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Cœliac disease V.S gluten sensitivity

I observe in consultations that there is confusion between coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS).

Indeed, many individuals tell me that they are not gluten intolerant because “the blood test was negative.”

What is gluten ?

Gluten is a protein divided into two groups: glutenins and prolamins. Prolamins are a set of storage proteins found in cereal grains. In wheat, its derivatives (such as khorasan wheat, also known as kamut, triticale) and spelt, the prolamin is present as gliadin; in rye, as secalin; and in barley, as hordein.

Oats contain avenin, which generally does not trigger a reaction in individuals with celiac disease. However, due to the risk of cross-contamination, oats should be avoided if not certified gluten-free or if not well tolerated.

Note that the likely test conducted by your doctor is for anti-transglutaminase antibodies.

This test helps rule out or confirm the possibility of CD. If the test is positive, a biopsy (sampling of the small intestine during endoscopy) will likely be performed to confirm the diagnosis.

If the result is negative and you were consuming gluten at the time of the blood test, it’s highly unlikely that you have CD.

To recap, CD is an autoimmune disease, and the only treatment is a lifelong gluten-free diet.

However, the anti-tTG antibody test does not rule out sensitivity to gluten.

NCGS is a disorder related to gluten ingestion in the absence of wheat allergy or celiac disease. The mechanisms behind this disorder are not fully understood, but the immune system and intestinal hyperpermeability could be contributing factors (Di Sabatino & Corazza, 2012; Lundin, 2014).

There is an overlap between Irritable Bowel Syndrome (IBS) and non-celiac gluten sensitivity (NCGS) (Makharia et al., 2015).

Although NCGS is still debated within the scientific community and is often self-diagnosed by individuals, it’s increasingly recognized.

As a historical note, the concept was introduced in 1978 through a case study published in The Lancet (a reputable scientific journal) (Ellis & Linaker, 1978). The authors described how eliminating gluten from the diet of a 43-year-old woman ended her chronic diarrhea, pain, and abdominal distension within 4 days. It’s worth noting that all prior medical exams had revealed nothing abnormal, and no antibiotic treatment had managed to alleviate her symptoms. Reintroducing gluten in her diet rapidly brought back her symptoms.

This “experiment” was carried out on 8 other women, and the results were the same: gluten elimination alone ended digestive symptoms without any previously identified abnormalities (Cooper et al., 1980).

In practice, many people feel better after reducing or eliminating gluten consumption.

However, these improvements should be approached with caution, as they often coincide with other hygiene and dietary measures.

Moreover, the primary dietary source of gluten is wheat, but other compounds such as alpha-1 antitrypsin inhibitors, lectins, and fructans (a type of FODMAP) can also induce symptoms.

Strategies to relieved symptoms linked to non coeliac gluten sensitivity

Probiotics

The intestinal microbiota seems to influence gluten digestion. Certain strains of Bifidobacterium (B.longum and B.bifidum) and Lactobacillus (L.delbrueckii and L.plantarum) can digest gliadin (Francavilla et al., 2017).

Therefore, using these strains could be a therapeutic approach, especially as a gluten-free diet reduces these two genera (Jérôme Manetta, 2018).

Digestive Enzymes for non coeliac gluten sensitivity

Digestive enzymes act as “scissors” that break down food for absorption.

The patented Tolerase-G® complex contains peptidase specifically for breaking down prolines, including gluten, which can be valuable for NCGS.

Diet

Eating gluten-free is becoming easier. While it requires habit changes, it’s achievable! To assist you, I’ve created several ebooks, including a recipe book that’s 100% gluten-free!

Here for some delicious gluten-free recipes !

Take-home messages

  • Not having coeliac disease doesn’t necessarily mean you tolerate gluten without issues (i.e. you don’t have non coeliac gluten sensitivity)
  • The beneficial effects you can observe after stopping gluten consumption are not always directly related to gluten itself.
  • Temporary gluten elimination can offer digestive comfort. We advise gradual reintroduction of gluten-containing foods to determine your tolerance threshold.
  • Quitting gluten impacts the intestinal microbiota, as gluten-containing foods are also sources of fructans, which are prebiotics (promote the growth of “beneficial” bacteria in the intestines).
  • Limiting gluten consumption is not a bad idea (and is recommended in certain situations like autoimmune diseases). However, it shouldn’t be at the expense of products labelled “gluten-free” that are loaded with additives and preservatives.
  • If you’re sensitive to gluten, you can consider supplementing with specific enzymes.

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