Gluten Intolerance and Coeliac’s Disease
Gluten Syndrome is a term that was coined by Dr Rodney Ford, an internationally-recognized authority on food allergy. Dr Ford is the author of more than one hundred publications and books and he runs a busy paediatric clinic in New Zealand, specializing in children with food intolerance problems.
Gluten Syndrome refers to the cluster of symptoms that are experienced by people that react to gluten, i.e. they have gluten intolerance. About one in ten people are affected by Gluten Syndrome but few are aware that they even have a reaction to gluten.
Gluten intolerance is a broad term which includes all kinds of sensitivity to gluten, from mild to severe. A small proportion of gluten intolerant people will test positive to Coeliac Disease test, and so are called Coeliac’s (~1% of the population) (1). These people are usually at the severe end of the spectrum and have an almost immediate allergic reaction to gluten.
What is the difference between Gluten Intolerance and Coeliac Disease?
Coeliac Disease is an autoimmune condition resulting from an allergic reaction and can, but not always, have a sudden and severe onset. Coeliac Disease occurs when the proteins in gluten (glutenin and gliadin) trigger your immune system to overreact, producing antibodies to the gliadin. Over time, these antibodies wear down the little hairs called villi which line the walls of your intestine (a process called villous atrophy). These finger-like tiny hairs grab and absorb nutrients as foods pass through your lower digestive tract. As Coeliac Disease symptoms slowly destroy these villi, you become less and less able to process any nutrition from your food. This sets off a domino-effect of increasingly serious health problems. This is essentially an auto-immune disorder and also a malabsorption disease having wide ranging effects when undiagnosed.
*(Note lack of villi on the coeliac intestinal lining.)
Gluten Intolerance or Non-Coeliac Gluten Intolerance is currently a little more difficult to pinpoint. It has a slower onset than Coeliac’s and may be hard to diagnose due to the broad range of symptoms. Basically, individuals who suffer from NCGI suffer very similarly to people with Coeliac Disease, but the blood test which identifies and diagnoses Coeliac Disease returns as negative as there are no antibodies produced by the body to gluten. Consequently this group is poorly diagnosed or misdiagnosed due the wide range of symptoms that gluten intolerance produces. The most accurate and effective way to identify NCGI is to do an elimination diet. The incidence of NCGI may be as many as 10% of the population or 1 in 10. (2)
Both Coeliac Disease and gluten intolerance can be exacerbated by emotional stress, infection, surgery, pregnancy and childbirth. Every individual with some level of gluten intolerance or allergy may experience different shades of symptoms, hence the challenge for medical practitioners to diagnose.
Symptoms of Gluten Intolerance
Diarrhoea or constipation
Bloating and gas
Gastric reflux or heartburn
Abdominal pain and cramps
Weight gain or loss
Aching joints and muscle pains
Cramps, tingling and numbness
Loss of feeling in hands and feet
An overall reduced sensation of feeling in either the face or entire body
Weakness – muscle and joints (Myopathies)
Exhaustion, fatigue, lethargy
Eczema, skin rashes and dermatitis
Runny nose and sinus problems
Low immune function
Depression and irritability or behavioural changes
Difficulty thinking clearly
Chronic iron deficiency/Anaemia
Attention Deficit Hyperactivity disorder
Malnutrition and stunted growth in children
Infertility, irregular menstrual cycle and miscarriage
As you can see there are many and varied symptoms and illnesses triggered by gluten reactions which is why Gluten Intolerance is so hard to diagnose. Of course gluten is not always the cause of these symptoms and illnesses but most people with Gluten Intolerance have repeatedly sought help and advice from medical professionals, but have found no relief from or solutions to the cause of their ill-health.
What is Gluten?
Gluten is a protein that is composed of glutenin and gliadin. It is found in the grass-like grains such as wheat, barley, rye and spelt. In western society we have come to rely on gluten not only as an important nutritional protein but as a way of obtaining a desired texture and elasticity in foods, it is used to thicken and ‘glue’ foods together and also as filler in many foods. Examples include soy sauce, gravies, soups, whiskey, and modified food starch.
Gluten fibres The main property of gluten is its stickiness. Dough is gluey because of the gluten it contains. It is this property of stickiness that makes gluten so valuable in baking. It helps stick the food together, and gives a pleasing texture to the baked items. Wheat gluten is unique in its ability to form sticky dough and thus produce a loaf of bread.
Why is gluten a problem?
Recent research has found that gluten is a potentially toxic substance*, especially to the gut, brain and nervous system. One of the problems with gluten is that we do not break it down very well in our intestine. Your gut cannot fully digest it therefore fragments of gluten can easily be absorbed into your body in an unchanged form. This can then start an immune reaction with your body making antibodies against gluten, which in turn can cause damage to your body’s organs such as your brain and nervous system. Even if your body does not produce antibodies to gluten, unmetabolised gluten can cause damage to your organs.
There are foods that cause inflammation in the body and there are foods that can reduce inflammation, such as turmeric or Omega 3 fatty acids. Gluten is an inflammatory food, and inflammation is at the heart of many diseases. Gluten activates the immune system, and anytime the immune system is activated there is always inflammation produced. (3)
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the body to remove the injurious stimuli and to initiate the healing process. However, chronic inflammation can cause damage to cells, tissue and organs and result in a range of diseases from autoimmune diseases like Coeliac Disease and arthritis, to obesity and heart disease. (4)
Chronic inflammation can have many effects on our bodies. One effect is that it triggers our bodies to produce cortisol. Since cortisol is also one of the major modulators of immune function, this suppresses our immune response. When cortisol production becomes abnormal, our hormonal and immune systems are affected. While elevated cortisol suppresses our immune response, it also causes a catabolic/breakdown state to exist in our body and symptoms of adrenal exhaustion will eventually appear: fatigue, depression, loss of libido, allergies, and frequent illness. Other result of chronic inflammation can be traced to destructive cell-signalling chemicals known as cytokines that contribute to many degenerative diseases.
