Gluten Free for None Coeliacs – If you are not coeliac, should you avoid gluten?
Recent research from the Center for Celiac Reasearch at the University of Maryland, USA shows that gluten may affect more than people with coeliac disease. There is another group of people who experience very similar symptoms from fatigue and brain fog to diarrhoea, but they don’t show any tissue transglutaminase (tTG) antibodies, the flattened villi that are evidence of coeliac. They may not express the HLA/DQ2 and DQ8 genes that coeliacs do.
Dr Fasano of the Center said in an interview for the Huffington Post: “Think of gluten ingestion on a spectrum. At one end, you have people with celiac disease. This autoimmune disorder triggered by gluten causes intestinal damage leading to malabsorption of nutrients, which results in a wide variety of symptoms and potential complications. It can affect the gastrointestinal system, the central nervous system, and other areas of the body. It can affect anyone at any age and is treatable through the implementation of a strict gluten-free diet for life. People with celiac disease can’t tolerate one ‘crumb’ of gluten in their diet. At the other end are the lucky folks who can consume all the pasta, bread and beer they want with no ill effects whatsoever. In the middle, we have this murky area of gluten reactions, including gluten sensitivity. This is where we are looking for answers about how to best diagnose and treat this recently-identified group of gluten-sensitive individuals”.
If you think that you may be sensitive to gluten, it is very important that you are tested for coeliac disease as there are increased health risks associated with having the condition. A blood test for tTG antibodies is the first stage which if positive will lead to a referral to a gastroenterologist. At this stage, it is important that people carry on eating gluten – the blood test will not work if there is no gluten in the diet.
Coeliac disease can be ruled out if there is a negative blood test or an endoscopy does not show damaged villi. But some individuals still experience symptoms such as bloating, wind, brain fog or joint pains when eating gluten in the diet. The term ‘non-coeliac gluten sensitivity’ (NCGS) is used to describe these symptoms. Like coeliac disease, there is no cure or treatment, other than a gluten-free diet. NCGS is also distinct because the innate immune system is activated rather than the aquired immune system as in coeliac disease. There is no test for NCGS, it is identified through an exclusion diet. – i.e. symptoms worsen on exposure to gluten and improve on a gluten-free diet.
Most of the research into NCGS is coming out of the USA and Europe, but there was an article published in the BMJ in November 2012 which talked about ‘A Patient’s Journey’ and brought the condition to the attention of British doctors. The author, Dr Rostami, estimated that 6-10% of the general population may be affected by this condition. The list of symptoms that can be attributed to NCGS is very long and varied including headaches, anxiety, depression, brain fog, diarrhoea, abdominal pain and bloating, rashes, cramp, joint pain and others. But as these symptoms may also be linked to other serious medical conditions, it is important that medical advice is sought.
Brottveit, M., Vandvik, P. O., Wojniusz, S., Løvik, A., Lundin, K. E., & Boye, B. (2012). Absence of somatization in non-coeliac gluten sensitivity. Scandinavian journal of gastroenterology, 47(7), 770-777.
Rostami, K., & Hogg-Kollars, S. (2012). Non-coeliac gluten sensitivity. BMJ: British Medical Journal, 345.
Sapone, A., Bai, J., Ciacci, C., Dolinsek, J., Green, P., Hadjivassiliou, M., … & Fasano, A. (2012). Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC medicine, 10(1), 13.