Coeliac Disease and Gluten Sensitivity, don’t they just both mean avoiding Gluten?
WHAT YOU NEED TO KNOW ABOUT BOTH CONDITIONS, THE SYMPTOMS, DIAGNOSIS AND WHY IT IS SO IMPORTANT.
Coeliac disease (CD) affects the tissue of the small intestine, this is the area that has the function of absorbing the nutrients from the foods we have eaten. When someone has coeliac disease and this tissue comes into contact with gliadin (one of the two proteins that make up gluten), it starts an immune reaction. This reaction ultimately destroys the lining of the small intestine, making it very difficult for it to do its job, including the absorption of nutrients. The figures show that it affects about 1% of the population in western countries. But some researchers believe the figure would actually be about 5%, because there are so many people living with the condition, undiagnosed.
Gliadin is found in gluten, which is a protein in wheat, rye, barley and triticale (a cereal crop developed from crossing wheat and rye). Oats contain a protein very similar to gluten and so must be avoided too. Any food made from part of these foods need to be avoided as well.
The damage to the tissue is reversed once a completely Gluten Free (GF) diet is adopted. This repair is a very lengthy process, it has even been found to take up to several years. Natural medicine can help to support the repair of the small intestine and possibly help to improve symptoms quicker.
Coeliac disease can develop at any age, even if you have been able to eat wheat in the past with no side-effects. It is an auto-immune condition. An auto-immune condition develops when your body starts seeing normally safe foods, particles or cells as foreign and something that needs to be attacked. In the case of coeliac disease your body starts to view gluten and the cells in your small intestine, as things that will hurt you and so it mounts an immune response, which ultimately destroys the lining of the small intestine. There are many auto-immune conditions and they attack different cells in the body. Another example is Type I diabetes, where the body starts to see the cells that make insulin (Islet cells found in the pancreas) as the enemy and destroys them. This leads to the person not being able to make insulin and therefore needing to rely on Insulin injections to maintain healthy blood sugar levels.
Non-coeliac gluten sensitivity (NCGS) is thought to affect 6% of the population, and has only recently gained more scientific validation of its existence. It has been debated in scientific journals since about 1980. Today though more and more people are choosing to eat GF, even though they have been told they do not have CD. This is because they have noticed that their symptoms improve while following a GF diet. This change has driven the availability of GF foods in supermarkets and when eating out. This is great news for everyone who needs to exclude gluten containing foods from their eating plan.
It is currently accepted that NCGS is not an autoimmune reaction or an allergic one, this means their body in not mounting an immune reaction. But the very latest research is showing the possibility of a new inflammatory marker being associated with this sensitivity. The cells in the small intestine look normal and there is no scarring but there are definite symptoms in the person when they consume gluten. These symptoms improve on a gluten free diet.
Please note some individuals with CD have no symptoms even though the disease is active
HOW AND WHY SHOULD YOU GET THE CORRECT DIAGNOSIS?
Diagnosis of coeliac disease usually starts with a referral for some blood tests. This can come from your GP, specialist or natural healthcare practitioner. If someone is eating a diet containing gluten and has coeliac disease they will test positive to antibodies for gliadin (the protein found in gluten) and self (their own tissue, as this is an autoimmune condition). When these two tests come back positive a gastroenterologist will then usually confirm the diagnosis by performing an endoscopy. To look at the small bowel for tissue damage and take a small biopsy (a small amount of tissue). It is a day procedure performed under a light anaesthetic. Biopsies need to be taken, as in some individuals the tissue damage may not be seen by the naked eye (or camera used in the procedure).
If you are already on a GF diet and testing is done then you may get a false negative test result. So it is important to not be on a GF diet prior to testing. If you have been on a GF diet for a while, a diet including gluten would need to be resumed for at least six weeks prior to testing as per the guidance from your specialist. The recommendation from “Coeliac Australia” is that for testing to be accurate, an adult must consume the equivalent of 4 slices of wheat bread per day and 2 slices for children per day. They say that although you may be worried about severe symptoms during this gluten challenge period, the symptoms usually reduce over time due to the damage to the small intestine lining.
Diagnosis of non-coeliac gluten sensitivity is similar to the diagnosis of IBS (Irritable Bowel Syndrome). It is a diagnosis of exclusion. So we would say someone has NCGS when their other tests for coeliac and wheat allergy come back negative and they have improvement of their symptoms once they exclude gluten from their diet. So someone who has negative tests results for the TTG and DGP antibodies may be tested for anti-gliadin antibodies. This test is positive in around 50% of people with NCGS, so can help to support the person’s observations. This was one of the early tests for coeliac disease, but was replaced by the two other tests as it was not found to be positive in 100% of patients with CD.
It is very important to get testing done accurately and have a clear and reliable diagnosis for the future of your health. If you get a false negative, you may feel you are able to include small amounts of gluten in your diet and if you do have CD you will continue to damage your gut lining. Some other really important reasons to be diagnosed correctly are:
· To have the support of your doctor or gastroenterologist and /or dietician throughout your life.
· To be sure that a 100% GF diet is absolutely essential for life
· To minimise the health complications of not adhering to a GF diet in CD
· In children, it is essential to allow for their best growth and development
· To inform first degree relatives, so that they too can be tested for CD
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Article written by:
Danielle Elliott
Adv Dip (Nat & WHM)
Danielle Elliott is a naturopath, herbalist & homeopath with a special interest in digestive complaints. She has been in clinical practice for 15 years and began specialising in gut health 9 years ago. Since then, Danielle has published a book entitled "Gluten Free and Happy", which helps educate people with Coeliac Disease and Non-Coeliac Gluten Sensitivity on how to optimise their digestive health and overall wellbeing. Danielle also does a lot of work with patients with SIBO and functional digestive disorders as well as running “Tummy Rescue”, an online community for patients with GI disease (see www.tummyrescue.com.au).