The Gluten Sensitivity Spectrum
The Gluten Sensitivity Spectrum
Gluten
Gluten is a protein naturally found in some grains. It is made up of two proteins — prolamins and glutelins — which are found in the endosperm of the grain seed. Prolamins are responsible for most of the adverse health effects of gluten.
Grains Containing Gluten
Wheat, barley, rye, triticale, spelt, kamut, couscous, farro, semolina, bulgur, einkorn, durum, matzo, mir, emmer, graham.
Gluten and Health
There's nothing inherently unhealthy about gluten, but people with certain medical conditions like celiac disease, gluten intolerance, or wheat allergy should avoid it, as it may cause serious adverse reactions. Gluten-containing whole grains provide various nutritious vitamins and minerals that can be part of a healthy diet for people who are not sensitive to gluten. Nevertheless, gluten itself provides no essential nutrients and is not necessary for a healthy diet. In reality, it could be contributing to low-grade inflammation in many individuals.
The Gluten Sensitivity Spectrum
There is a very broad spectrum of gluten intolerance and one can be on the gluten autoimmune-inflammation spectrum without having a serious gluten allergy. Symptoms vary from person to person.
Gluten and Inflammation
Various studies show that increased consumption of gluten is linked to higher levels of inflammation biomarkers and it seems that gluten ingestion may induce inflammation at the intestinal level for many individuals. However, this inflammation remains on a spectrum: some will experience inflammation more notably, while others may feel relatively unaffected.
Who Must Avoid Gluten
Celiac disease
Wheat allergy
Gluten ataxia
Dermatitis Herpetiformis
Non-celiac gluten sensitivity (gluten intolerance)
Who Should Avoid Gluten
Anyone on the gluten-sensitivity spectrum should avoid gluten in order to reduce inflammation.
Autoimmune diseases
Gastrointestinal disorders
Neurological disorders
Celiac Disease
Celiac disease is a serious autoimmune condition in which a person’s immune system attacks cells of their small intestine on gluten consumption.
When people with celiac disease ingest gluten, their body mounts an immune response that attacks the villi (small fingerlike projections that line the small intestine). When the villi get damaged and flattened, nutrients cannot be absorbed properly into the body and various nutrient deficiencies arise.
PRIMARY SYMPTOMS
Diarrhoea, constipation, abdominal pain, weight loss, poor appetite, intestinal discomfort, bloating, gas, feeling full, vomiting, acid reflux, heartburn, mouth ulcers, nutrient deficiencies, anemia, osteoperosis, dermatitis herpetifomis (an itchy skin rash), dental enamel spots, infertility, miscarriage, neurological conditions, psychiatric disorders, headaches, fatigue, bone and joint pain, seizures, growth delay in children.
DIAGNOSIS
There are various reliable tests to diagnose celiac disease. These include genetic tests, blood tests that detect certain antibodies, and intestinal biopsies. Tests may turn up negative if gluten hasn’t been consumed for a while, so it’s best to carry out as many tests as needed to confirm the diagnosis before excluding gluten from the diet.
TREATMENT
Complete and lifelong avoidance of gluten.
Wheat Allergy
A wheat allergy is an allergic reaction to foods containing wheat.
When a person with a wheat allergy is exposed to wheat, proteins in the wheat bind to specific IgE antibodies made by the person’s immune system. This binding triggers the person’s immune defenses, leading to reaction symptoms that can be mild or very severe. The immune response is most often temporary and can actually be outgrown.
PRIMARY SYMPTOMS
Stomach cramp, nausea, indigestion, vomiting, diarrhea, headache, nasal congestion, sneezing, asthma, skin rash, hives, difficulty breathing, anaphylaxis.
DIAGNOSIS
Diagnosis of an allergy can be made through a skin-prick test or a blood test. In the blood test, a blood sample is sent to a laboratory to test for the presence of immunoglobulin E antibodies to wheat protein.
TREATMENT
Management includes strict avoidance of wheat ingredients in both food and non-food products. Additionally, your doctor may suggest some medication, including antihistamines and epinephrine.
