Sensitivity and Intolerance
You may be one of the many people reading this book, because you suspect or have been told that you have a wheat or gluten sensitivity or intolerance. But what do those terms mean, how do they differ from an allergy, and most important, can you trust them as a diagnosis?

The terms sensitivity and intolerance are the source of much confusion. Is it any wonder, when even one of the most well-respected medical dictionaries doesn't provide a clear distinction? Often used interchangeably, both terms basically mean that your body doesn't react well to a particular food, and you should, therefore, avoid that food. Notice that I said "should" not "must."

This fuzzy interpretation of the words sensitivity and intolerance poses a problem. I don't "tolerate" bratty kids very well, but if my best client's CEO invites his bratty kid to attend our holiday party, I'll tolerate him just fine, thank you very much. In other words, I can stand him if I want to or really have to. Does the same logic apply to a wheat or gluten intolerance or sensitivity? Yes, if that's what you have and not something more severe. In most cases, though, the terms wheat and gluten intolerance or sensitivity are used when the condition is, in fact, celiac disease.

Celiac Disease: An Autoimmune Disorder
Years of research and talking to people around the world who "don't do well with wheat" have taught me that many people who think they have food allergies or sensitivities actually have celiac disease. It's not surprising that people don't know they have it. After all, most people have never heard of it, and doctors rarely diagnose it (you can't diagnose what you don't test for). However, celiac disease is more common than you might imagine, found in approximately one out of every 150 people.

Simply stated, celiac disease is a genetic intolerance to gluten. Unlike an allergy, celiac disease is an autoimmune condition, meaning that the body essentially turns against and "destroys" itself. Normally, the cells of the immune system can distinguish between body tissues and foreign organisms such as bacteria, viruses and other invaders. It's the job of the immune system to fight off these invaders, and it does so with antibodies produced by the body. In the case of an autoimmune disorder, though, the immune system mistakenly interprets the body's own tissues as foreign and launches an all-out attack on them.

Collectively, autoimmune diseases strike women three times more often than men. According to a recent study, autoimmune diseases are among the top 10 leading causes of death among American women age 65 and younger.

The American Autoimmune Related Diseases Association (AARDA) points out that autoimmune diseases are frequently misdiagnosed or never diagnosed at all. The fact that these diseases often have seemingly unrelated symptoms and unpredictable patterns of flare-ups and remissions and are often not well understood even by physicians are cited as reasons for late or misdiagnosis. According to the AARDA, 45 percent of patients who are diagnosed with serious autoimmune disease are initially written off as "chronic complainers" and not given proper treatment.

The "Compromised" Immune System?
When people are diagnosed with an autoimmune disorder, they often assume that their immune system is compromised, making them more susceptible to colds, viruses and other illnesses. Not true. Someone who has an autoimmune condition has an overactive immune system, not an under-active one. In most people, gluten doesn't trigger any type of immune response. But in people with celiac disease, certain cells in the intestines react against toxic portions of the gluten molecule and launch an attack on the intestinal wall, specifically affecting the villi of the small intestine. As mentioned earlier, the villi are small, hairline projections that act to increase the surface area of the small intestine, providing more opportunity for nutrients to be absorbed and digested into the bloodstream.

When celiacs eat gluten, the villi become damaged, and the harmful effects are cumulative. Damage to the villi begins at the tips and eventually blunts the villi so much that they become ineffective at absorbing the nutrients from digested food.

Villous bluntin generally starts just below the stomach in the duodenum – the part of the small intestine that connects to the stomach. People diagnosed in the earliest stages of celiac disease have less damage and therefore generally have several feet of small intestine left to absorb nutrients. The unaffected portion of the small intestines may be large enough that the person never experiences diarrhea or any of the other classic symptoms. This is one of the reasons that diagnosing celiac disease can be a difficult task.

Years ago it was thought that only people with the classic symptoms of diarrhea, abdominal distension, cramping and other gastrointestinal distress were candidates for a diagnosis of celiac disease. Today we know that the symptoms of celiac disease can be mild or severe and be all over the board, including one or all of those listed at the beginning of this chapter. Symptoms may not even include classic gastrointestinal manifestations, and in fact, many people with celiac disease have no symptoms whatsoever. We also know that even in those people without symptoms, internal damage can be serious and can lead to other complications, and that early detection has crucial implications in their future health.

From a lifestyle standpoint, the most important distinction between celiac diseases and other conditions is that if you have a food allergy or intolerance and you eat wheat (assuming you can stand the consequences), you won't cause long-term damage. Not so with celiac disease. Celiacs must adhere to a strict, gluten-free diet for life. If they continue to eat gluten, they put themselves at risk for malnourishment (the consequence of nutritional deficiencies) and a variety of other, sometimes serious, conditions.

Muddy Waters – The Wheat/Gluten-Sensitivity Spectrum
If you're still confused about the difference between an allergy, a sensitivity, an intolerance and celiac disease, you're not alone. Even the world's leading medical researchers can't seem to draw clear lines between the four. They do agree that there's a huge (and growing) spectrum of sensitivity, ranging from simple food allergies to celiac disease.

For the purposes of this book, we will use the terms as follows:

Sensitivity: A reaction to wheat/gluten due to an unknown or undiagnosed cause; an umbrella term referring to allergy, intolerance and disease. In a sensitive person, eating wheat or gluten will cause distress, but because the cause of sensitivity is unknown, long-term consequences may result.

Allergy: A response in which the body identifies wheat or gluten as an allergen, produces IgE antibodies and triggers an allergic response.

Intolerance: An inability to tolerate wheat or gluten, with long-term consequences if wheat or gluten are ingested. Celiac disease is a gluten intolerance.

Celiac Disease: A genetic intolerance to gluten. Long-term consequences, sometimes severe, can result if gluten is ingested.

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