Non-Coeliac Gluten Sensitivity

He even went through periods where he could not walk properly – CK

non-celiac gluten sensitivityI’ve been told personally that a little gluten never hurt anyone. Clinical experience proves otherwise. The combination of misunderstanding, ignorance and rise in everything pervasively gluten-free has made the topic seem like a modern day fad. Unfortunately, this phenomenon affects those most for whom gluten sensitivity is a real, clinical issue.

It is now becoming clear that, besides those with coeliac disease or wheat allergy, there are people with gluten sensitivity in whom neither allergic nor autoimmune mechanisms can be identified1. It has been estimated that for every person with coeliac disease there should be at least 6 or 7 people with non-coeliac gluten sensitivity (NCGS)1. In 2011 in London, a panel of 15 experts announced a new classification of gluten-related disorders (see yellow boxes below) that was then published in February 20122. The Second Expert Meeting on gluten sensitivity that was held in Munich in 2012, decided to change the name of gluten sensitivity to non-coeliac gluten sensitivity in order to avoid confusion with coeliac disease3.

The challenge with diagnosing NCGS is that currently there are no laboratory biomarkers specific for gluten sensitivity and the diagnosis is based mainly on exclusion criteria: elimination of gluten-containing foods from the diet and monitoring symptoms. Occasionally people will say they have attempted a gluten-free diet, yet symptoms persist. The problem with this is, firstly, foodstuffs nowadays are a complex minefield of chemicals and people may exhibit cross-reactivity with other wheat-based molecules and, secondly, the person may not have been strict enough with the diet or persisted long enough to heal the gut. Being completely gluten-free is incredibly challenging and often too difficult, so alternative diagnoses to gluten sensitivity are sought and the underlying issue is missed.

Many people that are intolerant of gluten are also intolerant of other proteins found in foods like dairy, eggs, and even coffee and milk protein. Critics of the gluten-free diet argue that people with irritable bowel syndrome (IBS) are not sensitive to gluten, but instead are reacting to a group of poorly absorbed carbohydrates called FODMAPs4 (figure below). From a practical perspective, wheat and many other gluten-containing grains are FODMAPs and should be avoided by people with gluten sensitivity anyway.

IBS FODMAPS

Coeliac disease is easier to diagnose than NCGS. Most doctors today know how to screen for coeliac disease. They will typically test for antibodies to alpha gliadin, transglutaminase-2, deamidated gliadin, and endomysium, and if positive do a biopsy to determine if tissue damage is present. However, we now know that people can (and do) react to several other components of wheat above and beyond alpha gliadin, the component that is implicated in coeliac disease. These include other epitopes of gliadin (beta, gamma, omega), glutenin, wheat germ agglutinin (WGA), gluteomorphin, and deamidated gliadin5,6.

The bottom line is standard blood tests by general practitioners are not comprehensive enough. The person may be reacting to deamidated gliadin, glutenin, gluteomorphin, and either transglutaminase-3 or -6, but not reacting to alpha gliadin or transglutaminase-2 (the antibodies used to screen for coeliac disease by most doctors). They will remain undiagnosed and continue to eat gluten for the rest of their lives, suffering symptoms and putting themselves at serious risk for autoimmune diseases.

The typical presentation of NCGS is a combination of IBS and systemic manifestations like headache, joint and muscle pain, muscle contractions, leg or arm numbness, chronic fatigue, “brain fog”, body mass loss and anaemia. Symptoms can also include behavioural disturbances such as changes in attention or depression2 (Table of NCGS symptoms).

IBS can include abdominal pain, nausea, bloating, flatulence, diarrhoea or constipation. People with IBS who respond well to a gluten-free diet can suffer from one of the three diseases: coeliac disease, wheat allergy or NCGS, where NCGS is the most likely option (figure above). In children, NCGS manifests with intestinal symptoms – abdominal pain and chronic diarrhoea – but also symptoms beyond the gut.

