Because Crohn’s and celiac disease (sometimes called celiac sprue) are similar in some ways, they may be hard to distinguish from each other at first. Among other features, they share common symptoms, including diarrhea and abdominal pain. It’s also possible for one person to have both diseases. In both Crohn’s and celiac disease, the immune system is reacting to some sort of environmental stimulus. “In celiac disease, we know that stimulus is gluten, but we don’t yet understand what the environmental stimulus is in Crohn’s,” says Karlee Ausk, MD, a gastroenterologist at the Swedish Medical Center in Seattle. The conditions are linked, though. A meta-analysis published in May 2020 in the journal Gastroenterology, which involved more than 60 individual studies, showed that people with celiac disease are almost 10 times as likely to have an inflammatory bowel disease — including Crohn’s disease and ulcerative colitis — compared with people who don’t have celiac disease. “If you look at the genetic predisposition for Crohn’s and celiac, there are some genes that overlap, which increases the risk of having both conditions,” Dr. Ausk says.
The Difference Between Crohn’s and Celiac Disease
If you have symptoms that suggest either Crohn’s disease or celiac disease, the first thing you should do is see your primary care doctor, who may refer you to a gastroenterologist. The path to a celiac diagnosis begins with blood tests, according to Kelly Kennedy, RD, a nutritionist for Everyday Health. It’s important to not start a gluten-free diet before completing these tests, according to Mayo Clinic, otherwise your labs may come back normal. But blood tests are only one part of the puzzle — to confirm the diagnosis, your doctor will likely need to perform an endoscopic biopsy, which involves inserting a thin tube called an endoscope through the mouth and into the stomach to see inside the GI tract. Or your doctor may advise a capsule endoscopy, where you swallow a pill containing a small camera that will take pictures of your GI track as it moves through your body. After this, your doctor will likely refer you to a nutritionist and recommend a gluten-free diet to see if your symptoms improve. A gluten-free diet eliminates certain types of proteins found in wheat, barley, rye, and foods made from these grains. While there is no single test that confirms a Crohn’s diagnosis, the process may include having a colonoscopy to examine the colon, blood tests looking for evidence of inflammation, magnetic resonance imaging (MRI) or a computerized tomography (CT) scan to examine the bowels, and an upper endoscopy to view the first part of the small intestine.
The Power of a Gluten-Free Diet
If examination reveals that your gastrointestinal upset and symptoms are due to Crohn’s disease, treatment recommendations will likely include a variety of medication approaches, and, in severe cases, surgery. If the diagnosis is celiac disease, treatment involves staying on a gluten-free diet. “Following a strict gluten-free diet can eliminate all of the gastrointestinal symptoms of celiac disease and allow the lining of the intestines to regenerate, leading to better absorption of the nutrients in food and improved overall health,” Kennedy says. The same gluten-free diet may also help ease some of the symptoms of Crohn’s disease. “In my practice I see a lot of people with Crohn’s disease who have worse symptoms when they are eating gluten,” Kennedy says. “I suggest people with Crohn’s try a gluten-free diet, and if it improves some of their symptoms, continue it.” According to a study published in the journal Inflammatory Bowel Disease, almost 20 percent of inflammatory bowel disease patients have tried a gluten-free diet, and 65 percent of those found a subjective benefit for their GI symptoms. For both Crohn’s and celiac disease, the guidelines for a gluten-free diet are the same. While you eliminate wheat, barley, and rye from your diet, you can eat these grains and flours:
CornRiceSoyBeansFlaxOats (in moderation)
You should also avoid processed lunch meats, as well as the following foods, unless they’re labeled “gluten-free” or made with corn, rice, or soy:
PastasFlourCereal products
Gluten may also be lurking in some surprising foods, including beer and other alcoholic beverages made from wheat, barley, or rye. For a complete list of foods to eat or avoid, check out the guidelines on the Celiac Disease Foundation website. Though Crohn’s and celiac disease may be related, having one condition doesn’t mean you’ll develop the other. But no matter which condition you have, a gluten-free diet may make your life a whole lot easier. A registered dietician-nutritionist, especially one who specializes in digestive health conditions, may be able to help people with Crohn’s home in even further on what their food triggers might be, Kelly says — perhaps by trying a low-FODMAP diet, which research published in December 2020 in Nutrients showed may hold promise in treating the symptoms of Crohn’s. “This allows you to keep your diet as nutritionally balanced as possible and manage your symptoms at the same time.” RELATED: Low-FODMAP Diet Guide “The bottom line is, if you’re diagnosed with celiac disease, you must follow a gluten-free diet. If you’re diagnosed with Crohn’s disease, it may be worth a try to see if a gluten-free diet can help to lessen your symptoms,” Kennedy says. Additional reporting by Amy Kraft and Monroe Hammond.
