Gluten sensitivity, also known as gluten intolerance, is a spectrum of disorders, including coeliac disease and wheat allergy, in which gluten has an adverse effect on the body. It is also referred to as 'gluten-related disorders spectrum'.
Gluten is a protein composite found in wheat and related grain species, including barley, rye and triticale (a hybrid of wheat and rye). Spelt is an ancient form of wheat and contains gluten. Kamut (khorasan wheat) is another ancient grain type that also contains gluten.
Gluten is also found in foods processed from these grains. The word ‘gluten’ comes from the Latin gluten, meaning ‘glue’. It gives elasticity to dough, helping it to rise and keep its shape. In baking, it helps foods to not crumble, and to not go stale as quickly.
Gluten is the composite of a gliadin fraction (alcohol soluble) and a glutenin fraction (only soluble in dilute acids or alkali), which is conjoined with starch in the endosperm of various grass-related grains. The prolamin and glutelin from wheat constitutes about 80% of the protein contained in wheat (grain).
The fruit of most flowering plants have endosperms. Endosperm is the tissue produced inside the seed, the part of the seed that acts as a food store for the developing plant embryo, usually containing starch with the protein (gluten) and other nutrients. The endosperm surrounds the embryo or germ. Bran is the outer protective shell of the seed.
True gluten, with gliadin and glutenin, is limited to certain members of the grass family (wheat (including spelt and kamut), barley, rye and triticale).
Oats contain a type of gluten, called avenin, which is different to the type of gluten found in wheat, barley, rye and triticale. 80% of those with gluten sensitivity tolerate oats. (Note that oats may be contaminated with wheat or other grains due to adjacent growing and transportation).
The stored proteins of corn (maize) and rice are sometimes called glutens, but their proteins differ from true gluten. They can be safely consumed by those with gluten sensitivity.
Until recently, the terms gluten sensitivity (gluten intolerance) and coeliac disease were used interchangeably in the medical literature. Coeliac disease is also called gluten-sensitive enteropathy. However, recent research indicates that gluten sensitivity has a broader scope than just coeliac disease.
A person with wheat allergy has developed a specific antibody to at least one of the following proteins found in wheat: albumin, globulin, gliadin or glutenin. Most allergic reactions involve IgE (immunoglobulin) antibodies to albumin and globulin. Allergy to gliadin and glutenin are less common.
If the medical history of a patient, along with clinical tests, rule out coeliac disease and wheat allergy, a diagnosis of idiopathic gluten-sensitivity can be considered.
Treatment of all three conditions is a gluten-free diet.
Causes of Gluten Sensitivity
Gluten sensitivity can develop at any point in life, and symptomatic disease may appear years after the condition develops. It is more common in females than males. A 2008 study from the University of Rome showed that coeliac disease was twice as common in females compared to males.
Coeliac disease is an autoimmune disorder (an immune reaction to gluten) in genetically susceptible or predisposed individuals of all ages, but often begins in middle infancy. The inflammation and destruction (atrophy) of the inner lining (mucosa) of the upper small intestine is caused by an allergic-type reaction to gluten in the diet. This chronic digestive disorder leads to malabsorption of minerals and nutrients. There is no cure for coeliac disease. The only effective treatment for this disorder is a gluten-free diet.
Wheat allergy is an IgE mediated disease.
The cause of idiopathic gluten sensitivity is not well-defined or is unknown, ie 'idiopathic'.
Symptoms of Coeliac Disease, Wheat Allergy and Gluten Sensitivity/Intolerance
There are actually dozens of symptoms caused by ‘the inability to digest gluten'. This inability to digest certain foods is the definition of 'Food Intolerance'.
A symptom is something the patient feels and describes, while a sign is detected by others, such as a physician during examination, or as the result of tests carried out.
It is possible to have coeliac disease without any symptoms at all. However, the symptoms in coeliac disease are mainly gastrointestinal, but some signs and symptoms are due to the malabsorption and malnutrition resulting from this disorder. Symptoms can vary greatly from person to person. Many of the signs and symptoms are the result of the malabsorption.
The symptoms of malabsorption in coeliac disease are due to the failure to absorb nutrients from the gastrointestinal tract, due to the damage to the mucosa caused by the gluten sensitivity, and can be intestinal or extra-intestinal. They include:
- bulky, frequent stools
- abdominal cramps and pain
- steatorrhoea (fat in the stools)
- gas and bloating
- irritable bowel syndrome
- weight loss
- growth retardation and failure to thrive
- delayed puberty in children
- oedema and fluid retention (due to loss of protein)
- anaemia (due to vitamin B12, iron and folic acid deficiencies)
- fatigue and weakness (symptoms of anaemia)
- muscle cramps, muscle wasting and muscle weakness
- osteomalacia and osteoporosis (impaired calcium absorption)
- bleeding and easy bruising (vitamin K deficiency)
- general symptoms such as feeling unwell, lack of motivation.
There may be other symptoms of coeliac disease which include:
- anxiety and irritability
- chronic fatigue syndrome
The symptoms of wheat allergy are similar to other food allergies, and include:
- abdominal cramp
Symptoms of idiopathic gluten intolerance are similar to those of coeliac disease and wheat allergy.
Diagnosis of Coeliac Disease, Wheat Allergy and Gluten Sensitivity
All of the above signs and symptoms are common to other health issues and diseases. So, how is gluten sensitivity or coeliac disease diagnosed?
Blood tests that are specific for coeliac disease include antigliadin antibodies, endomysial antibodies, and anti-tissue transglutaminase antibodies. Blood is screened for antigliadin antibodies (AGA) and andomysium antibodies (EmA). A small intestine biopsy procedure is considered the most accurate test for coeliac disease.
Wheat allergy can be diagnosed by skin testing with extracts of wheat protein, or by a blood test for specific antibodies (IgE) to wheat protein.
A therapeutic trial eliminating wheat and gluten from the diet, followed by their reintroduction as a challenge test, will confirm the diagnosis of coeliac disease/wheat allergy/idiopathic gluten-sensitivity: confirmation is the absence of symptoms with elimination (which may take up to 3 weeks), and the recurrence of symptoms when wheat and gluten are reintroduced into the diet.
Treatment of Coeliac Disease and Gluten Sensitivity
The standard treatment for coeliac disease is a complete avoidance of gluten for life. All products that contain gluten should be avoided for the rest of the patient's life. This is the only actual treatment. Strict observance to the diet allows the intestines to heal. This leads to the end of symptoms in most cases. Failure to observe the diet will cause relapse. Vitamin and mineral supplements are recommended to alleviate deficiencies caused by this disorder.
The management of wheat allergy and idiopathic gluten-sensitivity is a gluten-free diet.
It is difficult to avoid gluten. Many products have hidden gluten or wheat in them. Generally, the advice of a dietician is required, as well as research by yourself. It is essential to be aware of the foods that contain gluten, and to know which foods are safe.
However, on a gluten-free diet, the symptoms of gluten sensitivity, in the majority of cases, can be completely controlled and the complications, especially those of malabsorption, can be reversed and subsequently prevented.
*Copyright 2014: The Huntly Centre.
Disclaimer: All material in the huntlycentre.com.au website is provided for informational or educational purposes only. Consult a health professional regarding the applicability of any opinions or recommendations expressed herein, with respect to your symptoms or medical condition.
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