I have eaten gluten free for over two years now and I often get questions about the difference between Celiac disease, an allergy, an intolerance, or an insensitivity. With all these terms it can get quite confusing about how someone should know to what degree they are susceptible to food reactions. Through this article I hope to clarify some of these terms and help people understand what foods they should avoid.
When people think of the word allergy, they often imagine an anaphylactic reaction. Or at least I do on that Christmas Eve night when my brother ate pine nuts and his throat closed up until we stabbed him with an Epi-pen. Yes, allergies can be life threatening, but they can also have much different symptoms for different people even for a food like peanuts.
Many people believe that food allergies are defined by the mechanism underlying the reaction. With most food allergies, the IgE antibody reaction is involved. According to Dr. Stephen Wangen, the author of Healthier Without Wheat, "IgE antibodies are produced by the immune system and can lead to histamine release, which causes inflammation." However, if someone only has elevated IgE antibodies, a standard allergist won't diagnose them with a food allergy. Instead our medical community has become stuck in the paradigm of labeling an allergy if we only have one of these four symptoms: anaphylaxis, hives, asthma, or eczema. That is a very narrow viewpoint and can deter someone who has one of the hundreds of other symptoms from getting their allergy addressed.
The definition of a food intolerance is also skewed. An intolerance is encompassed for two foods in the medical community, a gluten intolerance or lactose intolerance, although the definition of these two reactions are very different.
Lactose intolerance is a deficiency in the enzyme needed to digest lactose. Lactose is a sugar in milk so if you do not produce enough of the enzyme called lactase (breaks down lactose) one can end up with digestive distress (rumbling stomach, bloating, etc.). Most people with lactose intolerance either avoid dairy products or take the enzyme to help digest milk products.
A gluten intolerance is a much different animal. Unlike lactose intolerance, it has nothing to do with an enzyme deficiency. It is an immune reaction that produces inflammation and, in some cases, it can be life threatening. For people with Celiac Disease, it is actually an autoimmune reaction, which means every time one ingests wheat their body attacks itself and destroys the gut even more. This can cause problems like Leaky Gut Syndrome, among others. A gluten intolerance involves the IgA and IgG antibodies, but also other parts of the immune system. It can be connected to countless other symptoms from anxiety to sluggishness. Personally, I believe I can categorize myself as having a gluten intolerance because whenever I ingest gluten I end up with digestive problems, a form of dry skin on my upper arms, and an overhanging fatigue. But, when people ask me do I tell them I have a gluten intolerance? No, usually I go for the word "allergy" because it sounds more formal and people understand its severity. The problem with the word intolerance is that it is just too broad of a term that means "things aren't working out well". If someone understands lactose intolerance, but not gluten intolerance, they just assume that gluten intolerance can be cured by taking enzyme pills and that it isn't threatening. This is not the case as it can be the antagonist to a host of other symptoms.
Finally, we turn to the word sensitivity. It is the most understood definition. It is when someone knows they don't react well so a certain food. For the medical community, they don't know what to call non-celiac gluten reactions so they are beginning to call it gluten sensitivities. This works, but it is also really broad because technically, someone with Celiac disease has a "sensitivity" to wheat, it is just more severe.
So as I was flipping through the wonderful magazine, Simply Gluten-Free, I found an article trying to sort it all out and how they sorted out the confusions. In 2001, experts in both the US and Europe came up with new definitions for food allergies. They started with the word sensitivity as an umbrella term which encompasses all food reactions. It then breaks down into two categories: non-immune reactions and immune reactions. All immune reactions are essentially a type of allergy (anything from wheat to peanuts). The immune reactions are categorized based on the antibodies that are elevated-- for gluten this is IgA and IgG antibodies. For a peanut allergy, that antibody is IgE. There are others as well.
For non-immune reactions we have enzyme deficiencies like lactose intolerance to MSG sensitivity. For now it is a broad category because there is a lot of poorly understood reactions.
Below is a chart I drew to understand the correct way to address food reactions. Please spread the word so that our community can properly understand how to discuss food sensitivities and the confusion is sorted out. Hope this article was helpful!