More and more attention is being paid to the difference between celiac sprue and other forms of gluten sensitivity. The most important difference is that studies have found evidence for celiac, but not for other forms of gluten sensitivity. Instead, experts—inducing the researcher who first identified non-celiac gluten sensitivity—say, the two main culprits in non-celiac gluten sensitivity are a protein called fructan and related proteins, and a psychosomatic response.
As knowledge of celiac becomes more widespread, and gluten-free foods more commonly available in more varieties, a growing number of people are convincing themselves that gluten is inherently harmful, or that a broad range of physical and mental symptoms are caused by it. In some cases, this is little more than the power of suggestion compounded by an inability to do a truly controlled study, but research points to the involvement of a group of carbohydrates called fermentable oligo-di-monosaccharides and polyols, or FODMAPs. This group includes fructan in wheat, fructose in fruits, lactose in dairy products, and others. People who go on gluten-free diets often also reduce their consumption of FODMAPs, and attribute the improvement to the gluten restriction.
Interestingly celiac itself is underdiagnosed, according to researchers. Often, the inflammation is minimal, with no noticeable abdominal gas or cramping, bloated stomach, fatty or greasy stool, chronic diarrhea, or constipation. Moreover, someone who has been living with these symptoms all their life may not realize that they are abnormal, particularly if they are mild. However, even unnoticed celiac can cause problems in the long run. The inflammation, even if it produces no other symptoms, interferes with absorption, of the body getting nutrients from food, and this can result in malnutrition. There’s also evidence that poorly controlled celiac leads to a heightened risk of lymphoma.
While currently, "control" means a carefully monitored diet free of gluten, there are new therapies for celiac being researched. Scientists exploring exactly how gluten triggers the immune response that causes the inflammation could find ways to silence it. In another study, researchers found an enzyme that neutralizes the gluten, allowing the body to more easily break it down and preventing a reaction from occurring.