Q. What is the difference between celiac disease and gluten intolerance? Is one more serious than the other?
A. The strict definition of celiac disease — positive antibodies to gliadin, intestinal endomysium, and tissue transglutaminase, together with the presence of HLA-DQ2 or HLA-DQ8 genes and an intestinal biopsy that shows at least 20-25 CD3 cells per 100 epithelial cells — will account for about 75-80% of all those sensitive to gluten. It must be noted, however, that there are injurious grain proteins that cause damage and produce symptoms by mechanisms that are as yet obscure. As well, many other gene markers for grain-mediated injury have been described, thus placing many into the category of gluten intolerant, but not truly having celiac disease. We do know the consequences of untreated celiac disease — an increased risk for lymphomas and other solid tumors, along with a host of associated auto-immune, neurological and endocrine diseases. It is unclear whether other people who are not celiacs but clearly cannot tolerate gluten are at risk for any other associated diseases. If you test negative for the strict criteria for celiac disease, but still cannot tolerate gluten, there is no harm in keeping to a gluten-free diet.
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