Gluten Ataxia
Gluten ataxia is a rare neurological autoimmune disorder that causes the body to attack parts of the brain (cerebellum) in response to gluten. The cerebellum is the part of the brain located in the back of the head above the neck. The cerebellum is responsible for movement and has a direct impact on activities such as balance, speech, posture, walking and running.
Gluten ataxia is a progressive condition, which means that symptoms may start off mild and almost unnoticed, and gradually progress to being debilitating. Without treatment, the central nervous system may become severely damaged, which will result in the symptoms becoming permanent.
PRIMARY SYMPTOMS
Problems with general movements (walking, arm control), unsteadiness, dizziness, issues with coordination, loss of precise movement skills, balance issues, difficulty with speech, vision issues, symptoms of nerve damage in the hands, feet, and limbs.
DIAGNOSIS
Since gluten ataxia is a relatively obscure condition, the methods used to diagnose the condition are relatively new. Researchers recommend using techniques that doctors use to diagnose celiac disease, such as blood tests. If ataxia symptoms stabilize or improve with diet, then it's considered a strong indication that the ataxia was gluten-induced.
TREATMENT
Treatment involves a strict removal of all gluten from a person’s diet. The elimination of gluten will eventually cause the symptoms to clear up.
Dermatitis Herpetiformis
Dermatitis herpetiformis is a chronic skin condition that produces extremely itchy bumps and blisters on the skin caused by a reaction to gluten ingestion.
Dermatitis herpetiformis is caused by the deposit of immunoglobulin A (IgA) in the skin, which triggers further immunologic reactions resulting in lesion formation. DH is an external manifestation of an abnormal immune response to gluten, in which IgA antibodies form against the skin antigen epidermal transglutaminase.
PRIMARY SYMPTOMS
Dermatitis herpetiformis is characterized by small, clustered papules and vesicles that erupt symmetrically on the elbows, knees, buttocks, back, or scalp. The face and groin can also be involved. A burning sensation may precede lesion formation.
DIAGNOSIS
A skin biopsy is used to confirm a diagnosis of DH. A skin sample is taken from the area immediately next to a lesion and a fluorescent dye is used to look for the presence of Immunoglobulin A (IgA) deposits that appear in a granular pattern. Skin biopsies of people with DH are almost always positive for this granular IgA pattern. Blood tests for other antibodies commonly found in people with celiac disease supplement the diagnostic process.
TREATMENT
Symptoms normally resolve with a strict, gluten-free diet. Additionally, your dermatologist may prescribe dapsone for short-term relief from the itching. People who can’t tolerate dapsone may be given sulfapyridine or sulfasalazine instead, although these drugs are less effective.
Gluten Intolerance
Gluten intolerance (also knows as non-celiac gluten sensitivity) refers to adverse reactions to gluten.
If a person is gluten intolerant, the consumption of gluten will cause short-term symptoms and doesn’t usually cause long-term harm to the body.
PRIMARY SYMPTOMS
Diarrhoea, constipation, abdominal pain, altered bowel function, bloating, gas, nausea, pain, anxiety, tiredness fibromyalgia, joint, bone or muscle pain, confusion, mood disorders, chronic fatigue, foggy mind, headache, migraine, arthritis, skin manifestations (rash or eczema).
*These symptoms may occur within hours to days following ingestion of gluten and reportedly dissipate upon the withdrawal of gluten.
DIAGNOSIS
While potential antigens and biomarkers that may lead to the onset of NCGS are still under investigation, the clinical diagnosis of NCGS is characterised by the following:
(1) Intestinal and extra-intestinal symptoms related to gluten ingestion.
(2) An absence of celiac disease and wheat allergy.
(3) Confirmation by gluten withdrawal and double blind placebo challenges.
TREATMENT
Individuals with gluten intolerance may find relief by supplementing with digestive enzymes to help alleviate the symptoms, reducing the volume of gluten in their diet, or eliminating gluten from their diet entirely.