Gluten - trouble for people with celiac disease only?

Celiac disease, as well as gluten sensitiveness, are often used as synonyms. However, in scientific literature, a phrase Non-Celiac Gluten Sensitivity (NCGS) exists and it relates to the condition more common in reality that celiac disease. In this article I will try to answer the question from the title, together with other interesting questions concerning using gluten-free diet, e.g. why using gluten-free diet may not bring any effects for some people.

The author of the article:
Łukasz Kowalski is a doctoral student in the Department of Dietetics at the Faculty of Human Nutrition and Consumer Services at the Warsaw University of Life Science. He has individual concultations and dietetic seminars. He is also an author of several dozens of articles concerning nutrition and physical activity published in magazines such as: Kulturystyka i Fitness Sport dla Wszystkich, Fitness Authority and Muscular Development.

The universality of occurrence of celiac disease and NCGS

Celiac disease is an autoimmune disease which is characterised by permanent gluten intolerance. This disorder probably concerns 1-2% of the whole population. Whereas NCGS, according to Sapone et al 2010 and 2011, can concern even 5 times more people than celiac disease, which is 6-7% of the whole population. In case of NCGS the consumption of food containing gluten may cause symptoms similar to those observed at patients with celiac disease: stomachache, egzema, headache, "hazy mind", tiredness, diarrhea, depression, anemia, numbing arms and legs, pain in joints (according to the observations done in the Center of Celiac Research and Treatment). The symptoms mentioned above may noticeably worsen the comfort of life, but their presence may also make it hard to shape the body and improve sports results.
Unfortunately, on the basis of the conclusions from the above publishings, there aren't any objective diagnostic tests for NCGS nowadays. In the commonly used tests only the reaction of the immune system on alpha-gliadin is assessed. The increase of anti bodies may be stimulated by other components of gluten and wheat, amog other gamma and omega gliadin, glutenins and agglutinin from the wheat sprouts, what was also confirmed in the recent research by Vojdani et al, 2013. The elimination diet still seems to be a valuable tool allowing the diagnosis of NCGS.

Consequences of consuming gluten with celiac disease and NCGS

The inflammation processes caused by the anti bodies against the components of gluten and wheat may be the reason for many autoimmune diseases such as type I diabetes, Hashimoto disease, reumatoid arthrosis, as well as illnesses which cause the autoimmune system to act against the structures of the nervous system (e.g. multiple sclerosis).
In the review article:  „The gluten syndrome: a neurological disease” the authors give convincing evidence which support the thesis that gluten may influence the nervous system in a negative way through different mechanisms. At the same time, in a quite recent research Vojdani and Tarash, 2013, observed strong reactions between the antibodies of gluten antigens and nervous system proteins (cerebellum proteins among others). The observed influence may be caused by the phenomenon of the molecular mimicry, which leads to the cross-reaction. In such situation the structures of the nervous system, because of the similarities in the amino acids sequences, may be incorrectly perceived by the immune system as the gluten antigen. I will only remind that cerebellum is a part of cerebrum responsible for the movement coordination and keeping the body balance.
It happens very often that, in order to improve the cognitive functions, many supplements are advised (e.g. fish oil, maidenhair tree, lecitin). However, it's good to think about the mechanisms which can stimulate the neurodegenerative processes (e.g. insulin resistance and therefore instable level of glycemia, lessening the flow of blood to the brain), not to chose any supplements without any knowledge. As it turned out, one of the mechanisms causing neurodegenerative processes can be also an undiagnosed sensitivity to gluten. In such situation, the supply of fish oil or lecitin may not be the most effective solution.

Gluten sensitivity or FODMAP intolerance?

Biesiekierski et al, 2013, led an interesting research with the participation of patients diagnosed with an Irritable Bowel Syndrome (IBS), who have noticed improvement after introducing gluten-free diet. The participats were convinced that their problem was NCGS. However, after using experimental diets (poor in gluten, rich in gluten and poor in FODMAP) there was no clear connection between the gluten consumption and the IBS symptoms. It's interesting that there was a visible improvement of symptoms after introducing a diet poor in FODMAP. In this research, in case of a diet rich in gluten its source were products rich in FODMAP, too (e.g. wheat or rye), which helped to isolate gluten influence from the FODMAP effects. The results of this research suggest that, in significant part of the cases, the FODMAP intolerance may be wrongly interpreted as gluten sensitivity, what needs to be confirmed in further research.
As an explanation, a diet poor in FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) is characterised with low amount of fermenting products - oligosaccharides, disaccharides, monosaccharides and polyols (table with food rich and poor in FODMAP).

Gluten-free diet in practice

Many food products may be polluted with gluten (e.g. oat flakes, buckwheat, nuts and instant coffee), therefore, abidance gluten-free diet is challenging. Partly because of that up to 30% of people with NCGS or celiac disease do not notice any noticeable improvement of the symptoms after using gluten-free diet.
Additionally, Vojdani and Tarash in their research, 2013, identified not only the reactions between the antibodies of gluten antigens and the human body antigens, but also the antigens found in food which is often consumed by people on gluten-free diet: cow milk, chocolate milk, milk butyrophilin, whey protein, casein, oat, corn, millet, rice and instant coffee. According to the researchers, when there is no improvement of the symptoms during using the gluten-free diet, the elimination of food products mentioned above may be justified.

In conclusion

For people who are more interested in this matter, I recommend to familiarize with the lecture by prof. Alessio Fasano: Spectrum of Gluten-Related Disorders: People Shall Not Live by Bread Alone, who, together with his team, found a protein - zonulin, which is the key to the intestinal barrier, as well as to the blood-brain barrier. One of the food component stimulating zonulin production is gluten.  Prof. Alessio Fasano was also Chris's guest at the Revolution Health Radio.

Sources: 1) Sapone i wsp. 2010. Differential mucosal IL-17 expression in two gliadin-induced disorders: gluten sensitivity and the autoimmune enteropathy celiac disease. Int Arch Allergy Immunol. 152: 75-80. 2) Sapone i wsp. 2011. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med. 9;9: 23. 3) Vojdani i wsp. 2013. The prevalence of antibodies against wheat and milk proteins in blood donors and their contribution to neuroimmune reactivities. Nutrients. 6: 15-36. 4) Ford. 2009. The gluten syndrome: a neurological disease. Med Hypotheses. 73: 438-40. 5) Vojdani i Tarash. 2013. Cross-Reaction between Gliadin and Different Food and Tissue Antigens. Food and Nutrition Sciences. 4: 20-32. 6) Biesiekierski i wsp. 2013. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 145: 320-8.e1-3.