Coeliac or non-coeliac gluten intolerance?
With Sue Kira
Coeliac disease, (also called non-tropical spru, gluten sensitive enteropathy, or celiac spru) is a condition that involves an inability to digest gluten.
Gluten is a tough elastic protein found in the glutinous grains such as wheat, rye, barley, and sweet rice. Oats also contain substantial gluten, but often this doesn’t cause the same problems as the other grains.
In celiac disease, the gluten in the cereals (except oats) is not digested, perhaps due to insufficient pancreatic enzymes.
Simple indigestion is not the only problem, however, as during the disease process, the villi of the small intestine are destroyed, impairing the assimilation of nutrients from all foods.
There are also many cases in which prior intestinal damage brings on coeliac disease — these may be caused by mental stress, long-term laxative use, intestinal infections and/or parasites, excessive coffee-drinking and protein deficiencies.
Frequent signs and symptoms
Weight loss, diarrhea, abdominal pain/distention, vomiting, anaemia, muscle cramps and spasms, fatigue, paleness, skin rash, bone pain, breathlessness, mouth ulcers, swollen legs and constipation can be signs of celiac disease.
• Dermatitis Herpetiformis, a chronic skin disease characterised by crops of small blisters that are intensely itchy, may also be seen in association with coeliac disease.
• It appears that many schizophrenics have coeliac disease. They frequently manifest similar digestive symptoms and carefully controlled studies showed that schizophrenics generally improve faster on a gluten-free diet.
• Coeliac disease often leads to lactose intolerance and increased intestinal permeability and frequently results in multiple food allergies.
Apart from the above symptoms thyroid abnormalities, insulin-dependant diabetes mellitus, psychiatric disturbances and hives have also been linked to gluten intolerance.
Non-coeliac gluten intolerance
This is where some individuals have a tendency to develop adverse reactions to gluten in the absence of any demonstrable abnormality of the small bowel mucosa. Clinical manifestations are variable.
Common symptoms include mouth ulceration and gastrointestinal disturbances such as nausea, abdominal cramps, flatulence and/or diarrhea.
• Genetic factors: people with specific genetic markers known as HLA-B and DRw that appear on the surface of cells (like the genetic markers of blood type) are significantly more likely to have coeliac disease than persons without the markers.
The HLA-B marker is found in 85-90% of coeliacs versus 20-25% of people who don’t have coeliac disease.
The frequency of HLA-B is low in Asia, an area where farming has a long history and the population has been able to adapt and assim-ilate wheat over many centuries.
However, in areas where wheat cultivation is a relatively recent development (from around 1000BC) in the northwest Indian subcontinent and northern central Europe, the incidence of HLA-B is much higher.
Coeliac disease is virtually unknown in Asia, but is estimated to occur in 1:300 people in the southwest of Ireland, and 1:2500 people in the US — a much more genetically diverse population.
• Gluten: The major component of wheat, gluten is composed of gliadins and glutenins. Only the gliadin portion has been demonstrated to activate coeliacs.
Among the different cereal grains, which are all members of the family Gramineae, the more closely a grain is related to wheat, the greater its ability to activate the disease.
• Protein digestion abnormality: Gliadin that has been completely broken down by digestion does not activate coeliac disease in susceptible individuals.
This suggests that coeliac disease may arise from a deficiency either of enzymes that break down gliadin or of some other factor involved in protein digestion.
• Immune system abnormality: The damage to the intestinal tract seen in coeliac disease is not due to some toxic property of gliadin, but it results when the immune system, in the process of trying to neutralise gliadin, destroys surrounding intestinal tissue.
• Early introduction of cow’s milk: Cow’s milk contains a number of highly allergenic proteins. A major portion of the immune system, the gut-associated lymphoid tissue (GALT), clusters around the intestines.
Particularly during the first 4 to 6 months of life, when the intestinal system is not yet fully developed, allergenic protein can leak across the intestinal wall, triggering an immune response from the GALT and the development of food allergies.
Risk increases with:
- Not having been breastfed as an infant
- Early introduction of cereal grains/or cow’s milk into the diet
- Northern and central European or northwest Indian ancestry
- Family history of coeliac disease
- Lactose intolerance
- Other allergies
Diet — Follow a gluten-free diet.
Eliminate milk and milk products until intestinal structure and function return to normal. Rotate other foods to minimise the potential for developing allergies.
In Australia, to be labelled as gluten-free, foods must contain no detectable gluten.
In some other parts of the world, eg, the UK, foods labelled as gluten-free may contain ingredients from wheat, barley, rye and oats if the protein content of these foods is 0.3% or less.
This level of protein approximately equates to the gluten remaining in wheat starch after the separation processes from the whole grain. In the US, the gluten-free recommendation is extremely tight.
Even distilled ingredients derived from gluten containing grains (eg, white vinegar, ethyl alcohol, spirits etc) are recommended for exclusion from a gluten-free diet.
Even if there was a universally accepted standard, the determination of the actual level of gluten in food is difficult.
The testing procedure is complicated and costly. Ingredients vary in composition and processes can give varying outcomes.
However, in general terms, the processing of grains can involve a chemical reaction, precipitation, filtration etc, or a combination of these.
The further the ingredient is processed from the gluten-containing source, the lower the gluten content is likely to be.
Some ingredients (eg, glucose syrup, caramel colouring) are so highly processed that, when tested, the results have shown ‘no detectable gluten’.
• Nutritional supplements. As there are often nutritional deficiencies in coeliacs it is advisable to use a high potency multi vitamin and mineral supplement and pancreatic enzymes.
My personal recommendation is to have a live blood analysis to assess any intestinal permeability and nutritional deficiencies and then make any necessary corrections as an adjunct to the diet.
For more info you can check out the website for the Australian Coeliac Society
Originally published in Here & Now magazine. Written by Sue Kira from True Vitality
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