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Gluten Intolerance and Non-Celiac Gluten Sensitivity

Gluten Intolerance Info

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Gluten intolerance is an intestinal disorder that occurs when the body can’t tolerate gluten, a protein found in wheat, rye, barley, and malt. Gluten intolerance is associated with the disease called celiac disease, also know as celiac sprue, nontropical sprue or gluten-sensitive enteropathy.1,2

Most researchers do not  include celiac disease as a food allergy. This abnormal immune system response does not involve an IgE antibody response which is often required by most researchers to be classified as an allergic response.1

Gluten intolerance or celiac disease is a permanent condition that can be diagnosed at any age.  A blood test now available to screen for the presence of specific antibodies helps to determine if the next step should be followed. The next step is to take a biopsy of the intestine (before beginning a gluten free diet)  to make a final diagnosis.  If the patient eliminates gluten prior to testing, it most likely will deliver false results.

If the diagnosis is negative for Celiac Disease, it is still possible for the patient to be Non-Celiac Gluten Sensitive.

Celiac Disease

If a Celiac Disease Patient consumes a gluten-containing food, the lining of the small intestine becomes damaged and less able to absorb essential nutrients such as fats, protein, carbohydrates, minerals and vitamins. Symptoms vary but may include diarrhea, constipation, weight loss, recurring abdominal pain and bloating, gas, pale, foul-smelling stool, unexplained anemia, muscle cramps, bone pain, pain in the joints, tingling numbness in the legs, delayed growth, fatigue, Dermatitis Herpetiformis (painful skin rash), osteopenia (mild) or osteoporosis (more serious bone density problem), psychiatric disorders such as anxiety or depression, missed menstrual cycles, tooth discoloration or loss of enamel, in extreme and rare cases intestinal cancer.   In children, symptoms of malnourishment including growth failure and delayed puberty can occur.  Some patients are asymptomatic (no noticable symptoms), because the undamaged part of the small intestine is still able to absorb enough nutrients.  However, these people are still at risk for complications of the disease. Currently, the only treatment for celiac patients is strict adherence to a gluten-free diet. When gluten is removed from the diet, the intestine gradually repairs itself and symptoms disappear, from a few days to a couple of years depending on the age and severity of the patient.3,10

Non-Celiac Gluten Sensitivity

Joining the spectrum of gluten related disorders is non-celiac gluten sensitivity (non-celiac GS or GS). While celiac disease and wheat allergies are considered autoimmune and allergic related, GS does not involve the immune system or elicit any allergic symptoms and is characterized by “both intestinal and extra intestinal symptoms with an early onset after gluten ingestion, a rapid relief after gluten withdrawal, and an immediate relapse after gluten challenge4”.

 Dr. Alessio Fasano, renowned doctor specializing in Celiac disease and the Director of the Center for Celiac Research at University of Maryland claims that six percent of the U.S. population suffers from non-celiac related gluten sensitivity5.   This statement is also backed up by a clinical trial held at the Maryland clinic where between the years of 2004 and 2010 approximately 5896 patients were seen and 347, or approximately 6%, presented with signs and symptoms of GS and is approximately six times more prevalent than celiac disease6.

 Individuals who present with GS may present with a variety of symptoms which are often similar to those of celiac disease and irritable bowel syndrome (IBS) making it essential that celiac disease and other conditions are ruled out before a diagnosis of GS is made.  Symptoms that accompany GS include: “abdominal pain (68%), eczema and or rash (40%), headache (35%), foggy mind (34%), fatigue (33%), diarrhea (33%), depression (22%), anemia (20%), numbness in the legs (20%), arms or fingers and joint pain (11%)7

 Despite studies attempting to identify biomarkers associated with GS, to date, there are no laboratory tests that can be conducted to diagnose GS1.  Once all other possible diagnosis are ruled out, an elimination diet is the only way to diagnosis GS.  If the individual does suffer from GS the symptoms should begin to subside and disappear anywhere from a few hours to a few days with symptoms returning when gluten is reintroduced into the diet.  As with celiac disease, food allergies or food sensitivities the only cure for GS is to permanently remove the offending ingredient, in this case gluten, from the diet7.

