Gluten Related Disorders - Do You Have Them?

The exact cause of the body reacting to gluten isn't known but it is thought that genetic factors play a major role in the development of these conditions. There are specific genes responsible which are prone to producing antibodies which react with gluten in the small intestines. The autoimmune reaction which occurs then manifests in the body causing it to respond in a number of ways. 

Symptoms of gluten-related disorders

The following symptoms may be experienced by an individual whose body is reacting to the presence of gluten in the intestines. Anyone presenting with a combination of these issues should be seen by their primary care doctor for further assessments and referral to specialists.

• A person can experience fatigue or being tired, as well as “brain fog” after consuming a meal which contains gluten products.
• Gastrointestinal issues such as abdominal bloating, increased flatulence, diarrhoea or constipation may be experienced. Children especially are quite prone to experiencing constipation.
• Migraine-type headaches are also characteristic of this condition. 
• Neurological symptoms can also be experienced. They include dizziness, lack of coordination and balance or even a tingling sensation and/or numbness in the hands and feet. Epilepsy has also been mentioned as a possible symptom, but there hasn’t been any conclusive proof of this being an actual issue.
• “Chicken skin”, otherwise known as keratosis pilaris, is a condition where a non-itchy rash of small skin coloured papules develops on the back of the arms. This occurs due to vitamin A and fatty acid deficiencies which are a result of fat not being absorbed by the small intestines due to damage caused by gluten reacting with the gut.
• In women, gynaecological issues such as hormonal imbalances, increased pre-menstrual symptoms (PMS), polycystic ovarian syndrome (PCOS) and infertility (where the cause is not determined) may be present.
• Muscle aches and pains, the cause of which can’t be explained. Patients then end up being diagnosed with conditions such as chronic fatigue syndrome (CFS) and even fibromyalgia.
• There can also be issues such as swelling, inflammation or pain of the joints such as the fingers, hips and knees. It’s important to take note here that there isn’t a specific set of joints involved, such as the weight bearing joints in osteoarthritis and the hands and wrists in rheumatoid arthritis, but rather that the involvement is generalized.

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• These patients are often diagnosed with other autoimmune disorders such as ulcerative colitis, rheumatoid arthritis (RA), Hashimoto’s thyroiditis, systemic lupus erythematosus (SLE), scleroderma and even multiple sclerosis. The symptoms of gluten-related disorders can be very similar to those caused by these mentioned autoimmune conditions, and thus it's important to do the correct tests to exclude them.
• The patient can also experience mood related conditions such as major depression and mood swings, as well as increased anxiety and even attention deficit disorder (ADD). These symptoms are collectively referred to as neuro-psychiatric manifestations of gluten-related disorders.

Celiac Disease: Diagnosis And Treatment 

Diagnosis

Celiac disease leads to damage of the villi of the small intestine, which are the hair like cells which absorb nutrients from food, due to the inflammation caused by the auto-immune reaction between the antibodies and gluten.

It would be important to mention how celiac disease is diagnosed seeing that it is the most common of the gluten-related disorders. It’s estimated that 99% of individuals who have celiac disease are never diagnosed with this condition. The reason for this is because patients aren't always symptomatic but damage to the gut does still occur.

In 2010, the 4-out-of-5 rule was suggested which means that 4 out of the following 5 criteria need to be fulfilled in order to confirm this diagnosis of celiac disease.

• The patient must experience typical symptoms of celiac disease (as mentioned above).
• Blood analysis shows serum celiac disease immunoglobulin to be positive and A-class auto-antibodies must be at a high titre.
• There’s a positive result of human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes on blood tests.
• It is found that celiac enteropathy is present on small bowel biopsy.
• The patient responds positively to a gluten-free diet.

Treatment

Besides wheat, rye and barley there are other foods that also contain gluten proteins and they include the following products that one would need to be aware of:

• Bulgur wheat
• Farina
• Durum
• Malt
• Graham flour
• Triticale
• Spelt
• Semolina

Packaged foods should then be avoided as most of them contain gluten, unless the package is labeled as gluten-free. These would include products such as breads, cakes, cookies, pies, gravies, candies/sweets, beer, imitation and/or processed meats. Unfortunately, even oats are recommended to stay away from as they can cause issues with patients with gluten-related issues.

Foods which can be consumed would then include fresh fish and meat (which aren't breaded or battered), dairy products, fruit and vegetables, potatoes, corn, rice, tapioca and rice. Gluten-free breads and pastas are also available at local supermarkets, too.

Within several weeks, the inflammation in the small intestines would have decreased tremendously, but one may start feeling better after a few days on a gluten-free diet. Healing and regrowth of the villi can take a few months up to several years to occur and improvement seems to be faster in children than in adults.

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Due to the damage which occurs to the villi, vitamin, mineral and nutrient absorption is then decreased and these will need to be supplemented. If gut absorption is still not adequate enough, then one would need to have these supplements administered via injection rather than orally. The most common deficiencies which need to be addressed are:

• Vitamin B12
• Vitamin D
• Vitamin K
• Calcium
• Folate
• Iron
• Zinc

Acute inflammatory episodes will need to be managed with steroid medication. These will need to be prescribed by your primary care doctor or specialist.