Extragastrointestinal manifestations seem to be less frequent but the most common is chronic tiredness. When a person with NCGS consumes wheat or other gluten-containing foods, he or she may not always experience the classic digestive symptoms associated with gut because they do not produce antibodies to transglutaminase-2 (which is mostly expressed in the gut). Instead, the intolerance of wheat may manifest in skin conditions like eczema or psoriasis; and in neurological or brain-related conditions like depression, peripheral neuropathy (pain, numbness, burning, tingling), ataxia (difficulty walking) or ADHD7. Current evidence suggests that neurological manifestations are immune-mediated and that there is cross-reactivity between immune cells, nerve cells and gluten proteins.

Gluten sensitivity is a common disorder that manifests in diverse ways, making it a difficult condition to diagnose. Many people who present with neurological manifestations of gluten sensitivity have no gastrointestinal symptoms7

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10 causes of leaky gut

10-things-that-cause-leaky-gutWhat is leaky gut?

Leaky gut, or intestinal permeability, is a condition in which the lining of the small intestine becomes inflamed, damaged, and porous, allowing undigested foods, bacteria, fungus, and other foreign invaders into the sterile environment of the bloodstream. Once in the bloodstream these toxins trigger the immune system, causing inflammation and leading to a long and varied list of symptoms. Chronic conditions associated with leaky gut include depression, joint pain, Crohn’s disease, food allergies, eczema, psoriasis, asthma, autoimmune diseases, and more.

Ten causes of leaky gut:

Although the causes of leaky gut can be ambiguous, Datis Kharrazian, DHSc, DC, MS has identified 10 factors that contribute to leaky gut:

  1. Diet: Most people blame poor diet, and rightly so, as many popular foods can damage the gut. Gluten in particular is associated with gut damage. Dairy, processed foods, excess sugar, and fast foods are common culprits. Excess alcohol is another gut saboteur.
  2. Medications: Certain medications increase the risk of leaky gut. They include corticosteroids, antibiotics, antacids, and some medications for arthritis. Some medications may also contain gluten as a filler.
  3. Infections: An overgrowth of H. pylori, a bacterium in the stomach, can cause ulcers and leaky gut. Overgrowth of other harmful bacteria, yeast infections, parasitic infections, and intestinal viruses can also cause leaky gut.
  4. Stress: Chronic stress raises the adrenal hormone, cortisol, which degrades the gut lining and contributes to leaky gut.
  5. Hormone imbalances: The gut depends on proper hormone levels for good health. When estrogen, progesterone, testosterone, or thyroid hormones are out of balance, this imbalance can contribute to leaky gut.
  6. Autoimmune conditions: We often think of leaky gut contributing to autoimmune diseases such as Hashimoto’s hypothyroidism, rheumatoid arthritis, or psoriasis. While this may be true, sometimes other factors can trigger an autoimmune condition, including toxic exposures or stress. In these cases, the autoimmune condition can be the cause of leaky gut and managing autoimmunity is a strategy to improving leaky gut.
  7. Industrial food processing: The food processing industry uses a variety of methods that can increase intestinal inflammation and leaky gut. These include deamidating wheat to make it water soluble, high-heat processing (glycation) of sugars, and adding excess sugar to processed foods.
  8. Environmental toxins: We are surrounded by toxins in our environment. Some of these toxins have been found to break down immune barriers like the gut. One way to shore up your defense against environmental toxins is to make sure your body is sufficient in glutathione, the body’s primary antioxidant.
  9. Vitamin D deficiency: Sufficient vitamin D is vital to good health and helps preserve gut integrity.
  10. Poor glutathione status: Glutathione is the body’s primary antioxidant and is necessary to defend and repair the gut lining. Poor diet and lifestyle factors deplete glutathione.

By better understanding the cause of your leaky gut, you will have more success restoring health to your gut and hence your immune system.

Reference: Kharrazian, D. Why do I still have thyroid problems when my lab tests are normal? Elephant Press. 2010.


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