WHAT IS GLUTEN?
Gluten is a protein which can be found in wheat, barley and rye. Existing confusion whether oats are a source of gluten is based on occurring cross contamination during production, transportation or storage. Oats are naturally gluten-free.
WHERE CAN YOU FIND GLUTEN?
The main sources of gluten are flour, biscuits, cakes, bread, breakfast cereals, pasta, pizza, pastry. This is not an exhaustive list and more often gluten can be hidden in other foods such as sausages, soups, instant meals and processed foods. You need to check your food labels!
SHOULD YOU BE EATING GLUTEN?
Based on current evidence, people diagnosed with Coeliac disease are advised to follow a gluten-free diet. A dietetic approach in these individuals is an absolute must as gluten causes an immune reaction to the lining of the small intestine resulting in damage on the villi thus altering the absorption of nutrients.
Typical symptoms include tiredness (even exhaustion), anaemia, headaches, nausea, bloating, constipation, diarrhea, hair loss and weight loss (though not in every case).
Coeliac disease and gluten allergy are two independent conditions and they should not be confused. Gluten allergy symptoms account for 10-25% individuals diagnosed with other foods allergies.
Symptoms occurring in gluten allergy can be divided into both immediate and delayed responses. The first one occurs in minutes to one hour after food ingestion and the latter can occur within few hours to even 1-2 days.
To ensure that gluten allergy symptoms are not a Coeliac Disease, the concentrations of celiac-specific antibodies (EmA and / or tTG) that are not present in gluten allergy are determined. The ‘gold standard’ for the diagnosis of food allergy is embarking on the Elimination diet with reintroduction of sensitizing food. Similar, to Coeliac disease, the only treatment for gluten allergy is a strict gluten-free diet.
NON-COELIAC GLUTEN SENSITIVITY
In the last few years researchers have shown that some people may present gluten sensitivity symptoms which are neither Coeliac disease nor allergy to gluten. This condition is called a Non-Coeliac Gluten Sensitivity.
The disorder mainly affects adults and is characterized by the occurrence of one or more symptoms not only limited to the digestive tract:
- Abdominal pain
- Rash, eczema
- Feeling of constant fatigue
- Numbness and soreness of the extremities
- Burning sensation in the oesophagus
- Nausea and vomiting
- Tongue inflammation
These symptoms usually appear within a few days or hours after eating gluten-containing foods. Due to the fact that there are no specific gluten sensitivity markers for the time being, the condition and diagnosis must be based on clinical criteria and patient observation after reintroduction of gluten (gluten-free diet).
WHEN CAN WE TALK ABOUT GLUTEN SENSITIVITY? (SUMMARY):
- IgE antibodies are in a normal range (which excludes allergy).
- Coeliac disease is excluded – based on normal antibodies levels: tTG, EmA, DGP.
- Intestinal villi atrophy is not present during biopsy (Marsh 0 or I).
- Possible presence of anti-gliadin antibodies AGA (IgA and / or IgG class).
- No genetic dependency – the patient may or may not have gene HLA DQ2 / DQ8.
- If the patient experiences symptom relief after following a gluten-free diet and the symptoms are back once a diet is reintroduced.
There are no specific diagnostic tests for non-coeliac gluten sensitivity
Once it is suspected that non-coeliac gluten sensitivity is more likely to be the reason for the previously mentioned symptoms and both Coeliac disease and gluten allergy are excluded, an individual should start following a gluten-free diet under control of the doctor and dietitian.
This is only a brief summary touching on the issues of Gluten allergy and non-coeliac gluten sensitivity. For further information on these topics or for a personalized diet and nutrition plan please leave me a message on the website contact page or reach me on the details below:
My next blog piece in a fortnight, will be on health concerns related to a gluten free diet! Yes, there are risks associated with this that you need to be aware of if you aren’t already and I will be drawing your attention to these in my next post so watch this space.
Until then, keep healthy!
Aleksandra Jagiello (BSc, MSc, ANutr)
Qualified Clinical Nutritionist