Since the month of May is Celiac Awareness month, I thought it appropriate to do a blog post on the subject of gluten sensitivity. Celiac Disease is classed as an autoimmune condition of the small intestine because of its reaction to gluten. Symptoms of Celiac can affect almost any area of the body with common symptoms being;
- Abdominal cramping and bloating
- Diarrhea with pale, loose, greasy stools
- Weight loss
- Malabsorption issues with iron, B12, calcium, vitamin D and K
- Mouth ulcers
- Skin concerns – itchy, sore, red areas
- Other autoimmune conditions including; Type 1 diabetes, hypothyroid, biliary cirrhosis, colitis
- Neurological symptoms ranging anywhere from headache, migraine to neuropathy, autism and schizophrenia
It can be challenging to get a proper diagnosis, but conventional testing will look at blood tests for specific antibodies including:
- AGA (antigliadin antibodies)-IgA
- tTG (anti-tissue transglutaminase)-IgA
- EMA (anti-endomysial antibodies)-IgA
- Total serum IgA
In addition to these tests, a biopsy of the small intestinal tissues may be performed as well as genetic testing looking for specific genes known as HLA-DQ2 and HLA-DQ8. The blood tests can produce false negatives, yet the biopsy test is more precise but also much more invasive, and the gene tests can show that you have a genetic predisposition for the disease but not Celiac disease itself.
In addition, the blood tests that indicate a positive for Celiac show an immune reaction to a specific gluten fraction known as alpha gliadin, and a specific enzyme known as tTG-2 (a transglutaminase enzyme). There are however several other fractions of gliadins in gluten (beta, gamma, and omega) and additional components like glutenin, wheat germ agglutinin, deamidated gliadin and transglutaminase type 3 and type 6. In short, there are several other factors that one may react to, which brings us to the topic of Non Celiac Gluten Sensitivity (NCGS for short).
For stats on both Celiac and NCGS I’ll refer you to a previous AOR blog post by Dr. Mainland here. This is a great article showing just how much both of these are on the rise. If you look in your local grocery store these days, it is clear that the gluten free movement is significantly on the rise.
NCGS is really a grey area in the medical community with no clearly defined diagnostic test. Symptoms for NCGS can affect virtually any area of the body adversely and may not present with any associated gastrointestinal symptoms at all. Symptoms may involve poor immune status, eczema/psoriasis, asthma, arthritis, migraine, osteoporosis, thyroid imbalance, other hormonal imbalances, diabetes or AD/HD. This list of potential negative effects as a result of consuming gluten goes on and on.
There are some forward thinking laboratories that have begun to offer tests to look at the other fractions of gluten and antibodies associated with NCGS conditions. Antibodies such as IgE, IgG, sIgA and gluten peptide testing can all reveal insights into the levels of gluten sensitivity in each individual. These tests are usually not performed by your GP and are more often found being done by a naturopathic doctor or other integrated practitioner.
The gold standard for assessment however, continues to be the elimination diet. This involves completely removing gluten from the diet for a period of at least 30 days, and then slowly adding it back in after that. If symptoms improve during the elimination period, and return when gluten is reintroduced, a diagnosis of NCGS can be made. It can be difficult to achieve both for adults and children alike since wheat is a major component of the North American diet, and hidden in many food items as well. That being said, it is clinically very conclusive.
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van der Windt DA, Jellema P, Mulder CJ, Kneepkens CM, van der Horst HE (2010). “Diagnostic testing for celiac disease among patients with abdominal symptoms: a systematic review”. JAMA 303 (17): 1738–46.
Carroccio, A et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol. 2012 Dec;107(12):1898-906.