Even a small amount of gluten is enough to cause symptoms and complications for Celiac Disease and Non Celiac Gluten Sensitive patients — that means all foods or food ingredients made from many grains, including wheat, barley, rye, and malt. This includes any type of wheat (including farina, graham flour, semolina and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt and triticale.2

Amaranth, buckwheat and quinoa are gluten-free as grown, but may be contaminated by other grains during harvesting and processing, so be sure the label says gluten-free or manufactured in a gluten-free facility. Oats may not be harmful for most people with celiac disease, but oat products are frequently contaminated with wheat, so it’s best to avoid oats as well. 2

Most foods made from grains contain gluten. Avoid these foods unless they’re labeled as gluten-free or made with corn, rice, soy or other gluten-free grain.

Table 1 contains a list of some of the foods where gluten may be found. 2

 

Table 1: Foods that may contain gluten
  • Breads
  • Cereals
  • Crackers
  • Pasta
  • Cookies
  • Cakes and pies
  • Gravies
  • Sauces

 

Many other foods have ingredients that contain gluten. Grains containing gluten may be used in food additives, such as malt flavoring, modified food starch and others. Other sources of gluten that might come as a surprise include medications and vitamins that use gluten as a binding agent, lipstick, postage stamps and contamination of gluten-free foods with foods containing gluten.

Because of damage to your small intestine from gluten, foods that don’t contain gluten also may cause abdominal pain and diarrhea. Some people with celiac disease aren’t able to tolerate milk sugar (lactose) found in dairy products, a condition called lactose intolerance. If this is the case, you need to limit food and beverages containing lactose as well as those containing gluten. Once your intestine has healed, you may be able to tolerate dairy products again. However, some people may continue to experience lactose intolerance despite successful management of celiac disease. 2

Casein has a molecular structure that is quite similar to that of gluten. Thus, some gluten-free diets are combined with casein-free diets and referred to as a gluten-free, casein-free (GFCF) diet.

Gluten and Autism

Some believe gluten and casein aggravate the symptoms of autism. A 2006 review of seven studies indicated that although benefits were seen in all studies from the introduction of elimination diets (e.g., casein and/or gluten free) in the treatment of autism spectrum disorders, none of the studies were performed in a manner to create an unbiased scientific opinion.4-8

Preliminary data from the first and only double-blind randomized control trial of a gluten and casein-free diet “indicated no statistically significant findings even though several parents reported improvement in their children.”5-9

The contents of this page have been supported by research efforts by Amber Reynolds, RD Student, East Tennessee State University

Gluten Intolerance – Links

Citations

1NIH: National Institute of Allergy and Infectious Diseases. NIAID’s Food Allergy Research.

2Mayo Clinic Celiac Disease.

3The European Food Information Council (EUFIC). Food allergy and food intolerance.

4Volta U, Tovoli F, Cicola R, et al. Serological Tests in Gluten Sensitivity (Nonceliac Gluten Intolerance). Journal of Clinical Gastroenterol. 2012;45:680-685

5National Foundation for Celiac Awareness.  Diagnosis of Non-Celiac Gluten Sensitivity. Available at: http://www.celiaccentral.org/non-celiac-gluten-sensitivity/testing-and-diagnosis Accessibility verified February 24, 2013.

6Aziz I, Hadjivassiliou M, Sanders D. Does Gluten Sensitivity in the Absence of Coeliac Disease Exist? BMJ. 2012: 1-4

7Spectrum of Gluten-Related Disorders: Consensus on New Nomenclature and Classification. BMC Medicine. 2012;10:1-12

8Christison GW, Ivany K (2006). J Dev Behav Pediatr

“Elimination diets in autism spectrum disorders: any wheat amidst the chaff?”.

doi:10.1097/00004703-200604002-00015.

PMID 16685183.

9Elder JH, Shankar M, Shuster J, Theriaque D, Burns S, Sherrill L (April 2006). J Autism Dev Disord–20.

“The gluten-free, casein-free diet in autism: results of a preliminary double blind clinical trial”.
doi:10.1007/s10803-006-0079-0.

PMID 16555138.

10UniversityofChicagoCeliacDiseaseCenter- Celiac Disease Available at http://www.cureceliacdisease.org/faqs