Wheat, Gluten, Gluten Sensitivity, Coeliac Disease, Non-Coeliac Gluten Sensitivity and Gluten Intolerance…. HOW CONFUSING!!
There are so many terminologies surrounding wheat and gluten today that I feel the need to clarify them. They create so much confusion and a majority of the time they being are used incorrectly.
Firstly, what is Gluten?
Gluten is a generic term; it is found in the endosperm (nutritive starchy tissue surrounding the embryo) of all grains (a grain is the seed of a grass). These proteins can be broken down into smaller proteins called Prolamines and Glutelins.
The prolamine gliadin is the most studied piece of gluten today as it relates directly to Coeliac Disease. It contains 69% of the total protein found only in wheat.
Other grains such as rye, oats and barley are the other traditional grains associated with Coeliac Disease each containing other forms of prolamine gluten.
Then there are some other grain prolamines such as millet, corn, rice and sorghum that also contain gluten in lesser concentrations.
What is Gluten Sensitivity?
The current definition from Coeliac Australia is as follows: “Gluten sensitivity is an immune reaction to the protein found in wheat, barley and rye” (sometimes is says oats, sometimes is doesn’t)
This definition is also synonymous with Coeliac Disease; wheat, barley and rye have been identified as the culprit grains and this has stuck.
But it is wrong!!!
It is inconsistent… What about other gluten containing grains?
Corn for example:
- An old Study done in 1983 proved intestinal permeability and harmful activity.
- Another Study in 2005 compared corn gluten to wheat gluten and concluded they have the same inflammatory reaction.
But today corn is still reported as being harmless in the intestines of humans.
Gluten Sensitivity is the state of a heightened immune reaction to ingested gluten.
Gluten Sensitivity can present in a broad spectrum of diverse manifestations; such as, iron deficiency anaemia (where there is no improvement in response to iron treatment).
Also chronic anxiety or depression, chronic diarrhoea or constipation, chronic fatigue, painful joints and much more.
Adverse reactions to the toxic family of gluten proteins found in wheat, barley and rye, along with their derivatives may trigger a diverse set of conditions.
These include wheat allergy (IgE antibodies are useful in this diagnosis), Non-Coeliac Gluten Sensitivity and Coeliac Disease.
Coeliac Australia states that Coeliac Disease (discussed below) is the cause of Gluten Sensitivity. Although, I have found that this statement is incorrect, and that Coeliac Disease is just one manifestation of Gluten Sensitivity.
There are many more manifestation of Gluten Sensitivity; such as, migraine headache or psoriasis.
Gluten Sensitivity is not a Disease.. Coeliac is though !
In conventional medicine today, the cause and treatment is not well understood; historically there was this misconception that Gluten Sensitivity was principally a disease of the small bowel.
So, is Gluten Sensitivity ‘principally’ a disease of the small bowel?
The answer is “No” it is not.
For every Gluten Sensitive patient with the symptoms of a classic Coeliac Disease there are another eight with no gastrointestinal symptoms at all.
Think of gluten sensitivity as the precursor to developing a disease, although, these two terms seem to get used synonymously; in actuality; they are very different..
What is The Importance of Recognising this?
Unfortunately, too many doctors will tell their patients that if the intestinal symptoms are not severe, or if there is no advanced intestinal damage (total villous atrophy), then the patient does not need to be vigilant in avoiding all gluten exposure.
Even trace amounts of gluten may be responsible for persistent symptoms in some patients with Coeliac Disease. So, if someones symptoms persist then they must adopt a “no detectable gluten diet”
What is Coeliac Disease?
Coeliac Disease is an autoimmune disease of the intestine (particularly the small intestine).
It is the most researched autoimmune disease affecting us today. Coeliac is also the only autoimmune disease for which the environmental trigger has been identified (gluten in wheat, rye and barley).
It occurs from a chronic autoimmune reaction to gluten, where auto-antibodies are produced that attack the intestines and other tissue in the body.
The intestinal wall is lined with microvilli (think of shag carpet) and each absorbs a different nutrient. Coeliac Disease happens when, due to exposure to gluten the microvilli wear down and become flat. The surface then begins to resemble “berber carpet”.
When this happens your intestines can no longer absorb nutrients properly. From this point forward, regardless of how many nutrients you consume you begin to become malnourished.