* Definition of a toxic substance: Any substance that can cause acute or chronic injury to the human body, or which is suspected of being able to cause diseases or injury under some conditions.
Diagnosing Gluten Intolerance
Since the 1960’s the normal method of testing for Coeliac Disease is to perform a small biopsy of the intestinal wall to see if there is damage to the villi of the lining. If there was no damage, a negative result for Coeliac Disease was given.
Recently, researchers discovered that people with Coeliac Disease have higher than normal levels of certain auto antibodies in their blood.(5) Antibodies are protective proteins produced by the immune system in response to substances that the body perceives to be threatening. Auto-antibodies are proteins that react against the body’s own molecules or tissues. To diagnose Coeliac Disease, physicians will usually test blood to measure levels of:
Immunoglobulin A (IgA)
anti-tissue transglutaminase (tTGA)
IgA anti-endomysium antibodies (AEA)
If the tests and symptoms suggest Coeliac Disease, the doctor will perform a small bowel biopsy. During the biopsy, the doctor removes a tiny piece of tissue from the small intestine to check for damage to the villi. Then if damage is found, a diagnosis of Coeliac Disease given.
These methods of testing have one main problem; they miss those people who have Non-Coeliac Gluten Intolerance (NCGI).
NCGI sufferers generally don’t have damage to the villi of their intestinal lining and can often have normal or only slightly raised antibodies levels. Another problem with this method of diagnosis is that up to 50% of people with gluten intolerance have no gastro-intestinal symptoms or signs. Some sufferers only have neurological, brain or skin symptoms, so often gluten is not even considered as a potential cause of their problems. Gluten sensitivity is therefore likely to be a missed diagnosis without a high degree of suspicion by the treating physician.
There most effective and least invasive method of finding if there is gluten intolerance is an Elimination Diet. This is when gluten is totally excluded from the diet. Improvement in symptoms and overall wellbeing is often noticed within a couple of days to a week, but not always. It may take several weeks for the accumulated gluten to be cleared from the body.
Treatment of Gluten Intolerance
The only real and effective treatment for Gluten Intolerance is totally elimination of gluten from the diet. This is not always as easy as it sounds as gluten is hidden in many processed products such as soy sauce, gravies, soup mixes, sauces, ice-cream and even bacon and sausages. Learning to read food labels and being aware of possible gluten additions to food is vital to being gluten-free. Special care is necessary when checking product ingredient lists since gluten comes in many forms; vegetable proteins and starch, modified food starch (when derived from wheat instead of maize), malt flavouring, and glucose syrup. Many ingredients contain wheat or barley derivatives and although many foods contain gluten, it is not always included in ingredients lists. This lack of inclusion is often because gluten is not used in the formulation of the product, but in the preparation (or manufacturing) of listed ingredients. One example is the dusting of the conveyor belts in the production facilities with gluten products to prevent the foods from sticking during processing. (6)
For some gluten intolerant people, even miniscule amounts can cause a reaction. So even having it in the house for others can cause contamination. You may need to replace your toaster, for example, to completely clear the house.
Also be aware that you may suffer withdrawal symptoms, as we are often addicted to the foods we are allergic to. These can range from fairly mild to severe – flu like feelings, headaches, etc. This should pass within 3-6 days and you should start feeling better.
Once you understand where gluten is found it becomes much easier. With time, identifying sources of gluten will become second nature to you. Despite the restriction of a gluten-free diet, you can still eat a healthy, well balanced diet that has plenty of variety. There are many substitutes that can be used and delicious alternatives and as gluten is not biologically necessary for good health, a gluten-free diet is a healthier one with an expanded variety of foods in it.
How did I get Gluten Intolerance?
Gluten intolerance – both NCGI and Coeliac Disease is ‘in the family’, or genetically inherited, generally. Indicators are European or Anglo-Celtic ancestry. If you are gluten intolerant, then up to 10% of the immediate family may also be affected, even if they don’t have any symptoms.
Some gluten intolerance is identified in children. But for others, it is not until much later in life that gluten intolerance is actually suspected. Frequently it is triggered by some life event like divorce, job loss or serious illness.
Another reason gluten intolerance is more prevalent in today’s society is the increased use of gluten in all forms of food manufacturing. The amount of gluten in the Western diet continues to increase as bread has become a staple food and is even at the base of ‘the food pyramid’. The use of gluten as an additive in food processing to get the desired texture and consistency has also raised the amount of hidden gluten we consume in our diet.
For a list of gluten-free foods and where to get them from please contact us on ph: 09 818 6565 if you are not already a patient to find out how to become one.
(1). Gastroenterology, Volume 128, Issue 4, Supplement 1, Pages S57-S67, April 2005 The prevalence of celiac disease in average-risk and at-risk Western European populations: A systematic review
(2). Journal of Paediatric Gastroenterology & Nutrition: October 2006 – Volume 43 – Issue 4 – pp E65-E66 Gluten Reactions: Ten Times the Celiac Problem
Ford, Rodney P.
(4). International Journal of Obesity (2003) 27, S29–S34. doi:10.1038/sj.ijo.0802497
(5). Gastroenterology, Volume 115, Issue 6, Pages 1317-1321, December 1998