Monday, January 07, 2019

Gluten sensitivity

Gluten sensitivity
Also called: gluten intolerance



Sensitivity to gluten, a protein found in wheat, barley, and rye.
Very common
More than 3 million US cases per year
Treatment can help, but this condition can't be cured
Usually self-diagnosable
Lab tests or imaging often required
Chronic: can last for years or be lifelong
Gluten sensitivity ranges from full-blown celiac disease with small bowel inflammation and damage, to allergy to or intolerance of gluten.
Symptoms can include bloating, diarrhea, abdominal pain, tiredness, and skin rashes.
A gluten free-diet generally reverses or stops the symptoms.
Ages affected
3-5
Common
6-13
Common
14-18
Common
19-40
Very common
41-60
Very common
60+
Very common

GLUTEN SENSITIVITY

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(also known as non-celiac gluten sensitivity, or non-celiac wheat sensitivity) 


Some individuals who experience distress when eating gluten-containing foods and show improvement when following a gluten-free diet may have what is commonly referred to as gluten sensitivity (GS), instead of celiac disease (CD). It is important to keep in mind that GS is not well understood, and it is still not clear whether other components of gluten-containing grains may be involved in causing symptoms, at least in some individuals. The symptoms seen in gluten sensitivity often resemble those that are associated with celiac disease, but often with a prevalence of non-gastrointestinal symptoms.
Diagnosis: 
Because gluten sensitivity is still poorly understood and no bio-markers have been identified, there are no specific medical tests that can be performed to confirm the condition. Instead, it is a “rule out” diagnosis. To diagnose gluten sensitivity, both celiac disease and wheat allergy must be ruled out. Other conditions which may be causing symptoms should also be ruled out. Antibody testing and small intestine biopsy would rule out celiac disease. Immune-allergy tests to wheat would also be negative. Finally an elimination diet and “open challenge” (monitored reintroduction of gluten-containing foods) are most often used to evaluate whether health improves with the elimination or reduction of gluten from the diet.
If you think you may have gluten sensitivity, It is important to consult with your personal physician before giving up gluten. Other possible causes of symptoms should be ruled out. In addition, the screening tests for celiac disease will not be valid if gluten has already been removed from the diet.
Treatment: 
Scientific studies regarding treatment of non-celiac gluten sensitivity are limited at this time; however the recommended course of action is to follow a gluten-free diet. It may be possible for some individuals with gluten sensitivity to tolerate a low-gluten diet instead of a gluten-free diet. Consult a physician or dietitian for dietary guidelines.

Frequently Asked Questions

Will gluten damage my intestines? 
If you have an intestinal biopsy which shows that you do not have celiac disease, there is no reason to believe that damage is being done to the intestine.
If I have gluten sensitivity now, will I develop celiac disease later? 
There is no research that shows whether or not individuals with gluten sensitivity will develop celiac disease. Continue to be checked by your doctor regularly if you continue to eat gluten.
Why is a gluten-free diet effective for some people with autism, multiple sclerosis or chronic fatigue, even when they do not have celiac disease? 
It is possible that they have GS. This may be one reason why eliminating gluten from their diets results in improvement of some symptoms.
My doctor says that I have moderately elevated blood tests but do not have celiac disease. What do I have? 
You may have a form of GS that brings about a slight immune response but does not cause intestinal damage. Avoiding gluten may help you to feel better. Talk to your doctor to develop a treatment plan specific to you.
I avoid wheat, but I am still having symptoms. What is wrong with me? 
A wheat allergy is different from gluten sensitivity. If your symptoms are due to celiac disease or non-celiac gluten sensitivity, you need to avoid all gluten-containing foods: wheat, rye and barley, as well as any products derived from these grains. (Note: oats should also be avoided unless they are specifically labelled gluten-free, since oats are commonly cross-contaminated with wheat.)

Overview of Gluten Sensitivity

Updated July 21, 2016
Until recently, people who got negative results on the blood tests and intestinal biopsy used to diagnose celiac disease were told to eat whatever they wanted—gluten wasn't their problem.
However, many of those people tried the gluten-free diet anyway—a diet that eliminated every food that included the gluten grains wheat, barley, and rye—and reported they felt much better. Their symptoms (which included fatigue, digestive complaints, and neurological issues) cleared up when they ate gluten-free.
Many of these people felt they were sensitive or intolerant to the gluten protein, even though testing showed they didn't have celiac disease. In some cases, their doctors agreed with their assessments and agreed they shouldn't be eating gluten. In other cases, they simply continued to avoid gluten without a physician's blessing.
Now, many researchers (although not all) believe that such a condition involving a problem with those gluten grains (a problem that's not celiac disease) does exist.
They're calling it "gluten sensitivity," "non-celiac gluten sensitivity (NCGS)," "non-celiac wheat sensitivity," "gluten intolerance," or even "gluten allergy."
However, the condition's existence hasn't yet been proven definitively, and as of yet there's no explanation for why it occurs and how it might be related to celiac disease. There's not even a universally accepted name for it, although most of the experts in the field have coalesced around "non-celiac gluten sensitivity" or "non-celiac wheat sensitivity."
It's also not clear if it's the protein in wheat, barley, and rye that causes the symptoms of the condition.
In fact, researchers have identified other compounds in wheat, specifically, they say could be responsible. Some of these compounds, known as FODMAPS, are found in other foods, such as garlic and onions, as well as in wheat.
In addition, a study published in July 2016 indicates that the culprit in non-celiac gluten/wheat sensitivity may in fact be a leaky gut. The study, conducted by researchers at Columbia University Medical Center, found that those with wheat sensitivity had immune system markers indicating "systemic immune activation."
The results of the study suggest that this immune system activation occurs because microbes and food proteins are crossing the intestinal barrier into the blood stream, causing widespread inflammation.
Finally, despite a few recent studies showing gluten sensitivity may exist, many doctors don't yet agree that it's a real medical condition, and there's no accepted medical test for it. Research continues to seek the truth about wheat/gluten sensitivity, and as further results are awaited, your doctor may be more or less of a believer in the condition.

