Recently, gluten-free diets and wheat avoidance have become a popular campaign as more and more people experience symptoms of adverse reactions to food items that contain gluten. This is probably because a lot of packaged and processed food being sold on supermarket shelves or meals being served in most restaurants contain wheat or a wheat by-product.
Since most Americans are accustomed to a high-calorie diet that is comprised of carbohydrates, sugars, and processed food, health conditions that include chronic inflammation, metabolic diseases, and gut disorders have become increasingly common.
What is Gluten Sensitivity or Gluten Intolerance?
Gluten sensitivity or gluten intolerance refers to a condition where a person experiences negative reactions to the ingestion of gluten, a composite protein that is found in wheat, barley, and rye. The symptoms can include fatigue, diarrhea, joint, pain, “foggy mind,” and depression. The symptoms are usually resolved by implementing a diet that eliminates gluten or wheat products.
It is to be distinguished from celiac disease as those affected with gluten intolerance often test negative for the former.
How Does Gluten Sensitivity Differ from Celiac Disease?
Gluten sensitivity is different from celiac disease although some of the manifesting signs may appear similar. Celiac disease is a rare autoimmune disorder that affects approximately only 1% of Americans.
Researchers have found that unlike celiac disease, gluten sensitivity does not cause intestinal inflammation that harms the villi of the small intestines. Neither is it characterized by the development of transglutaminase (tTG) autoantibodies. As a result, non-celiac gluten sensitivity (NCGS) does not cause long-term damage to the small intestine in the way that celiac disease does.
However, some symptoms of gluten intolerance may also be experienced by some people who test negative for celiac disease. Thus, the term “non-celiac gluten sensitivity,” broadly refers to a condition which is diagnosed among patients who show signs of “sensitivity” to gluten or wheat products but who do not have celiac disease.
What Are the Symptoms of Gluten Sensitivity?
Gluten-related disorders cause several symptoms that affect various organs and systems including the central nervous system, the endocrine system, cardiovascular system, skeletal system, and the reproductive system.
The signs of gluten sensitivity or intolerance include the following:
• Digestive and bowel symptoms such as abdominal pain, cramping, gas, bloating, constipation, and diarrhea
• Difficulty in concentrating or “foggy mind”
• Headaches
• Changes in mood
• Anxiety and depression
• Behavioral changes including display of ADHD symptoms
• Muscle and joint pain
• Chronic fatigue
• Numbness
• Tingling in the arms and legs
• Skin diseases such as eczema, rosacea, and skin rashes
• Keratosis Pilaris or “chicken skin” on the back of the arms
• Nutritional deficiencies including iron deficiency and Vitamin A deficiency
• Reproductive disorders including infertility and hormonal imbalances
• General reduction of symptoms when gluten products are eliminated from the diet
NCGS is also associated with the risk of developing complicated medical conditions such as the following:
• Neurological diseases such as Alzheimer’s and dementia
• Psychiatric disorder such as schizophrenia and other forms of psychosis
• In children, learning disabilities including autism and ADHD
Several research studies have established that there is a connection between a balanced gut flora and a person’s overall health. Gluten can trigger alterations in the gut microbiota and when someone has gluten intolerance, the changes affects several vital processes including nutrient absorption, hormone production, metabolic function, and mental processes. As such, the symptoms go beyond simple gastrointestinal disturbances.
Causes of Gluten Sensitivity
Generally, gluten disrupts the normal digestion process and it affects people in varied ways. In some, gluten can cause damage to the lining of the gut. This allows the “leaking” of other molecules to the bloodstream that incites an inflammatory response. This is why some people experience an “intolerance” to gluten.
The causes of the symptoms could be traced to the overall diet, the resulting impairment to the gut flora, genetic predispositions, and hormonal imbalance.
Some studies have shown that apart from gluten, the other short chain carbohydrates, otherwise known as FODMAPs (fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols) that are present in most grains and cereals can also provoke or aggravate symptoms of NCGS because they tend to be poorly absorbed in the gut.
In addition, some people afflicted with NCGS may also have adverse reactions to other proteins called ATIs (-α-amylase/trypsin inhibitors). ATIs are contained in most cereals and have been shown to cause intestinal inflammation in some people.
Diagnosis of Gluten Sensitivity
Currently, there are no tests available that can specifically determine whether a person has NCGS. The diagnosis is arrived at by a process of elimination or after celiac disease has been medically ruled out.
When a patient complains of adverse reactions to the ingestion of gluten that include gastrointestinal disturbances, the doctor is likely to order a blood test or a skin-prick test to check for the presence of gluten antibodies which would indicate that the person has celiac disease or wheat allergy. In some cases, an intestinal biopsy may also be conducted.
When the physician has ruled out celiac disease based on laboratory results and other markers, then it can safely be concluded that the patient has NCGS.
It is important that a patient does not voluntarily begin a gluten-free diet before the testing procedures are completed. Eliminating gluten can reduce the production of antibodies which will affect the results. This can delay an effective diagnosis and a subsequent treatment plan.
Management and Treatment
The next logical step is to treat NCGS by implementing meal plans that are absolutely gluten-free. This will help to assess whether making dietary changes can reduce or resolve the symptoms.
A gluten-free diet is one that excludes products that contain gluten. This means the patient has to give up most bread, pastry items, pasta, and cereals. He must make sure to read the ingredient labels on food and beverage packages before making a purchase and should avoid eating in restaurants which serve meals that contain gluten.
The degree to which gluten cross-contamination should be avoided is unclear. Most NGCS patients do not have severe reactions to small and infrequent amounts of gluten which may permit them to eat wheat-contaminated products. There are reports though of those who suffer symptoms even from consuming tiny portions of gluten. Careful monitoring has to be done to observe whether the symptoms appear even with the smallest consumption of food items that may contain gluten.
In addition, the daily meals should comprise more nutritious food including fruits, vegetables, lean proteins, probiotics, and gluten substitutes. There are alternatives to wheat products which are available in most health shops and supermarkets. These include brown rice, quinoa, sweet potatoes, coconut flour, and chickpea flour.
The diet must be observed for at least a year before gluten could be reintroduced to observe any possible reactions. A patient should always consult his physician or nutritionist before attempting to reintroduce wheat products to his diet. He should also work with the appropriate medical professionals to determine which meal plans are to be best observed to manage or treat his gluten sensitivity.
A number of studies have established that NCGS is less damaging to the gut compared to celiac disease. It also manifests symptoms which are less severe which makes the condition more manageable and treatable.
The best approach remains to be the implementation of changes in diet and lifestyle by eliminating food items and practices that lead to gluten exposure. Over time, a patient is likely to have fewer symptoms and will notice a significant improvement in his overall health.
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