Celiac disease – what it actually is, how it’s diagnosed, and how it differs from gluten sensitivity and wheat allergy

In short: what is celiac disease?

Celiac disease is an autoimmune condition: in people with a genetic predisposition, eating gluten causes the immune system to attack the lining of the small intestine. Gluten is a protein found in wheat, barley and rye. Israeli regulations also include oats on the list – mainly because oats tend to be contaminated with gluten from other grains.

The inside of the intestine is lined with a kind of “carpet” of tiny projections called villi, and that’s where the body absorbs most of its nutrients. In people with celiac who keep eating gluten, the villi become inflamed and flattened, and absorption suffers. That’s why celiac can also show up as problems that seem to have nothing to do with the gut, such as anemia or ongoing fatigue.

It’s important to understand that celiac is not an allergy and not a passing “intolerance”. It’s a chronic disease, and commonly cited estimates put it at around one percent of the population – with many of those people not even aware they have it. It clearly runs in families, so when someone is diagnosed, first-degree relatives are usually advised to consider getting tested too.

What does it feel like? Symptoms come in many forms

One of the confusing things about celiac is that there’s no “single picture”. Some people have obvious symptoms, some only experience fatigue or low iron, and some are diagnosed almost by chance, without any particular complaints. Signs that doctors pay attention to include:

• ✓Digestive symptoms: diarrhea or constipation, bloating, gas and abdominal pain
• ✓Iron-deficiency anemia that doesn’t improve as expected, and ongoing fatigue
• ✓Weight loss, and in children – delayed growth or puberty
• ✓Recurring mouth ulcers and defects in tooth enamel
• ✓A very itchy skin rash (dermatitis herpetiformis) that’s linked to celiac
• ✓Joint pain, headaches and mood changes

💡 This list is meant to raise awareness, not to diagnose. If something here sounds familiar, that’s a good reason to see your family doctor – not to change your diet on your own.

How is celiac diagnosed?

Diagnosis usually starts with a simple blood test that looks for antibodies typical of celiac. If the result is suspicious, the next step for most adults is a gastroscopy – a procedure in which a thin tube with a camera is inserted and small samples are taken from the small intestine. A pathologist examines them under a microscope, looking for the characteristic damage to the villi. In children, according to certain professional guidelines, there are cases where doctors rely on blood tests alone – that’s a decision for a pediatric gastroenterologist.

Sometimes a genetic test for genes called DQ2 and DQ8 is also used. It’s mainly useful for ruling celiac out: if you don’t have these genes, the chance that you have celiac is very low. On the other hand, having the genes doesn’t mean you have the disease – they’re common in healthy people too.

💡 The most important rule: don’t cut out gluten before getting tested. Once you stop eating gluten, antibody levels drop and the intestine starts to heal – so the tests may come back normal even if you do have celiac. Any change to your diet before diagnosis should be coordinated with your doctor.

Celiac, gluten sensitivity and wheat allergy – not the same thing

These three conditions are often confused, partly because some of the symptoms are similar. But the mechanism is different, and so is what it means day to day:

• ✓Celiac disease: an autoimmune reaction to gluten that damages the intestine. Diagnosed with blood tests and usually also a biopsy. Even a very small amount of gluten – crumbs, cross-contact – can cause damage, even when you don’t feel anything.
• ✓Non-celiac gluten or wheat sensitivity: people who experience symptoms after eating wheat or gluten, but whose celiac and allergy tests are negative. There’s no dedicated test for it, and it’s diagnosed after other conditions have been ruled out. Science is still investigating exactly what triggers the symptoms – it may not be only gluten, but other components of wheat as well.
• ✓Wheat allergy: an allergic immune reaction to proteins in wheat, which usually appears soon after exposure – a rash, swelling, difficulty breathing and sometimes even a life-threatening reaction. It’s more common in children, is diagnosed by an allergist, and doesn’t always require avoiding barley or rye.

And the treatment? A gluten-free diet – truly for life

As of today, the only proven treatment for celiac is a strict gluten-free diet, for life. The good news: for most people the intestine starts to heal after switching to this diet, and symptoms gradually improve. The less pleasant news is that even small, repeated exposures can cause harm, so being careful matters even when you don’t feel anything.

After diagnosis, it’s highly recommended to meet with a clinical dietitian who knows celiac, and to stay under follow-up with a gastroenterologist. They’ll help you build a varied menu, check for nutritional deficiencies such as iron, vitamin D or folic acid, and answer questions that come up along the way.

In Israel there are also quite a few rights and resources worth knowing about – for example, an alternative medication when a drug covered by the health basket isn’t suitable for people with celiac, accommodations in educational settings, and special consideration during military service. The Kol Zchut website (an Israeli rights information site) brings this information together, and there are also celiac associations and organizations that support families after diagnosis.

Where “Bli Pirurim” fits in

After diagnosis, one of the first questions is “So where can I eat?”. That’s exactly why we built this site: every place gets a tag based on what it declares – “100% gluten-free”, “Separate GF kitchen” or “Has GF dishes” – and sometimes also “Separate gluten-free menu”.

We want to be transparent: the tags are based on the places’ own declarations, not on lab testing or supervision by us. So, especially if you have celiac, always check with the staff before ordering.

FAQ

More on the blog

• 🍽️How to eat out safely with celiac – the questions worth asking at a restaurant
• 🕵️Where does gluten hide? The Israeli guide to foods, ingredients and labels