have Celiac disease but what's the difference between the two and how would you know if you have one? Dr. Ronnie Jankelson answers these questions and more.
Featured Speaker:
Ronnie Porat Jankelson, MD
Dr. Jankelson is a Gastroenterologist at Maimonides Medical Center in Brooklyn, NY. Dr. Jankelson completed her Residency and Fellowship in Israel and later on moved to New York to fulfill her dream of helping people with GI problems. Special interests- endoscopy and nutrition. Transcription:
Gluten Sensitivity Versus Celiac Disease
Maggie McKay: The latest research estimates that 18 million Americans have gluten sensitivity. That's six times the amount of Americans who have celiac disease. But what's the difference between the two and how would you know if you had one? To help us make sense of the difference between gluten sensitivity and celiac disease is Dr. Ronnie Jankelson, gastroenterologist at Maimonides Health. This is Maimo Med Talk. I'm your host, Maggie McKay. Thanks for joining us, doctor.
Dr. Ronnie Jankelson: Hi, Maggie. Thank you for having me.
Maggie McKay: Absolutely. Before we get into the two different conditions, can you please explain what exactly is gluten and what does it do to our bodies?
Dr. Ronnie Jankelson: So gluten is the protein component of wheat. In a healthy person, it's simply digested by the body. We use it completely and it's just another food component.
Maggie McKay: Do we need it or is it okay to go without it?
Dr. Ronnie Jankelson: We do need it, but we can definitely go without it. Again, in a healthy person with no gluten sensitivity and no celiac disease, it's part of the food in a normal diet, and there's no reason to avoid it.
Maggie McKay: Okay. What is celiac disease?
Dr. Ronnie Jankelson: Celiac disease is an immune reaction to gluten digestion. Gluten is absorbed at the small intestine. People with celiac disease develop antibodies to the gluten and create inflammation in that portion of the small intestine that absorbs the gluten.
Maggie McKay: And what is gluten sensitivity or non-celiac gluten sensitivity, NCGS?
Dr. Ronnie Jankelson: Gluten sensitivity is symptomatic response to gluten ingestion without serologic or histologic evidence of celiac disease, meaning the patient will have the same symptoms as a celiac patient, but without any evidence to that immune reaction that I mentioned,
Maggie McKay: What causes celiac disease and NCGS?
Dr. Ronnie Jankelson: Celiac disease is a genetic disease. There's no environmental component to it, either you're born with that genetic trait or not. Non-celiac gluten sensitivity is triggered by gluten obviously, but then again, there's no real reason. You cannot skip something in your diet or in your habits to avoid that.
Maggie McKay: And can lifestyle choices affect either?
Dr. Ronnie Jankelson: In the case of celiac disease, not at all. In the case of non-celiac gluten sensitivity, if a person will avoid gluten, you will avoid the symptoms.
Maggie McKay: Is there anything a person can do to decrease their chance of developing NCGS?
Dr. Ronnie Jankelson: Well, yes. A person can eat a healthy diet and avoid simple sugars. Those can sometimes lead to symptoms that are diagnosed as non-celiac gluten sensitivity, but it's actually sensitivity or reaction to those short-chain carbohydrates.
Maggie McKay: You said the magic word, doctor. Always, like what's the worst enemy? Sugar always, right? How do the symptoms of celiac disease differ from those in NCGS?
Dr. Ronnie Jankelson: Clinical symptoms, the GI symptoms are very similar. One cannot differ between the two entities just by those symptoms. Celiac disease can lead to more systemic symptoms, meaning anemia signs of malabsorption. There is a specific skin rash that is specific for celiac and will not appear in people with non-celiac gluten sensitivity and so on. But just by the GI symptoms, it's very similar and one cannot tell between the two.
Maggie McKay: That's what I was going to say. If the symptoms are similar, how does a symptomatic person know which condition they have? They don't?
Dr. Ronnie Jankelson: They don't. They should get tested. They should go and see a GI and have the right blood work done, you know, to get a diagnosis.
Maggie McKay: And what's involved in that testing? Just giving blood?
Dr. Ronnie Jankelson: Initially, yes, that would be the first step. If the blood test will indicate that the antibodies to gluten do exist, then the next step will be endoscopy and taking biopsies from the small intestine.
Maggie McKay: And so, the steps a person should take if they notice symptoms is, first, go to the doctor, see what it is, get tested, give blood. And then if they find out they have it, is there medicine to take? Or do you just avoid certain foods? How does that work? What are the treatment options?
Dr. Ronnie Jankelson: Treatment is very simple. If one is diagnosed with celiac disease, simply avoid gluten and all foods that contain gluten. With non-celiac gluten sensitivity, again, the treatment is avoiding gluten, but the diet should not be as strict as the diet of celiac patients.
Maggie McKay: Is there a cure?
Dr. Ronnie Jankelson: The diet is the cure. Yeah. Avoiding the gluten is the cure.
Maggie McKay: Wow. Okay. So there's no medicine.
