Celiac or sensitivity?

People use these words interchangeably and they are not the same thing.

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Celiac, wheat allergy, or sensitivity?

People use these words interchangeably, but they aren't the same thing.

Which one you're dealing with changes how careful you have to be, and whether a crumb matters at all. This planner is built for the strictest case, celiac disease. If you're casual about celiac, you do real damage.

Autoimmune

Celiac disease

Celiac disease isn't an allergy and it isn't an intolerance. When you eat gluten, your immune system attacks the lining of your own small intestine. Over time, that damage causes the long term problems.

The damage happens whether or not you feel anything that day. "A little bit won't hurt" is wrong for exactly that reason. It's also the hardest thing to explain to people who mean well.

How strict
Total, for life. Even trace amounts count. A shared toaster or a shared fryer is enough to cause a reaction.
How common
Roughly one in a hundred people.
Allergy

Wheat allergy

This one is a true allergy. The immune system reacts to wheat proteins, not to gluten specifically. A reaction can come on fast and it can be severe, up to and including anaphylaxis.

With a wheat allergy, "gluten free" is the wrong filter, and it's wrong in both directions. Barley and rye contain gluten but they aren't wheat. And "gluten free" on the front of a pack tells you nothing about the other allergens inside.

How strict
Strict about wheat, but what counts is different from celiac. You're reading labels for something else.
Over time
Many kids outgrow it. Celiac disease doesn't work that way.
Sensitivity

Non-celiac gluten sensitivity

People get real symptoms after eating gluten, but without the autoimmune damage of celiac disease and without the allergic reaction of a wheat allergy.

Doctors diagnose it by ruling the other two out first. Researchers still haven't settled on what causes it. For some people, other parts of wheat seem to be the trigger, not the gluten.

How strict
Usually guided by symptoms, not by damage, so trace exposure tends to matter less. Ask your doctor how strict you need to be.
Testing
No single test confirms it. Celiac disease has to be ruled out properly first.
Choice

Gluten free by preference

There's no medical reason behind this one. If you don't have one of the conditions above, cutting gluten hasn't been shown to do anything for you. Gluten free processed food also tends to carry less fiber and more sugar and fat than the food it replaces.

You still need to know about it. Some kitchens hear "gluten free" and think it's a preference they can accommodate, not a medical requirement. A lot of cross contamination starts right there.

How strict
Whatever you like. This is the group the strict ones get mistaken for.
Get tested before you cut gluten out

Celiac tests look for your body's reaction to gluten. If you've already stopped eating it, the tests can come back negative even when you do have celiac disease. You may then be asked to eat gluten again for weeks before anyone can retest you, and that's a miserable thing to hear after the fact. If you think it might be celiac, talk to a doctor before you change what you eat.

This is background information. It isn't a diagnosis and it isn't medical advice. Testing, diagnosis, and how strict your own diet needs to be are all things to work out with your doctor or a dietitian.

Next Gluten safety quiz Real situations, for kids and for adults. The quickest way to find the gaps in what you already know.