GLUTEN DISORDERS EXPLAINED – Gluten Free Works

Gluten Sensitivity

by John Libonati
December 9, 2014

Gluten Sensitivity is an umbrella term that refers to any and all problematic health responses to gluten in any body system. We first defined gluten sensitivity in our ground breaking text, Recognizing Celiac Disease first published in 2006. Gluten Sensitivity includes celiac disease, gluten allergy, and non-celiac gluten sensitivity reactions.¹

Under Pathophysiology in Recognizing Celiac Disease, we confidently published the fact, against the opinion of some noted specialists but in accord with others, that “non-celiac gluten sensitivity” exists as a condition distinct from celiac disease and which must be distinguished from celiac disease for proper treatment of both.

Today, although there lacks a general agreement for the term “gluten sensitivity,” the medical community has accepted the reality of non-celiac gluten sensitivity.

As a result, researchers are calling this condition the “new frontier.” As Dr. Lundin has stated, “We are still challenged with finding stricter clinical criteria for the condition, developing a usable clinical approach for gluten challenge in these individuals, and understanding the pathogenesis of the condition.”²

Celiac disease is characterized by a specific immune reaction in the small intestinal lining that is both an innate response (inflammatory) and a humoral response (antibody production) to peptides of gluten that leads to malabsorption of nutrients and increased intestinal permeability (leaky gut).³ The humoral antibody response involves the production of immunoglobulin A (IgA) and immunoglobulin G (IgG). Only persons who have inherited this immune response are at risk to develop celiac disease. Celiac disease results in malabsorption and any of a great number of health problems that can develop from the toxic action of gluten peptides entering the body through a leaky gut.

Gluten allergies are immunoglobulin E (IgE) mediated immune responses where hives, asthma, and similar reactions develop. Allergy involves the production of specific antibodies to specific antigens, which would be a peptide of gluten. For example, wheat allergy commonly targets gliadin as the antigen. IgE immune responses appear to be inherited.

Non-celiac gluten sensitivity can be diagnosed in those patients with gluten intolerance who do not develop antibodies that are typical either of celiac disease or of wheat allergy and who do not suffer from lesions in the duodenal mucosa characteristic of celiac disease.⁴ Symptoms that occur soon after gluten ingestion rapidly improve after gluten withdrawal and relapse in a few hours or days after gluten challenge.⁵

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Non-celiac gluten sensitivity is an innate immune response producing mild inflammation (Marsh I class) of the small intestine lining to gluten when present in the diet but negative to production of the anti-EMA, and anti-tTG immunoglobulins (humoral response), which are autoantibodies mounted in celiac disease.

Sources:

Libonati, Cleo. Recognizing Celiac Disease, p. IX [↩]
Lundin KE. Non-celiac gluten sensitivity – why worry? BMC Med. 2014 May 23;12:86. doi: 10.1186/1741-7015-12-86. [↩]
Brottveit M, Beitnes AC, Tollefsen S, Bratlie JE, Jahnsen FL, Johansen FE, Sollid LM, Lundin KE. Mucosal cytokine response after short-term gluten challenge in celiac disease and non-celiac gluten sensitivity. Am J Gastroenterol. 2013 May;108(5):842-50. doi: 10.1038/ajg.2013.91. [↩]
Czaja-Bulsa G. Non coeliac gluten sensitivity – A new disease with gluten intolerance. Clin Nutr. 2014 Aug 29. pii: S0261-5614(14)00218-0. doi: 10.1016/j.clnu.2014.08.012. [↩]
Caio G, Volta U, Tovoli F, De Giorgio R. Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. BMC Gastroenterol. 2014 Feb 13;14:26. doi: 10.1186/1471-230X-14-26. [↩]

Celiac Disease

by Cleo Libonati, RN, BSN
February 19, 2014

What Is Celiac Disease?

Celiac Disease is a common health disorder affecting more people than breast cancer or Type 1 diabetes mellitus, but is greatly underdiagnosed.¹

One person in a hundred is estimated to have celiac disease, but less than 5% of these people are being diagnosed. The other 95% are being harmed on a daily basis by eating common food like bread and pizza.

Celiac Disease is serious and the personal cost can be great. If left untreated, Celiac Disease can cause health problems ranging from inconvenience to debilitation and even death. It can affect work and relationships. The good news is that many health problems can be avoided by early diagnosis and eating a gluten-free diet.

To date, gluten is the only known environmental factor to play a direct causal role in celiac disease, and the only treatment for celiac disease is a gluten-free diet.²

The Name: Celiac Disease

“Celiac Disease” was the name given to this disorder because it was thought to primarily cause digestive symptoms. “Celiac” means bowel. Other names for celiac disease are Gluten Sensitive Enteropathy, Celiac-Sprue, and Non-Tropical Sprue.

The term, Celiac Disease, is used worldwide. Medical coding systems use it for billing purposes and as a tracking tool. The International Classification of Diseases (ICD-9-CM) code for Celiac Disease is “579.0 celiac disease.” This is the code your doctor will use for your medical records.

Celiac Disease Explained

Celiac Disease is a common, inherited lifelong sensitivity to gluten, a protein in the grains of wheat, barley, rye, and oats. When the immune system is activated by gluten, the inherited predisposition becomes a digestive disorder that results in malabsorption of food nutrients with or without digestive symptoms like pain, bloating, diarrhea or constipation.

Active Celiac Disease involves a specific auto-immune response in the small intestine that inflames and damages the vital tissues of the lining. Resulting health problems are called multi-systemic because they may involve any body system. Symptoms may be few and mild or mind boggling in number and severity.

Characteristics Of Celiac Disease:

Sources:

National Institutes of Health, National Institutes of Health Consensus Development Conference Statement, Celiac Disease, August 9, 2004;1-14. [↩]
Pozo-Rubio T, Olivares M, Nova E, De Palma G, Mujico JR, Ferrer MD, Marcos A, Sanz Y. Immune development and intestinal microbiota in celiac disease. Clin Dev Immunol. 2012;2012:654143. Epub 2012 Sep 11. [↩]

Gluten

by John Libonati
May 23, 2013

The Grains That Contain Dietary Gluten

Although few in number, the gluten-containing grains, called toxic or unsafe grains, are widely used in food preparation. The excessively high use of unsafe grains in the Western diet makes avoiding consumption difficult. The chart below highlights the four gluten-containing grains, popular strains of wheat, and triticale. Triticale does not naturally occur but is hybidized by crossing wheat with rye.

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Wheat and these wheat strains: Durum, Kamut, Spelt, Einkorn, Emmer, Farro.
Barley.
Rye.
Triticale (wheat / rye hybrid).
Oat.[/box]

Anatomy Of Gluten-Containing Grains

Gluten that is the cause of immune responses in susceptible individuals is a formless storage protein in wheat, rye, barley and oat grains. These grains belong to the grass family of seed plants, called cereal grains. Gluten is called a “storage protein” because it is stored, or inactive, until the seed begins to grow.