For many people gluten is bad news – and you don’t have to be a coeliac to suffer. So before you label people avoiding gluten, as ‘faddy eaters’ understand the difference between coeliac disease and non-coeliac gluten sensitivity.
I see many clients who have genuine problems with gluten. Many of them have suffered for years without any support or dietary advice. Yet through laboratory testing (e.g Cyrex) it is clear that gluten is provoking an immune reaction. While some of these clients are coeliac there are many others who fall into the category known as non-coeliac gluten sensitivity.
The definition of non-coeliac gluten sensitivity actually goes back to 1986, and there are sporadic reports of this entity but not as strong as in the past few years. Interest has increased after recent advances enabling us to make a clear differentiation between coeliac disease and gluten sensitivity.
It is now clear that, besides those with coeliac disease or wheat allergy, there are many people with gluten sensitivity in whom neither allergic nor autoimmune mechanisms can be identified.
In fact it has been estimated that, for every person with coeliac disease, there may be at least six or seven people with non-coeliac gluten sensitivity. Gluten sensitivity may therefore affect 6-10% of the general population. This means approximately 4-7 million people in the United Kingdom have this condition, and the vast majority are unaware of their sensitivity to gluten. There are in fact numerous studies that reveal a wide range of issues with gluten.
If you suffer with gluten sensitivity you may have negative immuno-allergy tests to wheat and negative coeliac disease serology as well as normal endoscopy and biopsy. However when you follow a gluten free diet your symptoms resolve. One of the problems is the symptoms of non–coeliac gluten sensitivity can be identical to those suffering with coeliac disease. So for example you may experience problems with your digestive system, your skin, nervous system, muscles and joints, sleep, and mood. Perhaps you always feel fatigued, have IBS, suffer with brain fog, headaches or joint pain.
There are no laboratory biomarkers specific for gluten sensitivity. The diagnosis is generally based on exclusion criteria – i.e when you eliminate gluten containing foods from your diet your health improves and worsens when you reintroduce gluten. However it is also worth considering Cyrex array 3 before you remove gluten. This is probably the most comprehensive laboratory gluten test available and can provide you with information about your reaction to gluten and the test of choice in our clinic.
If you do suffer with non-coeliac gluten sensitivity your symptoms may include not just digestive symptoms but a wide range of extra intestinal symptoms. What happens in the gut unfortunately does not stay in the gut. Inflammation arising from a reaction to gluten can affect any body system. Gluten sensitivity may also be the single biggest contributor to a leaky gut in people with autoimmune disease.
Unlike coeliac disease the development of tissue transglutaminase tTG autoantibodies is not present. The adverse reaction to gluten appears to involve the innate immune system, which is a different response than in coeliac disease. Only 50% of non-coeliac gluten sensitivity patients express the HLA-DQ2 or HLA-DQ8 haplotype, indicating that these genes are not necessary to develop gluten sensitivity.
With gluten sensitivity antibodies can be created against gluten. Antibody response is typically measured by testing the blood for IgE (technically an allergy), IgA, IgG and IgM antibodies against the protein faction of gluten known as gliadin. However some people can be gluten sensitive in ways that do not result in antibody formation. Gluten may cause a leaky gut by interacting with the tight junctions between gut enterocytes and activate immune cells in other ways. This means that the easiest way to diagnose gluten sensitivity is to stop eating gluten to see if it makes a difference.
Non-coeliac gluten sensitivity does exist and can cause numerous life limiting symptoms. So if you have been told you are not coeliac but suspect gluten is a problem then consider cyrex array 3 and after testing eliminate all gluten from your diet to see if your health improves. Listen to your body. Once you have removed gluten, follow a gut healing programme to lower inflammation, restore digestive function and optimise your health. Contact our clinic for a consult
|Coeliac Disease (CD)||Gluten Sensitivity (GA)||Wheat Allergy (WA)|
|Time interval between gluten exposure and onset of symptoms||Weeks — Years||Hours — Days||Minutes — Hours|
|Pathogenesis||Autoimmunity (Innate and Adaptive Immunity)||Immunity? (Innate Immunity?)||Allergic Immune Response|
|HLA present?||HLA DQ2/8 restricted (~97% positive cases)||Not HLA DQ2/8 restricted (50% DQ2/8 positive cases)||Not HLA DQ2/8 restricted (35–40% positive cases as in the general pop.)|
|Autoantibodies||Almost Always Present||Always Absent||Always Absent|
|Enteropathy||Almost Always Present||Always Absent (slight increase in intraepithelial lymphocytes)||Always Absent (eosinophils in the lamina propria)|
|Symptoms||Both intestinal and extraintestinal; gastrointestinal symptoms not distinguishable from those of gluten sensitivity or wheat allergy||Both intestinal and extraintestinal; gastrointestinal symptoms not distinguishable from those of gluten sensitivity or wheat allergy||Both intestinal and extraintestinal; gastrointestinal symptoms not distinguishable from those of gluten sensitivity or wheat allergy|