The ImmuneCare Guide to Gluten Sensitivity
Gluten Sensitivity Introduction Gluten sensitivity, also called non-coeliac gluten sensitivity (NCGS), is a condition related to gluten ingestion that can cause symptoms similar to coeliac disease (CD) and wheat allergy (WA). As a result NCGS is sometimes confused with CD or WA, but these conditions differ. Coeliac disease is an autoimmune disorder triggered by the exposure to gluten in genetically predisposed individuals. The resulting inflammation damages the lining of the small intestine. The surface area available for digestion is therefore decreased, interfering with the absorption of nutrients. Over time, this can lead to serious health problems. A high level of ttg antibodies in the blood indicates that there might be significant bowel damage. A wheat allergy is an abnormal response of the body to any of the proteins found in wheat characterised by the production of wheat specific IgE antibodies. This immune response can cause many symptoms, some of which are potentially life-threatening (anaphylaxis). Gluten sensitivity is not regarded as an autoimmune disorder or an allergic reaction. However, it is an abnormal immune response. Like CD and WA, NCGS patients report an improvement in their symptoms on a gluten-free diet yet they lack damage to the small bowel tissue and the antibodies found in CD and WA. NCGS is usually associated with normal levels of ttg antibodies, elevated levels of IgG-gliadin antibodies and sometimes slightly raised IgA-gliadin antibodies. There is frequently a family history of similar illness. It has been estimated that 1 in 10 people are gluten-sensitive, mostly young and middle aged adults. The disorder appears to be more common in females with a male-to-female ratio of about 1:3.
Aetiology The pathophysiology of NCGS remains largely undetermined. Diagnosis can be reached only by excluding CD and WA and even then the findings are not always clear-cut. Some people with NCGS may actually be in the early stages of CD but they haven t yet developed any bowel tissue damage and elevated ttg levels. In other cases, NCGS may not be caused by gluten but by other (non-gluten) proteins present in gluten-containing grains and their derivatives. In situations where there is only a partial resolution of symptoms with a glutenfree diet, patients may find that they improve greatly with the addition of a low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols)-diet. FODMAPs are certain types of carbohydrates that can cause the bowel to distend by drawing in more fluid and rapidly generating gas when they are fermented by bowel bacteria. FODMAPs present in gluten-containing grains (fructans) are a possible cause of gastrointestinal symptoms in people with NCGS. Another NCGS subgroup may not improve much on a gluten-free diet due to the often high amounts of additives and preservatives in gluten-free products they react to. Signs and symptoms NCGS is much more than a digestive disease, it affects the whole body. It is a combination of IBS-like symptoms, behaviour disturbances and systemic manifestations. The symptoms occur soon after gluten ingestion, improving or disappearing within hours or a few days after gluten withdrawal and then reappearing following its reintroduction. Intestinal symptoms: Abdominal pain Constipation Diarrhoea Bloating Reflux (GORD gastro oesophageal reflux disease)
Vomiting Leaky gut Extra-intestinal symptoms: Behaviour disturbances Irritability Poor growth/poor weight Foggy mind Headache Fatigue/lethargy Eczema/skin rash Anaemia Joint/muscle pain Poor sleep Naturopathic perspective Since there is no biomarker for NCGS, exclusion of CD and WA is needed in order to make a diagnosis of NCGS. This is critical as undiagnosed and untreated CD can leave the patient with risks of long-term complications. Leaky gut can be a possible cause or a dominant symptom of NCGS. The main culprits damaging the gut are certain foods (esp. gluten, sugar and processed foods), alcohol, nonsteroidal anti-inflammatory drugs, toxins, microbiome imbalances and stress. Although removing those triggers can help control leaky gut, supplementation is needed to repair the intestinal lining.
Nutrition Avoid all foods that contain gluten. If gluten alone is not responsible for the symptoms produced by the condition FODMAPS may be part of the problem. The glutencontaining grains wheat, barley and rye are all high in FODMAPS. High fibre foods (i.e. prebiotics) help probiotic bacteria thrive in the gut. Supplements An enzyme formulation such as Glutenase Plus helps with the digestion of gluten proteins, making the ingestion of gluten much less of a problem. A high quality multi mineral-vitamin supplement to help the recovery from nutritional deficiencies. L- glutamine is an amino acid that helps repair the lining of the intestinal wall (leaky gut). Probiotics normalize gut mucosal dysfunction, down-regulate hypersensitivity reactions and alleviate intestinal inflammation. Iron to correct any iron deficiency anaemia. Essential fatty acids required for the structure and function of the immune cells. Herbs Immune enhancers stimulate different aspects of the immune reaction: Andrographis panniculata (Andrographis) Immune modulators such as Echinacea spp. modulate and balance the activity of the immune system.