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Over the past decade, the frequency of conversations about gluten intolerance (GI) and celiac disease (CD) in the United States has gone from almost unheard of to commonplace. Chances are your local supermarket sells dozens of items labeled “gluten free” where none existed five years ago. Restaurants and school lunch programs frequently offer gluten-free alternatives. What happened?

Before I dive into that discussion, I want to clarify some terms to minimize confusion. “Gluten” is the general term for a mixture of tiny protein fragments (called polypeptides), which are found in cereal grains such as wheat, rye, barley, spelt, faro, and kamut. Gluten is classified in two groups: prolamines and glutelins. The most troublesome component of gluten is the prolamine gliadin. Gliadin is the cause of the painful inflammation in gluten intolerance and instigates the immune response and intestinal damage found in celiac disease. Although both conditions have similar symptoms (pain, gas, bloating, diarrhea), or sometimes no gastrointestinal symptoms at all, celiac disease is an autoimmune reaction to gluten that can cause severe degradation of the small intestine; whereas, gluten intolerance/sensitivity is an inability to digest gliadin with no damage to the intestines.