Healthy

Gluten intolerance: symptoms, diagnosis and treatment

Original in Russian: blog.skillbox.by
Gluten Intolerance: Symptoms, Diagnosis, and Treatment

Contents:

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In this material, you will learn information about the following:

  • what is gluten;
  • Celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS) are three different conditions associated with a reaction to components of wheat and gluten.

    Celiac disease – is an autoimmune disease in which gluten consumption damages the lining of the small intestine. In people with this disease, the immune system mistakenly perceives gluten as a threat, causing inflammation and tissue damage, which in turn can lead to various complications in the digestive system and other organs.

    Wheat allergy is an immune system reaction to proteins found in wheat, including, but not limited to, gluten. In this case, the body reacts to wheat as an allergen, which can manifest as skin rashes, breathing problems, or even anaphylaxis. This condition requires the complete elimination of wheat from the diet.

    Non-celiac gluten sensitivity (NCGS) differs from the first two conditions. With this disorder, a person experiences symptoms similar to those of celiac disease, but does not have an autoimmune response and intestinal damage. People with NCGS may experience discomfort and other unpleasant sensations after eating foods containing gluten, yet tests for celiac disease and wheat allergy are negative.

    Thus, these three conditions have different mechanisms, causes, and consequences, requiring an individualized approach to diagnosis and treatment.

  • Diagnosing intolerance involves several steps. First, a doctor will conduct a thorough medical history, clarifying the symptoms and their relationship with the consumption of certain foods. Then, various tests may be prescribed, including blood tests for antibodies and skin tests. In some cases, a more accurate determination of intolerance may require keeping a food diary to track the body's reaction to various foods.

    As for prevention, the best way to avoid intolerance manifestations is to eliminate those foods that cause negative reactions from the diet. Education on how to read labels and recognize potentially dangerous ingredients is also helpful. In some cases, it may be recommended to consult a nutritionist who will help create a balanced menu that does not include components that are undesirable for the body.

  • Is it possible for gluten intolerance to develop during life?
  • What foods should you eliminate from your diet and what can you replace them with?
  • Should everyone give up gluten for better health?

A doctor specializing in gastroenterology and hepatology at the SM-Clinic.

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What is gluten

Gluten is a complex protein complex found in cereals. The main sources of this protein are wheat, rye, barley, and their combinations.

Protein plays a key role in ensuring the normal growth and development of plants, and also has a unique ability to combine various elements into a homogeneous mass. That is why gluten obtained from cereals has another name - "gluten". When humanity realized that grains could be used to create dough, it revolutionized culinary science!

For the vast majority of the population, gluten poses no threat. Like other substances, gluten is easily broken down into amino acids in the gastrointestinal tract and is easily digested. However, the situation changes for people with celiac disease, a condition characterized by gluten intolerance. In these patients, the immune system perceives plant protein as a threat and begins to react. Upon exposure to gluten, the body begins producing antibodies that target the cells of the small intestine.

With celiac disease, if a person continues to eat foods containing gluten, they experience repeated attacks. This condition causes damage to the villi, which are located on the surface of the intestinal mucosa and play a key role in the absorption of nutrients. As a result of this situation, the body begins to experience a lack of vitamins and other essential substances, which can lead to malfunctions in various organs and systems.

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The immune system: principles of its functioning and possibilities for strengthening

The immune system is a complex network of cells, tissues, and organs that work together to protect the body from infections and diseases. It functions thanks to various components, including white blood cells, antibodies, and the lymphatic system. These elements work in unison to recognize and destroy pathogens such as viruses and bacteria.

There are two main types of immunity: innate and acquired. Innate immunity is the first line of defense that acts immediately when foreign organisms enter, while acquired immunity develops over time and is formed after exposure to specific pathogens, often through vaccinations or previous infections.

The question of whether it is possible to boost immunity is a matter of great debate. While some methods, such as maintaining a healthy lifestyle, a good diet, and regular physical activity, can indeed help strengthen the immune system, there are no universal solutions. It is important to understand that the desire to "boost" Immune function testing may not always be appropriate, as an overactive immune system can lead to allergies or autoimmune diseases.

However, maintaining good overall health, including getting enough sleep, managing stress, and avoiding unhealthy habits, can significantly improve immune function. Ultimately, self-care and paying attention to your body are key to maintaining an effective immune response.

Unique Features of Celiac Disease Compared to Other Gluten-Related Disorders

When a person begins to suspect that their body is reacting negatively to the gluten they consume, their first thought is usually that they have an intolerance to the substance. However, there are actually several medical conditions in which gluten can be harmful to the body.

Celiac disease is a genetic autoimmune disorder in which the immune system perceives gluten as a threatening compound, which disrupts the process of its normal digestion. As a result of this immune reaction, the villi of the small intestine are damaged, which leads to various adverse manifestations, especially in the digestive system:

  • bloating
  • excessive gas
  • discomfort and discomfort in the abdomen
  • Intestinal dysfunction can manifest itself in the form of diarrhea or, conversely, constipation.

