If you’ve ever wondered about gluten-free labels or been curious why some people avoid gluten, celiac disease is one reason why. Individuals with this disease cannot properly digest gluten, a condition that leads to an adverse response by their gastrointestinal (GI) and immune systems. While awareness of the disease is increasing, it is still commonly misdiagnosed as irritable bowel syndrome (IBS) or may even go undiagnosed entirely. This is because the symptoms of celiac disease may mimic those of IBS, and some individuals experience no symptoms at all.
Why Gluten?
Gluten is a protein found in wheat, barley, and rye. This protein contains a component known as a prolamin which triggers the body’s immune response and is treated as a pathogen. Prolamins go by different names depending on the grain. In wheat, for example, it is known as gliadin. In rye products, it is called secalin, and in barley it is hardeins. While these three prolamins are known to elicit an immune response, other less known prolamins from other grains may also contribute to it.
Understanding Celiac Disease
Individuals with celiac disease have a hard time digesting gluten, an intolerance that triggers an immune response in their small intestine. The prolamin released from gluten makes its way into the lining of the small intestine where it induces inflammation and the degradation of tissue.
Also known as the mucosa, the lining of the small intestine has tiny projections known as microvilli. Microvilli are responsible for the absorption of most nutrients in the body and are destroyed along with the lining in response to prolamins.
Over time, damage to the intestinal lining becomes severe, and a person with celiac disease will become malnourished. Conditions like anemia, osteoporosis, and even malignancy may arise. Once gluten is removed from the diet, however, the lining slowly repairs itself and nutrient absorption can resume.
Risk Factors
While celiac disease has a hereditary component, it is not strictly hereditary. The disease develops from an interaction between immunity, genetics, and the environment. In other words, while some may be predisposed to the disease or have a relative who has it, it is not a guarantee that the disease will develop.
The exact interplay that causes celiac disease is still being researched. Certain genes that create complex proteins have been shown to be involved in the majority of cases. Yet, not everyone who has these genes has celiac disease. It is a complex dynamic. It is important to associate symptoms with blood tests and endoscopic analysis of the mucosal lining to make a diagnosis.
Celiac Disease v.s. Gluten Sensitivity
While gluten sensitivity and wheat allergy can get clumped-in with celiac disease, these conditions are not the same. Gluten sensitivity doesn’t necessarily have the same immune response as celiac disease, and a wheat allergy will tend to be more acute.
Gluten sensitivity is characterized by adverse symptoms experienced in-response to eating gluten, but these are quite subjective. One person might describe headaches and “brain fog” while others feel gastrointestinal distress. More importantly, a biomarker test for gluten sensitivity not related to celiac disease is not yet available. Gluten sensitivity diagnoses are based on reported symptoms in response to gluten consumption.
What To Do?
If you are experiencing adverse symptoms similar to IBS after consuming gluten, celiac disease could be the problem. This is especially true when malnutrition or nutritional deficiencies are apparent. If such is the case, consult a physician and get help from a registered dietitian. You’ll probably have to cut gluten from your diet. Avoiding such a commonplace ingredient is difficult and there is a learning curve when it comes to it- you’ll need help. In such cases, consulting a dietitian is still recommended.
References-
- Kagnoff, Martin F. “Overview and Pathogenesis of Celiac Disease – Gastroenterology.” Gastroenterology, 2005, https://www.gastrojournal.org/article/S0016-5085(05)00177-0/abstract.
- Biological Markers for Non-Celiac Gluten Sensitivity: a …http://journals.sbmu.ac.ir/ghfbb/index.php/ghfbb/article/download/1326/795.