Symptoms of Gluten Sensitivity

The symptoms associated with gluten sensitivity sound remarkably like those associated with celiac disease: digestive problems, bloating, and fatigue.
Problems such as diarrhea, constipation, and abdominal pain occur frequently in those who have been diagnosed with gluten sensitivity. They're also common in those who report feeling ill from gluten-containing foods, but who don't have a diagnosis.
Joint pain, headaches, and brain fog are more frequently noted symptoms, and there's one small study that found gluten can cause depression in people who don't have celiac disease.
It's not clear whether these symptoms indicate actual damage to your body's systems, or whether they just show you've eaten something that doesn't agree with you. Some researchers say people who are gluten-sensitive actually can experience damage to other organs and systems, especially their neurological systems, but this hasn't been proven in scientific research.

Gluten Sensitivity vs. Celiac Disease

When you're diagnosed with celiac disease, it usually means you've met strict medical criteria—you have damage to your intestinal villi (known as villous atrophy) that was caused by an autoimmune reaction to gluten in your diet.
Celiac disease affects approximately one in every 133 people in the U.S., making it a relatively common condition.
Most people who show symptoms of celiac disease don't have the condition, but some of these people do find relief from their symptoms on a gluten-free diet, and may, therefore, have gluten sensitivity.
Doctors need to rule out celiac disease before they can diagnose gluten sensitivity. This usually means you'll need to undergo celiac blood tests and then (possibly) an endoscopy, a procedure doctors use to look directly at your small intestine. If these tests don't show signs of celiac disease, then you and your doctor can consider alternative diagnoses, including gluten sensitivity.

Testing Options for Gluten Sensitivity Remain Unproven

Since many researchers do not agree that gluten sensitivity exists, there's no proven test to diagnose the condition. So what can you do to test for it if you think this might be your problem?
Once you and your doctor have ruled out celiac disease, you do have a few options for gluten sensitivity testing.
However, you should be well aware that none of those options have yet been validated by medical research.
For example, some physicians will use positive results on certain blood tests—tests that look directly for gluten antibodies in your blood—to help diagnose gluten sensitivity. A few others will diagnose you based on your response to the gluten-free diet—in other words, if you eliminate gluten and feel better, you're gluten-sensitive.
You also have the option of pursuing direct-to-consumer gluten sensitivity testing through EnteroLab—just be aware that the testing methodology used by this lab hasn't been proven or accepted by most physicians.

Many Unanswered Questions on Gluten Sensitivity

It's possible that gluten sensitivity and celiac disease represent different aspects of the same condition, but it's more likely that they represent completely separate conditions. Since researchers don't yet agree on a definition for gluten sensitivity, we can't say for sure why it may occur and how it might relate to celiac disease.
In addition, it's likely that not everyone who avoids gluten needs to do so. If you drop gluten from your diet and feel better, you may be sensitive or intolerant to gluten. But there may be other explanations for your health turnaround.
For example, some people may feel better simply because they're eating a healthier diet—by cutting out gluten, you're also cutting out many forms of processed and junk foods. In fact, this is part of the reasoning behind popular "gluten-free cleanse" diets promoted by various celebrities, and may be the reason some people lose weight when they go gluten-free.
It's also possible that you feel better simply because you believe you're doing something positive for your health, i.e., feeling better on the gluten-free diet represents the placebo effect in action.
I don't say this lightly—in the past, too many doctors downplayed and dismissed potential symptoms from gluten, and the "it's all in your head" mantra still persists in parts of the medical community, despite advances in awareness. But it's true that some people who believe they can't tolerate gluten may be able to tolerate it just fine, as evidenced by the fact that some people who say they're gluten-sensitive can "cheat" on the diet without clear symptoms.
In fact, several studies have found that some people who believe they're gluten-sensitive don't react to pure gluten, or to gluten-containing grains, when they consume those substances in a blinded study. Others do react, though, which provides evidence that the condition does exist.

Gluten Sensitivity Treatment: The Gluten-Free Diet

As with celiac disease, the only current treatment for gluten sensitivity is the gluten-free diet.
There's quite a lot of debate over how strict that diet needs to be for someone who may "only" be gluten-sensitive. Some physicians will tell you to go ahead and cheat on occasion, while others will recommend a very strict gluten-free diet.
It's not clear whether following a gluten-free diet can provide you with health benefits beyond those you get from simply feeling better, or whether consuming gluten grains when you're sensitive entails health risks. As I said earlier, there's been little research indicating that you experience physical damage from gluten (no matter how unpleasant the symptoms you experience might be). But there's also been no research showing that you don't experience damage. This is an area that researchers are just beginning to explore.
As with everything involving gluten sensitivity, there are only a few studies that provide any insight, and some of the medical research to date has been contradictory. Eventually, scientists hope to provide more answers. In the meantime, if you're diagnosed with gluten sensitivity, you'll need to decide for yourself—in consultation with your doctor—how strictly to follow the gluten-free diet.

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