Obvious deficiencies of vitamins and minerals may indicate gluten intolerance, since intestinal damage prevents their normal absorption.

Celiac disease is characterized by a variety of systemic manifestations. Changes affecting the nervous system can be particularly alarming:

  • persistent fatigue,
  • dizziness,
  • difficulty concentrating,
  • mood swings.

Skin problems are another noticeable sign. A certain category of people suffering from celiac disease may develop dermatitis herpetiformis. This condition manifests itself as a red, itchy rash that is most often localized on the scalp, as well as on the elbows, knees, and buttocks.

Wheat allergy is a typical allergic reaction to the proteins contained in this grain. Symptoms of the disease can appear within a few hours after consuming the product, and in some cases, manifestations can be observed almost immediately. Key signs of an allergic reaction include:

  • skin rashes,
  • Rhinitis, which is an inflammatory process of the nasal mucosa,
  • coughing fits.

In the presence of a severe allergic reaction, swelling of the larynx or anaphylactic shock may occur. Both of these conditions are seriously life-threatening and require immediate medical intervention.

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An allergist is a specialist who diagnoses and treats allergic diseases. If you are experiencing problems related to allergic reactions, such as rash, itching, runny nose, watery eyes, or difficulty breathing, you should consult this type of doctor.

Allergists help identify the causes of allergies and conduct various tests to determine what exactly is causing the reaction. You can see them with problems such as asthma, allergic rhinitis, eczema, food allergies, or reactions to insect bites. The doctor can offer various treatments, including medications and immunotherapy, and also make recommendations for lifestyle and environmental changes to reduce exposure to allergens.

Non-celiac gluten sensitivity (NCGS) is a reaction to gluten that is unrelated to the immune system. This condition has only become a subject of research in recent years, so its characteristics are not yet fully understood. According to various estimates, between 0.5% and 13% of people worldwide may experience gluten sensitivity. Although gluten consumption does not cause intestinal damage in these patients, it can lead to symptoms similar to those observed in celiac disease. These symptoms include bloating, flatulence, and bowel disturbances. In some cases, headaches and general fatigue may occur.

The process of diagnosing celiac disease: key methods and approaches

Typically, diagnosis begins with a blood test for the presence of specific antibodies produced by the immune system in response to gluten intolerance. The key antibodies are those to gliadin peptides, which are part of gluten, and to the enzyme transglutaminase, which actively binds to gliadin components.

For a more accurate diagnosis, instrumental diagnostics are used. First, an endoscopic examination of the small intestine is performed, followed by a biopsy. Analysis of the mucosal sample helps detect possible damage. If these are detected along with positive antibody results, this serves as sufficient grounds for establishing a diagnosis of celiac disease. In addition, the patient may be recommended an abdominal ultrasound, as well as a CT or MRI scan.

Genetic testing, which detects the presence of genes responsible for gluten intolerance, is also an option. However, it should be noted that genetic testing alone is not sufficient to diagnose celiac disease. What causes this?

Celiac disease occurs exclusively in people with a specific genetic combination, namely HLA-DQ2 and HLA-DQ8. If these genes are absent, it is a clear indication that the patient does not have celiac disease. However, the presence of these genes is not a definitive indicator of the disease. In fact, only approximately 3% of those who carry these genes suffer from celiac disease. Therefore, genetic testing is more suitable for excluding this diagnosis than for confirming it.

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Nutrigenomics is the science that studies the interactions between genes and nutrients. It helps to understand how individual genetic characteristics affect the body's response to different foods and diets. This field of knowledge can be particularly useful in developing personalized nutrition plans aimed at improving health and preventing disease. For example, knowing your genetic predisposition to certain diseases can help you adjust your diet to minimize your risks.

However, despite all its benefits, nutrigenomics is not a panacea. Many factors influence human health, including lifestyle, environment, and social conditions. Therefore, relying solely on genetic data to create the perfect diet is not advisable. It is important to keep in mind that nutrigenomics is only one element of a larger picture, which includes other aspects of overall health.

Methods for Detecting Wheat Allergy

Initially, a blood test is performed to detect the presence of immunoglobulin E (IgE) to the protein in wheat flour. These antibodies are the immune system's protective response to the first encounter with an allergen. Subsequently, it is immunoglobulins that play a key role in the release of histamine, a substance that initiates a chain of allergic reactions in the body.

Another approach is skin testing, in which a small amount of wheat extract is applied to the skin. In this case, an allergic reaction will manifest itself as redness and swelling in the area where contact with the allergen occurred.

Methods for Diagnosing Non-celiac Gluten Sensitivity

Detecting this disease is significantly difficult. Diagnosis can only be made by excluding other possible causes. This requires a series of tests, including allergy tests, as well as a biopsy to ensure the absence of intestinal damage. If neither celiac disease nor a wheat allergy is confirmed, the patient is offered an elimination diet, which involves completely eliminating gluten-containing foods from the diet for at least four weeks. During this period, both the patient and the doctor closely monitor changes in their health. After this, gluten is reintroduced into the diet, and the body's reactions are assessed. If symptoms return, the diagnosis is finally confirmed.

