Updated: May 18
Whether you are avoiding gluten or happy to see it listed as the only item on the food allergen label (instead of milk, egg, or soy), gluten intake is one of the most important considerations in nutrition and overall health. In fact, depending on your symptoms and exposure frequency to gluten, you may develop an intolerance.
What is Gluten?
Gluten is a general name to describe storage proteins, such as glutenin, secalin, hordien and gliadin that can be found in wheat, rye, barley, bulgur, couscous, farina, graham flour, kamut, matzo, semolina, spelt, and triticale . Gluten is the special binder that combines the food items that you eat, so that they can maintain shape and composition. Even though some of the healthier gluten options, such as kamut and spelt, may seem harmless to you, these items may affect you in a way that you are unaware of and possibly worsen symptoms related to celiac disease.
Gluten Intolerance: Celiac Disease vs Gluten Sensitivity
An intolerance to gluten is any abnormal response after the consumption of gluten. Depending on whether the response is mild or severe, the gluten intolerance can be further classified as a gluten sensitivity or celiac disease.
Celiac disease is an autoimmune disease where the immune system attacks the gluten particles and then causes an inflammatory reaction with the cells and tissues of the intestines. Over time, this reaction leads to extensive damage to the villi of the intestines. This is important because the villi are responsible for the absorption of nutrients from food items. So, this damage may result in a malabsorption of many of the key nutrients required for normal body function, leading to nutritional deficiencies .
The mechanism of action behind why celiac disease affects certain individuals is not completely understood. However, it is thought to have something to do with genetics, excessive consumption of gluten, leaky gut syndrome, and fungal infections. With genetics, some studies show that there is a genetic susceptibility in certain individuals with a mutation of the DQ2 or DQ8 gene. Many individuals can present with this gene, but it is what we are exposed to environmentally (i.e a diet high in gluten products) that may stimulate an inappropriate immunological response, leading to celiac disease.
Celiac disease is considered a 'permanent' dietary disorder, but there is much question of whether or not this condition can actually be treated until cured. It is shown that if a gluten free diet is followed strictly, the villi of the small intestines can heal and tissues integrity can be restored. In addition, there are a number of herbs that can be used to reduce inflammation, which may further allow for a greater healing of the gut.
Gluten sensitivity is very similar to celiac disease in that it is a dietary disorder caused by an immune response to exposure of gluten, but it's true mechanism of action is also poorly understood. Individuals with gluten sensitivity may experience some of the same symptoms of individuals diagnosed with celiac disease. The main difference with gluten sensitivity is that there is not extensive damage of the intestines, it is not permanent, and the diagnostic testing will be negative for any abnormality in gastrointestinal function. In fact, that is what makes gluten sensitivity a 'rule out' condition, in that in order to diagnose it you must first rule out celiac disease.
Gluten Intolerance Symptoms
It is true that symptoms of gluten intolerance can present as early as 6 months after the introduction of solid foods, but the majority of cases are unidentified during childhood and actually worsen in adulthood. There are many individuals that go several years with symptoms of celiac disease, however, the clinical diagnosis is made in only about 10 % of those individuals.
Commonly reported symptoms of gluten intolerance are: fatigue, stomach upset (i.e. gas, bloating, diarrhea, constipation, pain, nausea, acid reflux), headaches, irregular periods, hair loss, bone/muscle pain, skin inflammation (eczema, psoriasis, and tineas), memory fog, mood problems, and even anemia. These symptoms are usually identified and worsen after consuming gluten.
The symptoms associated with gluten intolerance may be confused with other conditions such as irritable bowel syndrome and bacterial infections. Therefore, it is important to visit a trained professional if you desire to have an appropriate diagnosis. If not, then you must really stick to strict lifestyle modification in order to have symptom relief.
Many individuals may not be aware of the harmful effects that an abnormal gluten response can have on the body. It is shown that celiac disease can lead to leaky gut syndrome, which is where toxins and food particles may enter the blood stream and contribute to the worsening of autoimmunity and systemic inflammation.
Other things that it can lead to include:
oral health issues
extreme fatigue and weakness
If you are having any of the sign and symptoms associated with these issues, it is important to not ignore them. If left untreated, these issues will get progressively worse and quality of life will diminish.
Diagnosing Gluten Intolerance
There is a two step process in figuring out if you have celiac disease: screening and diagnosing.
With screening you can expect a serum tTG-IgA test, which is the most specific and sensitive test for celiac disease preferred by the American College of Gastroenterology. During this test, a person should be currently not restricting gluten for the test to appropriately work . A positive result of this test occurs if there is an increased antibody response to gluten, which in turn will cause inflammation within the tissues.
As mentioned previously, there is also genetic testing that can be performed to rule a genetic predisposition to celiac disease. People with celiac disease carry one or both of the HLA DQ2 and DQ8 genes. If these genes are absent, there is a 99% chance that the gluten intolerance is not indicative of a more serious, celiac disease, however, that still leaves gluten sensitivity as an option.
Diagnosis can also be performed by undergoing an endoscopic biopsy which is performed by a gastroenterologist as an outpatient procedure. In this procedure, a very small portion of the small intestine is removed and assessed for intensity of damage consistent with celiac disease. Celiac disease is confirmed if there is improvement in comparison to biopsied intestine when on a gluten free diet.
Other test that may be ordered in order to rule out celiac disease and or diagnose gluten sensitivity are: stool, saliva, blood and urine samples .
When to Visit the Doctor
If you decided to self-treat and avoid diagnosing, it is important to at least be on the lookout for the symptoms of possibly more serious issues that warrants an immediate evaluation from your Medical or Naturopathic practitioner. For instance, if your diarrhea or constipation is lasting longer than usual (i.e. for greater than 7 days), this may be a sign of a more serious condition such as a bacterial infection or a bowel obstruction. Additionally, if you are experiencing pain in areas that you haven't felt before, it is important to have immediate evaluation. This can be a sign of appendicitis, inflammatory bowel, or even the inflammation of a surrounding organ depending on the location and severity of the pain.
Learn about the management of gluten intolerance, here.
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