Dr. Ronnie Jankelson: No, and no medicine is needed because the culprit, the reason for that inflammation is the gluten. And once the gluten is removed from the diet, there's no inflammation and no disease. I always explain it to my patients that if one avoids gluten for a while, let's say for six months and we'll redo the serology, we'll redo the blood tests, and look for those antibodies that helped us diagnose the patient to begin with, those antibodies are gone. So if there's no gluten, there's no inflammation and the end of the symptoms as well.
Maggie McKay: Wow. How common are celiac disease and NCGS?
Dr. Ronnie Jankelson: Celiac disease is easier to define. And so we are saying that about 0.5% to 1% of the population have celiac disease. Non-celiac disease diagnosis is more complex and sometimes there's misdiagnosis with IBS or other entities. And I would say 1% to 3% of the population fall under that diagnosis.
Maggie McKay: How long have we known about celiac disease? Because it seems like, I don't know, just personally, I never heard about it until maybe the last decade. Has it always been around?
Dr. Ronnie Jankelson: Yeah, celiac disease has been ongoing for a while. I think it's became more popular these days with a lot of food labeling will mention if the food contains gluten, yes or no, and people are trying to improve their diets and so gluten is being really talked about recently. But it has been there for a while.
Maggie McKay: So, I guess the good news is now there are sections in the market that offer gluten-free options. There's menu items at certain restaurants, and even some star athletes are shedding light on gluten-free diets, so that must help patients. Is there anything else you'd like to share with our audience about either condition?
Dr. Ronnie Jankelson: Yes. Super important, very important, if you suspect that you have celiac disease or non-celiac gluten sensitivity, do not change your diet before you go and see a GI. Very important because if somebody decides to go on a gluten-free diet and then goes to see a GI and get tested later on, then it's a little bit too late because once you're off the gluten, the antibodies, as I mentioned, disappear, and the diagnosis becomes impossible. So if you want to change something, go see the GI just a little bit before. And once you get the right diagnosis, then you can do whatever changes needed to be done.
Maggie McKay: Okay. Is it easy to live a gluten-free life?
Dr. Ronnie Jankelson: I mean, hard for me to say, because I don't practice that, but I think it's manageable. And even if you are aware and if you know that that's the right diagnosis for you, then I think it's easier to keep that. But if you're just guessing, then you know, it's harder to stick to that diet.
Maggie McKay: Thank you so much, doctor, for your time and sharing your knowledge. I appreciate it.
Dr. Ronnie Jankelson: Thank you so much. Thank you for having me
Maggie McKay: To learn more or to make an appointment with one of our gastroenterologists, please call 718-283-5900 or visit maimo.org, M-A-I-M-O.org/treatments-care/gastroenterology. This has been my Maimo Med Talk. I'm your host, Maggie McKay. Be well.
Gluten Sensitivity Versus Celiac Disease
Maggie McKay: The latest research estimates that 18 million Americans have gluten sensitivity. That's six times the amount of Americans who have celiac disease. But what's the difference between the two and how would you know if you had one? To help us make sense of the difference between gluten sensitivity and celiac disease is Dr. Ronnie Jankelson, gastroenterologist at Maimonides Health. This is Maimo Med Talk. I'm your host, Maggie McKay. Thanks for joining us, doctor.
Dr. Ronnie Jankelson: Hi, Maggie. Thank you for having me.
Maggie McKay: Absolutely. Before we get into the two different conditions, can you please explain what exactly is gluten and what does it do to our bodies?
Dr. Ronnie Jankelson: So gluten is the protein component of wheat. In a healthy person, it's simply digested by the body. We use it completely and it's just another food component.
Maggie McKay: Do we need it or is it okay to go without it?
Dr. Ronnie Jankelson: We do need it, but we can definitely go without it. Again, in a healthy person with no gluten sensitivity and no celiac disease, it's part of the food in a normal diet, and there's no reason to avoid it.
Maggie McKay: Okay. What is celiac disease?
Dr. Ronnie Jankelson: Celiac disease is an immune reaction to gluten digestion. Gluten is absorbed at the small intestine. People with celiac disease develop antibodies to the gluten and create inflammation in that portion of the small intestine that absorbs the gluten.
Maggie McKay: And what is gluten sensitivity or non-celiac gluten sensitivity, NCGS?
Dr. Ronnie Jankelson: Gluten sensitivity is symptomatic response to gluten ingestion without serologic or histologic evidence of celiac disease, meaning the patient will have the same symptoms as a celiac patient, but without any evidence to that immune reaction that I mentioned,
Maggie McKay: What causes celiac disease and NCGS?
Dr. Ronnie Jankelson: Celiac disease is a genetic disease. There's no environmental component to it, either you're born with that genetic trait or not. Non-celiac gluten sensitivity is triggered by gluten obviously, but then again, there's no real reason. You cannot skip something in your diet or in your habits to avoid that.
Maggie McKay: And can lifestyle choices affect either?
Dr. Ronnie Jankelson: In the case of celiac disease, not at all. In the case of non-celiac gluten sensitivity, if a person will avoid gluten, you will avoid the symptoms.
