Gluten Sensitivity and Celiac Disease
What is Gluten?
It is a protein that is found in wheat, rye and barley. Gliadin is part of this protein and it is gliadin that is responsible for many of the reactions to gluten.
Gluten Sensitivity (Non-Celiac)
This covers a broad range of disease. Some patients may meet some but not all of the criteria necessary to diagnose Celiac Disease but have the symptoms or complications of Celiac Disease. Other patients may have serious symptoms outside of the gastrointestinal tract such as a severe rash (seen in patients with Dermatitis Herpetiformis) or abnormalities in their nervous system resulting in unbalanced gait (seen in patients with cerebellar ataxia related to gluten). Less serious sensitivities may present with symptoms suggestive of irritable bowel syndrome, bloating, constipation or headaches.
In its most severe form, genetically predisposed individuals can mount a very severe immune reaction to gluten consumed in the diet. This autoimmune reaction results in damage to the intestinal lining with symptoms such as bloating and diarrhoea or can present with malnutrition, slow growth in children. Some patients may only be diagnosed with Celiac Disease after being investigated for anemia, infertility or osteoporosis. The diagnosis is made in the presence of abnormal antibodies produced by the immune system and when an endoscopy of the small intestines retrieves a biopsy that shows significant small intestinal lining damage.
Allergies to wheat tends to present like typical allergic reactions e.g. hives, asthma-like symptoms. The wheat can cause a reaction whether it is consumed or inhaled. Testing for IgE antibodies against wheat will confirm the diagnosis.
Gluten and Other Autoimmune Diseases
Gliadin affects the immune system by affecting the permeability of the intestinal lining. Substances can either be absorbed in the intestines by passing through the intestinal lining cells or between the intestinal cells. Gliadin increases the permeability between these cells. This increase is usually temporary but in genetically susceptible individuals, this increased in permeability is more prolonged.
Infections of the intestines and certain medications can also result in damage to the intestinal lining and persistent increased permeability. A large majority of the body’s immune cells are lined up close to the intestinal lining. Increased permeability increases the exposure of proteins from food and bacteria and causes over stimulation of the immune system. This can result in increased risk of the development of autoimmune diseases such as Hashimoto’s thyroiditis and rheumatoid arthritis.