Gluten Intolerance and Celiac Disease: A Discussion with Gastroenterologist Dr. Jack Ramage

February 27, 2014

Going gluten-free to get healthier has become a growing trend, with numerous books, celebrities and media outlets touting the health benefits of a diet free of gluten. While those with gluten sensitivity may benefit from eliminating it from their diet to reduce intestinal discomfort and other symptoms, it’s important to note that the classic form of gluten intolerance known as celiac disease is a serious autoimmune digestive disease.

How does gluten cause problems?

Gastroenterologist Dr. Jack Ramage with Hanover Gastroenterology, part of New Hanover Regional Medical Center Physician's Group, explains that in the case of celiac disease, gluten – a protein found in wheat, barley and rye – creates an immune reaction in the body that causes inflammation of the small intestines. “This inflammation can cause symptoms in the GI tract like diarrhea, bloating, pain and even anemia,” said Dr. Ramage. “Celiac disease can affect any organ in the body – thyroid disease, thinning of the bones, migraine headaches and other neurological symptoms – all can be related to celiac disease.”

What is the difference between celiac disease and gluten sensitivity?

Celiac disease is an autoimmune digestive disease that damages the villi of the small intestine and interferes with absorption of nutrients from food, which can lead to malnourishment. If left untreated, serious complications such as other autoimmune diseases, osteoporosis, thyroid disease, and cancer can arise.

As Dr. Ramage explains, only about one percent of the population is affected by celiac disease. The less severe form of gluten sensitivity known as non-celiac gluten intolerance affects approximately 18 million people, or six percent of the population, according to research from the Center for Celiac Research & Treatment.

While the symptoms of gluten sensitivity, such as fatigue, “foggy mind,” diarrhea, depression and joint pain can be similar to those of celiac disease, the clinical outlook is less severe. Gluten sensitivity does not result in the damage to the intestinal wall that characterizes celiac disease, and therefore does not cause the kind of serious long-term consequences that untreated celiac disease does.

Treatment Options

Because the symptoms of gluten intolerance and celiac disease are similar, it’s important to speak to your doctor if you believe you may have celiac disease. The most common symptoms include stomach pain or discomfort, bloating, diarrhea and anemia. “Celiac disease can be screened for with a simple blood test and if abnormal, it can be confirmed with an upper endoscopy,” says Dr. Ramage.

Once a patient has been diagnosed, they must change their diet to avoid gluten. “Common foods we think of that contain gluten are pastas, baked goods, breads and processed foods. But other less well-known sources of gluten must also be avoided, such as supplements, some of which have fillers that contain gluten, and beer and ales,” says Dr. Ramage.

“So the treatment is simple, but difficult, because it’s a dramatic change in diet and lifestyle.” But as he points out, with the increase in awareness of gluten intolerance and celiac disease, many gluten-free choices are now widely available in restaurants and grocery stores.

Dr. Ramage is a member of Hanover Gastroenterology - NHRMC Physician Group. For a free directory of NHRMC Physician Group partners, call 910.342.3400 or visit for a full list of NHRMC physicians.