Maggie McKay: Is there anything a person can do to decrease their chance of developing NCGS?
Dr. Ronnie Jankelson: Well, yes. A person can eat a healthy diet and avoid simple sugars. Those can sometimes lead to symptoms that are diagnosed as non-celiac gluten sensitivity, but it's actually sensitivity or reaction to those short-chain carbohydrates.
Maggie McKay: You said the magic word, doctor. Always, like what's the worst enemy? Sugar always, right? How do the symptoms of celiac disease differ from those in NCGS?
Dr. Ronnie Jankelson: Clinical symptoms, the GI symptoms are very similar. One cannot differ between the two entities just by those symptoms. Celiac disease can lead to more systemic symptoms, meaning anemia signs of malabsorption. There is a specific skin rash that is specific for celiac and will not appear in people with non-celiac gluten sensitivity and so on. But just by the GI symptoms, it's very similar and one cannot tell between the two.
Maggie McKay: That's what I was going to say. If the symptoms are similar, how does a symptomatic person know which condition they have? They don't?
Dr. Ronnie Jankelson: They don't. They should get tested. They should go and see a GI and have the right blood work done, you know, to get a diagnosis.
Maggie McKay: And what's involved in that testing? Just giving blood?
Dr. Ronnie Jankelson: Initially, yes, that would be the first step. If the blood test will indicate that the antibodies to gluten do exist, then the next step will be endoscopy and taking biopsies from the small intestine.
Maggie McKay: And so, the steps a person should take if they notice symptoms is, first, go to the doctor, see what it is, get tested, give blood. And then if they find out they have it, is there medicine to take? Or do you just avoid certain foods? How does that work? What are the treatment options?
Dr. Ronnie Jankelson: Treatment is very simple. If one is diagnosed with celiac disease, simply avoid gluten and all foods that contain gluten. With non-celiac gluten sensitivity, again, the treatment is avoiding gluten, but the diet should not be as strict as the diet of celiac patients.
Maggie McKay: Is there a cure?
Dr. Ronnie Jankelson: The diet is the cure. Yeah. Avoiding the gluten is the cure.
Maggie McKay: Wow. Okay. So there's no medicine.
Dr. Ronnie Jankelson: No, and no medicine is needed because the culprit, the reason for that inflammation is the gluten. And once the gluten is removed from the diet, there's no inflammation and no disease. I always explain it to my patients that if one avoids gluten for a while, let's say for six months and we'll redo the serology, we'll redo the blood tests, and look for those antibodies that helped us diagnose the patient to begin with, those antibodies are gone. So if there's no gluten, there's no inflammation and the end of the symptoms as well.
Maggie McKay: Wow. How common are celiac disease and NCGS?
Dr. Ronnie Jankelson: Celiac disease is easier to define. And so we are saying that about 0.5% to 1% of the population have celiac disease. Non-celiac disease diagnosis is more complex and sometimes there's misdiagnosis with IBS or other entities. And I would say 1% to 3% of the population fall under that diagnosis.
Maggie McKay: How long have we known about celiac disease? Because it seems like, I don't know, just personally, I never heard about it until maybe the last decade. Has it always been around?
Dr. Ronnie Jankelson: Yeah, celiac disease has been ongoing for a while. I think it's became more popular these days with a lot of food labeling will mention if the food contains gluten, yes or no, and people are trying to improve their diets and so gluten is being really talked about recently. But it has been there for a while.
Maggie McKay: So, I guess the good news is now there are sections in the market that offer gluten-free options. There's menu items at certain restaurants, and even some star athletes are shedding light on gluten-free diets, so that must help patients. Is there anything else you'd like to share with our audience about either condition?
Dr. Ronnie Jankelson: Yes. Super important, very important, if you suspect that you have celiac disease or non-celiac gluten sensitivity, do not change your diet before you go and see a GI. Very important because if somebody decides to go on a gluten-free diet and then goes to see a GI and get tested later on, then it's a little bit too late because once you're off the gluten, the antibodies, as I mentioned, disappear, and the diagnosis becomes impossible. So if you want to change something, go see the GI just a little bit before. And once you get the right diagnosis, then you can do whatever changes needed to be done.
Maggie McKay: Okay. Is it easy to live a gluten-free life?
Dr. Ronnie Jankelson: I mean, hard for me to say, because I don't practice that, but I think it's manageable. And even if you are aware and if you know that that's the right diagnosis for you, then I think it's easier to keep that. But if you're just guessing, then you know, it's harder to stick to that diet.
Maggie McKay: Thank you so much, doctor, for your time and sharing your knowledge. I appreciate it.
Dr. Ronnie Jankelson: Thank you so much. Thank you for having me
Maggie McKay: To learn more or to make an appointment with one of our gastroenterologists, please call 718-283-5900 or visit maimo.org, M-A-I-M-O.org/treatments-care/gastroenterology. This has been my Maimo Med Talk. I'm your host, Maggie McKay. Be well.