Coeliac Disease & Gluten Sensitivity
Coeliac Disease is an auto-immune condition affecting the small intestine which occurs in genetically predisposed people.
In order to be Coeliac you must have one of the Coeliac genes: HLA DQ2, HLA DQ8 (research suggests that there may be other affected genes).
Coeliac disease is thought to affect 1 in 100 people in the UK and can affect any age group, from middle infancy onwards.
- Pain and discomfort in the gastro-intestinal tract
- Chronic constipation
- Failure to thrive may be seen in children: they can be malnourished and their growth impeded.
- Adults may present with anaemia (which fails to resolve with iron supplementation) or fatigue
Coeliac disease is also associated with other disorders with major pathology outside the GI tract. It is also common for Coeliacs to suffer vitamin deficiencies due to the fact that the small intestine cannot properly absorb nutrients from food. Some people may not have any digestive symptoms whatsoever but may have symptoms in other body organs. For example, atypical Coeliac Disease can be found in patients who present primarily with:
- Liver enzyme elevations
- Addison’s disease
- Type 1 diabetes mellitus
Coeliac disease is caused by a reaction to gluten proteins found in wheat, barley and rye. When exposed to these proteins, an enzyme tissue modifies them, and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction.
Testing for Coeliac disease involves a blood test for Endomysial Antibodies (EMA), Trans Tissue Glutaminase (tTGA), Anti Gliadin Antibodies (AGA) and a small bowel biopsy for villous atrophy. The only “cure” for Coeliac disease is a life-long exclusion of gluten combined with gut healing foods and supplements.
Non Coeliac Gluten Sensitivity (NCGS)
Many people believe they have an issue with wheat, have been tested by their GP for Coeliac disease, and told that the test was negative.
But avoiding wheat makes them feel better.
So what is happening?
Studies have confirmed that 1% of the UK population are true Coeliac, meaning that they carry the genes for Coeliac disease. However, a much larger population of people are Non Coeliac Gluten Sensitive (NCGS).
NCGS occurs when the body is sensitised to fragments of any of the proteins found in wheat and gluten. This condition is thought to be much more common than Coeliac disease, estimated to affect up to 6% of the population. However, incidence is much higher – 28-30% in IBS patients.
See “Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders” Nutrients. 2013 Oct; 5(10): 3839–3853
In NCGS, symptoms usually occur soon after gluten ingestion (often within hours, but it can be longer), disappear when gluten intake is stopped, and reoccur when gluten is re-introduced. The “classical” presentation of NCGS is IBS-like symptoms, including
Joint and muscle pain
Leg or arm numbness
Dermatitis (eczema or skin rash)
Bowel habit abnormalities (diarrhoea or constipation)
Some patients may have already made a link between their symptoms and gluten exposure but may have been tested by their GP for Coeliac disease and told that the test was negative.
IBS Clinics offer Cyrex Laboratories’ Gluten Sensitivity Tests: just about the most accurate way of assessing NCGS in individuals in the world today.