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Gluten Sensitivity: Real or Not

Wednesday, 19 December 2012 by

…..Is the title to the BMJ’s Editor’s Choice article this week (Dec 12th 2012) and whilst we in the Nutritional Therapy world find the concept that physicians still deny the empirical evidence of people recovering post gluten and often lactose excluding diets as NOT being indicative of there being a problem, Fiona Godlee does recognise a problem exists.[1]

Coeliac disease (CD), also called gluten-sensitive enteropathy or non-tropical sprue, is a unique autoimmune disorder which results from the interaction between gluten and immune, genetic and environmental factors. Originally CD was considered as a malabsorption syndrome of childhood, whereas it is now recognised as a disease which may be diagnosed at any age.

Gluten sensitivity is a new concept to define a condition of some morphological, immunological and functional disorders that withdraw with a gluten free diet in patients with or without HLADQ2/ DQ8 positive, with negative gluten-specific autoantibodies and without histological characteristic of coeliac disease (CD).

Coeliac disease (CD) is a permanent intolerance to gluten found in wheat, rye and barley. Gluten induces an autoimmune reaction in the small intestinal mucosa resulting in inflammation, villous atrophy and malabsorption. The only effective treatment is a gluten-free diet, which usually leads to healing of the intestinal mucosa and recovery from signs and symptoms.[1]

If you have been diagnosed with coeliac or gluten sensitivity then the exclusion of wheat rye and barley will have been established as a vital component of your gluten free future. Oats however, will have been given the all clear due to the absence of the immune activating gluten proteins. Yet some studies have suggested that oat exposure may result in immune responses and prevent satisfactory recovery from gluten related damage.

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What is the Best Test for Coeliac Diagnosis?

Thursday, 06 May 2010 by | Comments: 1

Coeliac disease is regarded as a common disorder, yet many clinicians miss the cardinal signs that indicate further investigation is warranted. Coeliac disease is becoming an increasingly recognised autoimmune enteropathy caused by a permanent intolerance to gluten. Once thought to be a rare disease of childhood characterised by diarrhoea, coeliac disease is actually a multisystemic disorder that occurs as a result of an immune response to ingested gluten in genetically predisposed individuals and includes non gastrointestinal symptoms such as depression.

So how can practitioners decide if their patient has wheat intolerance or is requiring strict gluten avoidance to reduce the risk of linked diseases.

A paper out in the Journal of The American Medical Association on May the 5th looks at a variety of papers published since 1947 until 2009 to determine the evolution of investigative tests and to see which was most accurate. Two principle mechanisms for valid confirmation were identified.[1]

Gluten May be Causing Your Brain Problems!

Tuesday, 09 March 2010 by | Comments: 1

An interesting paper published in the Sept 2008 Annals of Neurology described a ‘new to science’ brain aggravating enzyme, triggered by reactivity to gluten, but acting independently of other coeliac symptoms.[1]

Most clinicians understand that overt gluten reactivity is classified under coeliac disease and the the classic constellation of symptoms and signs characterising  malabsorptive syndrome is a readily recognised manifestation  of  coeliac  disease. Frank malabsorptive symptoms include steatorrhea, weight loss or failure to thrive, bloating, and flatulence, with multiple deficiency states. More common but more difficult to recognise, however, are the other diverse ways in which coeliac disease presents.

Coeliac disease may also mimic many common clinical entities. These atypical modes of presentation include deficiencies of single micronutrients; nonspecific gastrointestinal complaints such as bloating, abdominal pain, diarrhoea, constipation, flatulence, secondary lactose intolerance, and dyspepsia; and non-gastrointestinal complaints such as fatigue, depression, arthralgia, milk intolerance, osteomalacia or osteoporosis, and iron deficiency anaemia.

Coeliac Disease – Local & Systemic Consequences

Wednesday, 09 December 2009 by | Comments: 1

leaky gutCoeliac disease is an inflammatory disorder with autoimmune features that is characterised by destruction of the intestinal epithelium and remodelling of the intestinal mucosa following the ingestion of dietary gluten. The human gut is home to trillions of commensal microorganisms, and we are just beginning to understand how these microorganisms interact with, and influence, the host immune system. This may also include the late onset development of Coeliac Disease, or gluten intolerance.

Gastroenterology journal coverCoeliac disease is an autoimmune disorder triggered by gluten, a protein in wheat, barley, rye and spelt. Currently, the only treatment available is the adoption of a lifelong gluten free diet, which is made particularly challenging due to the ubiquity of wheat in western diets. It is an excellent example of environmental challenge meeting gene susceptibility, and is a unique example of how exclusion of an environmental trigger can resolve the symptoms.

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