According to a study carried out by Ross Albert B. et al in 2020, in recent years gluten has become a very important subject for doctors, as it is associated with a wide range of illnesses. There are generally three gluten-related diseases:
- Enteropathy or more commonly known as gluten-sensitive coeliac disease (CD)
- Non-celiac gluten sensitivity (NCGS) or gluten intolerance
- Wheat allergy, gluten ataxia and dermatitis herpetiformis (DH)
In 2018, around one in every 100 people worldwide is diagnosed with coeliac disease (CD) and almost 6% has non-celiac gluten sensitivity (NCGS). Today’s figures are much higher. In fact, some dieticians are reporting 1 to 3 new cases a day, or almost 15 new cases a week in major hospitals.
Where do the problems associated with gluten come from?
According to Carin Andrén Aronsoon (2016), it is still difficult to know why coeliac disease or non-celiac gluten sensitivity arose. However, a number of research studies have been carried out around the world, and they have all come up with common ideas. Gluten-related problems may originate in childhood, as soon as a baby is breast-fed or gluten is introduced into its diet.
They may also stem from individual eating habits or geographical origin. A study by Sweden’s Lund University (2016) was carried out on children. The results were clear: children who consumed more than five grams of gluten a day up to the age of two were twice as likely to develop coeliac disease as those who consumed less. Other results from the same study conclude that children with coeliac disease consume much more gluten than other children.
There could also be a genetic link: 5 to 10% of people with coeliac disease have relatives with the same disease. In fact, the incidence is increasing, with 1 in 10 people in each family having already been diagnosed with coeliac disease.
What is coeliac disease?
Where does coeliac disease come from?
After the Second World War, a study was carried out on 10 children suffering from an intestinal disease. When gluten was added to their diet, symptoms such as diarrhoea and fatigue reappeared immediately. However, they also included starch, but the effect was not conclusive. This led doctors to deduce that gluten was responsible for coeliac disease.
According to the French Gluten Intolerant Association (AFDIAG), coeliac disease is ‘an autoimmune disease that affects the villi covering the small intestine’. This disease generally causes intestinal villous atrophy, meaning ‘destruction of the folds of the mucosa and connective tissue of the small intestine’. This leads to poor absorption of nutrients, particularly iron, calcium and folic acid.
Here are the opinions of several researchers:
Mendoza Nicky (2005) states that CD is characterised by ‘immune-mediated’ damage to the jejunal muscosa caused by gluten protein.
According to Steven L. Kaplan (2015), ‘celiac disease is an autoimmune disease affecting 1% of the population, seriously disabling and potentially serious, synonymous with intestinal deterioration, leading to digestive disorders.’
Mayer Chaves Araújo, et al (2012) speak in particular of changes and modifications to the normal characteristics of the small intestine. Villi atrophy can reduce the surface area available for nutrient absorption in the body.
FRPT- FMCG (2018) reports that the gluten-free diet is generally strongly advised for people with CD. This disease is said to be an allergy where even a small amount of gluten swallowed can generate an immediate immune response that damages the lining of the small intestine. Eating gluten for coeliacs could also lead to problems such as osteoporosis, infertility, nerve damage and convulsions.
We also know that CD is characterised not only by inflammation of the tissues of the small intestine, but also by neurological defects such as axonal neuropathy and cerebellar ataxia (ataxia is not a disease in itself, but a symptom resulting from damage to the cerebellum).
The symptoms of coeliac disease in children
Coeliac disease used to be considered a childhood disease, with numerous symptoms such as diarrhoea and severe sleep deprivation. In addition, the disease can lead to slower growth in weight and height, abnormal stools, abdominal distension, muscle wasting, lack of appetite and negative effects on the child’s psychological state. The child may be sad and tired, with a frequently bloated stomach, delayed onset of puberty, abnormal dental enamel or joint pain.
However, Horberg L, et al (2003) consider that a small proportion of people with CD show symptoms of diarrhoea or weight loss. In fact, he refers in particular to psychological symptoms, but also to symptoms that are still very vague, which would be more representative of the disease. According to him, coeliac disease is more regularly diagnosed around the age of 50.
Symptoms of coeliac disease in adults
In adults, symptoms usually include ‘bloating, diarrhoea-constipation episodes and worrying weight loss’. Women may also experience ‘menstrual irregularities or repeated miscarriages’. (AFDIAG).
Today, CD can be diagnosed at any stage of life: in childhood, adolescence or adulthood.
Tests to diagnose coeliac disease
In the past, the only way to tell whether someone had coeliac disease was to see whether stopping gluten in the diet reduced the pain.
Today, new tests make it possible to reliably diagnose whether or not a person has coeliac disease.
Non-celiac gluten sensitivity (NCGS), gluten intolerance
Most cases of NCGS describe a long-standing, unresolved history of abdominal pain, bloating, changes in bowel habits and fatigue. Yet they have not been diagnosed as coeliac.
In fact, thanks to the new tests that have been created to determine whether or not there is CD, clinicians have decided to carry out these tests on anyone who reports having symptoms similar to CD. However, for some of them, the biopsies did not indicate any case of CD. This has led to the emergence of a new typology: non-celiac gluten sensitivities (NCGS).
The symptoms between coeliac disease and gluten intolerance are more or less similar. According to a 2014 study by Khamsi R., NCGS are more prone to headaches, without really suffering from digestive problems.
However, Jackson, J.et al (2014), denounce the fact that NCGS also suffer from nutritional deficiencies, coexisting autoimmunity and reduced bone mineral density compared to the general population. Gluten has also been shown to cause depression and autism in NCGS. (Study by Jackson, J.; Eaton, W. et al, 2014).
In most cases, pain and symptoms appear within a few hours of ingesting gluten in CNSs. This digestive disorder is generally diagnosed in adulthood rather than as a child.
To this day, there are still major difficulties in diagnosing and managing NCGS.
Wheat allergy, gluten ataxia and dermatitis herpetiformis (DH)
It is important not to confuse coeliac disease with a wheat allergy. The immune mechanism is very different from that of a disease versus an allergy. The latter manifests itself as angioedema, skin rashes or anaphylactic shock. When there is an allergy, it is possible to notice an IgE-mediated manifestation, which is generally associated with wheat protein allergens. In other words, wheat flour triggers an ‘IgE meditation’ food allergy, which is among the top eight food allergies (Study by Patel, B.Y. et al, 2015).
Regarding dermatitis herpetiformis (DH), ‘a rare autoimmune disease consists of skin involvement in the form of irritating lesions that impair quality of life.’. More common in men than in women, this disease is diagnosed by skin sampling. You might think there was no link with coeliac disease, but when you look at the stomachs of patients, there is, like CD, intestinal villous atrophy.
Research carried out during my final dissertation in July 2020.
Chloé