Is it possible to develop gluten intolerance later in life?

Yes, celiac disease, or gluten intolerance, can manifest at any age, but only in those people who have a predisposition associated with certain genes. The mechanisms behind this process are not fully understood by scientists. However, it is known that certain autoimmune diseases can act as catalysts for the development of celiac disease. For example, these could include thyroid disease or type 1 diabetes. In some cases, the onset of the disease can be triggered by severe emotional stress, serious viral infections, as well as pregnancy or childbirth.

Currently, no methods have been developed to prevent gluten intolerance. If you have a family history of celiac disease, you may want to consider genetic testing. However, even with a positive result, the absence of symptoms of intolerance is not a reason to switch to a gluten-free diet "just in case." The most important things are to follow a balanced diet, engage in active physical activity, and support your immune system.

Is a complete recovery from celiac disease or non-celiac gluten sensitivity possible?

Currently, there are no treatments or medications that can completely eliminate celiac disease or non-celiac gluten sensitivity (NCGS). The only truly effective method is strict adherence to a gluten-free diet. Patients suffering from celiac disease can gradually restore the mucous membrane and normalize the function of the small intestine by following this diet. However, if the patient violates the diet, a relapse is inevitable: the intestines will again be damaged, and symptoms will reappear.

A balanced diet continues to be a key element in the treatment of wheat allergy.

Allergen-specific immunotherapy (ASIT) is a promising approach in the treatment of allergies. This method involves gradually introducing small doses of the allergen to the patient, which helps "train" the immune system and reduce its reactivity. ASIT has already proven effective in combating allergic reactions to pollen and house dust mites. However, this method has not yet been applied to food allergies, and this topic requires further study.

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Gluten is a protein compound found in grains such as wheat, rye, and barley. It plays an important role in giving dough its elasticity and texture, making it indispensable for baked goods and other flour products. In recent years, many myths and concerns have arisen around gluten, leading many to exclude it from their diets.

However, it is important to understand that for most people, gluten poses no threat. Problems associated with this protein arise only in those who suffer from celiac disease or gluten intolerance. For these people, consuming gluten can cause serious digestive problems and other health issues.

For others who do not suffer from these conditions, gluten can be part of a balanced diet. It also contains beneficial nutrients and can be a source of energy. Therefore, before jumping to conclusions about the harm of gluten, it is important to consider your individual characteristics and consult a healthcare professional.

Foods to Avoid with These Conditions

People with celiac disease must follow a strict diet that involves the complete elimination of all foods containing gluten. This primarily concerns grains such as wheat, rye, and barley, as well as products made from them. These include bulgur, couscous, baked goods, bread, various types of pasta and noodles, porridge, cookies, and beverages such as beer and kvass. This diet should be followed for life.

In addition, the presence of hidden gluten in various products should be taken into account. The list of such products is quite extensive, since manufacturers often add gluten to a wide range of products. These products include, for example, various soup mixes, sausages and smoked products, as well as chocolate, candy, jams, breaded semi-finished products, crab sticks, mayonnaise, ketchup, and other sauces.

People with a wheat allergy can theoretically consume any other grains, including those containing gluten. However, in practice, most choose to adhere to a strict gluten-free diet. This approach can significantly reduce the likelihood of an allergic reaction due to cross-contamination with wheat-containing products during the manufacturing process.

Non-celiac gluten sensitivity requires avoiding foods containing this protein. However, the restrictions may not be as strict as those for celiac disease. Each case is unique and requires discussion with a doctor: some patients are completely prohibited from consuming any gluten-containing products, while others only need to exclude a few from their diet.

Choosing Alternative Products for Replacement

Instead of wheat, barley, and rye, it is recommended to include buckwheat, rice, and quinoa in your diet. It is also beneficial to increase the amount of legumes, such as beans, peas, lentils, and chickpeas. As for baking, a wide selection of gluten-free flour is available in modern stores. Alternatively, consider rice, buckwheat, corn, or almond flour.

Hidden gluten poses a serious threat to people with celiac disease. To minimize the risks, it is crucial to carefully read package labels and pay attention to the ingredients in dishes offered in cafes and restaurants. It is recommended, whenever possible, to avoid products with confusing ingredients, containing unknown additives, as well as those marked with the phrase "may contain traces of gluten." Even if such products are seemingly gluten-free, they may accidentally become gluten-free during the manufacturing process. For example, this situation can occur if gluten-free buckwheat products and wheat products are processed in the same room.

Common Misconceptions About Gluten

The first myth concerns the benefits of a gluten-free diet when it is abandoned without medical indications. It's important to note that a gluten-free diet doesn't necessarily mean you're leading a healthy lifestyle. Grains play a key role in providing the body with fiber, B vitamins, iron, magnesium, and other essential micronutrients. Eliminating these foods from your diet requires careful planning. Otherwise, there's a risk of micronutrient deficiencies.

The second myth concerns the special benefits of gluten-free products. Many believe they're healthier and suitable for dietary purposes. However, in reality, such products often have higher calorie counts because manufacturers add more sugar and fat to compensate for the lack of gluten.