Testing for Ceoliac Disease
I believe the current testing procedures for Coeliac Disease is flawed.
This involves a small bowel biopsy; a few samples are taken from a tremendously long intestinal tract; is this really enough to be indicative of 100% of the tract.
If those biopsies don’t show up villous atrophy; does that mean it doesn’t exist?
A good analogy for this is:
“take a bucket and fill it from the ocean, if there are no fish in it, does that mean there are no fish in the ocean” No!!
The most common though is a blood test, testing for positive anti-tissue transglutaminase antibodies or anti-endomysial antibodies. But! This just tests for gluten gliadin (found only in wheat).
What about all the other glutens in all the other grains? And, if this test is positive, it only confirms an immune response to gliadin gluten. Therefore it can’t possibly confirm Coeliac Disease as it doesn’t indicate if there is villous atrophy.
What is Non-Coeliac Gluten Sensitivity?
Non-Coeliac Gluten Sensitivity presents with a similar set of symptoms as Coeliac Disease. The most significant difference between them is that Non-Coeliac Gluten Sensitivity does not wear down the microvilli in the intestines.
There will be however, just as much, if not more inflammation with Non-Coeliac Gluten Sensitivity as there is with Coeliac Disease
What is Gluten Intolerance?
Gluten Intolerance on the other hand, is not inflammatory and the reaction is not one produced by the immune system. People just have problems when they ingest it, it doesn’t digest very well.
Food consumed just sits there and feed bad bacteria, allowing them to overgrow and cause an imbalance of the gut flora; this is called “Gut Dysbiosis”.
These bad bacteria then make by-products that can create damage to our intestinal wall. This damage can cause leaks in our intestinal lining; referred to as “Leaky Gut”.
As more leaks develop and undigested food particles make their way through into the bloodstream. This is when we will start to get an autoimmune response and larger issues may start to develop; such as thyroid issues and allergies.
FODMAPS & Coeliac
Emerging research indicates it may not be only gluten contributing to the problem. Another contributing factor may be the malabsorption of fermentable sugars or “Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols”. These are known as (FODMAPs) may be the culprit in those with irritable bowel syndrome.
However, clinical and laboratory diagnosis is complex. For example, Irritable Bowel Syndrome (IBS) is the most common abdominal complaint. Although, the frequency of IBS with accompanying Coeliac Disease is only about 1%.
The frequency of IBS with accompanying Non-Coeliac Gluten Sensitivity is over 30%. A resolution of IBS symptoms occurs in most individuals when they adopt a gluten free diet .
There are least 2 distinct groups of Non-Coeliac Gluten Sensitivity individuals
There are those who are sensitive to just wheat and those who have other food sensitivities as well; such as, cow’s milk protein, eggs and tomato. This is frustrating for patients and practitioners; when a GFD is unsuccessful in those suspected or identified with having Non-Coeliac Gluten Sensitivity.
Therefore, making a differential diagnosis for gluten related disorders would benefit and guide practitioners toward making an accurate diagnosis. Thereby, in-turn recommending the correct course of action, such as nutritional and other medical advice.
The current therapeutic approach for treating those with Coeliac Disease, Non-Coeliac Gluten Sensitivity and Wheat Allergy; include, the complete elimination of gluten.
This in conjunction with additional dietary analysis and advice from a trained Functional Practitioner has a better chance of achieving positive results.
Many patients may find compliance difficult. Alternative foods list and menus plans should be provided. Education on food labelling and hidden sources of gluten is a must, as knowledge is power.
This protocol along with addressing biomarkers of malabsorption and creating a more balanced microbiome will move the patient forward in bringing the autoimmune attack into remission.
The above leads me to conclude that the current “Gluten Free Diet”, which is the prescribed treatment of all the above is enormously flawed. In most cases, it may even be quite counterproductive; a grey area.
As part of a successful treatment protocol “All Prolamine Glutens” (not just gliadin) need further scientific analysis and investigation. Followed by clarification for both conventional and functional practitioners.
Until such a time “Gluten Free” should mean exactly that “elimination of all gluten” from all grains.
If the problem lies with just a few prolamine gluten proteins such as Gliadin (found only in wheat), Secalinin (found in rye) & Avenin (found in barley) then this needs to be examined and clarified as soon as possible.
People’s health, quality of life and life depends on it.
BEFORE YOU GO!