Gluten Intolerance

Causes Of Gluten Intolerance

Gluten is a type of protein that is majorly found in wheat. The other sources include rye, barley, and oats. 

What causes gluten allergy?

• Proteins are normally digested by the enzymes present in the stomach. 

• Gluten is, however, not digested completely by these enzymes due to the high content of indigestible protein in it. 

• The undigested gluten usually goes into the small intestine. It stays in the body for 1-2 days after which it is excreted with other waste products.

What causes gluten intolerance?

In some individuals, gluten can cross the epithelial barrier of the small intestine and activate the immune system. This can lead to symptoms in two ways:

• Triggering an allergic reaction

• Initiating an autoimmune reaction by remaining in the small intestine
  
  

This causes significant changes in the gastrointestinal tract and causes intestinal and extraintestinal symptoms mentioned in the ‘Symptoms’ section. Most of the symptoms are developed due to damage in the lining of the small intestine by the antibodies developed as an immune reaction. 

Types Of Gluten Intolerance

1. Celiac disease

• Genetic, autoimmune disease in which ingested gluten damages the small intestine

• Can run in families

• If left untreated, it can lead to other health problems such as thyroid disorders, low bone density and even intestinal cancer.

2. Wheat allergy

• Refers to immediate allergic reaction after consumption of wheat

• Mostly presents with symptoms such as itching, hives, and swelling lips or tongue

3. Non-celiac gluten/wheat sensitivity (NCGS/NCWS)

• Used to describe a diagnosis for individuals who do not have celiac disease or wheat allergy.

• Individuals with NCGS do not possess the same antibodies and intestinal damage seen in celiac disease.

Have you heard about FODMAPs?

FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are short-chain carbohydrates that are resistant to digestion. FODMAPs are commonly found in food items like pasta, bread, onion, garlic, legumes, pulses, milk, apples, honey, processed meats, certain sweeteners etc. FODMAPs have been found to be associated with NCGS.

Note: Everyone with celiac disease is intolerant to gluten but not everyone with gluten sensitivity will develop celiac disease. 

Symptoms Of Gluten Intolerance

People with gluten intolerance usually experience symptoms within 1 hour of consuming gluten. Some people face a delayed gluten reaction which may even take 12 hours to develop symptoms. The common symptoms include:

I. Intestinal symptoms

• Abdominal pain (most commonly observed symptom)

• Diarrhea 

• Nausea

• Bloating

II. General bodily symptoms

• Headache

• Joint pain

• Muscle contractions

• Numbness, especially in the hands and feet

• Tiredness

III. Behavioral symptoms

• Not able to focus

• Depression

• Anxiety

• Hyperactivity

• Lack of balance and coordination while walking

IV. Skin-related symptoms

• Redness of the skin

• Dry and itchy patches on the skin

Risk Factors For Gluten Intolerance

Anybody can have gluten intolerance but there are some factors that increases its risk:

1. Family history

Individuals with a positive family history of celiac disease or lactose intolerance are more prone to develop gluten intolerance. 

2. Genetic conditions

Certain genetic conditions such as Down syndrome, William syndrome or Turner syndrome makes the person more sensitive to gluten containing food. 

3. Colitis

Colitis i.s.inflammation of the colon (large intestine) also increases the risk of developing gluten intolerance.

4. Diabetes

Type 1 diabetes increases the risk of celiac disease in which the immune system mistakenly attacks the body’s own cells. 

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Diagnosis Of Gluten Intolerance

1. Ruling out the possibility of other digestive conditions

Celiac disease, wheat allergy, and gluten intolerance have similar symptoms upon ingestion of gluten. Firstly, the individuals are kept on a gluten-free diet for some weeks to examine the symptoms. The possibility of other diseases is ruled out if the symptoms start resolving with the removal of gluten from the diet.

2. Diagnosing celiac disease

The diagnosis of celiac disease is usually made through the identification of several antibodies in the blood. Some such antibodies include:

• Tissue transglutaminase antibody - IgA

• Tissue transglutaminase antibody - IgG

• Gliadin antibody IgG

• Endomysial antibody IgG

• Endomysial antibody IgA

• Endomysial antibody IgM

In some cases, a biopsy (tissue examination under the microscope) is needed for confirmation. 

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3. Diagnosing wheat allergy

• Wheat allergy marker blood test: IgE is a type of antibody that is usually elevated in allergy. In this, the level of total IgE level is determined. 

• Skin test: In this skin test, the doctor scratches the skin with the needle containing wheat. The skin reactions are examined to detect allergies. 
  
  

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4. Diagnosing Non-celiac gluten (NCGS)

• Firstly, individuals are given a diet containing gluten for a few weeks. 

• It is followed by giving placebo.

• There is a washout period in between in which placebo and gluten are not given. 

• Symptoms are traced in both cases which helps in establishing the correlation between gluten and symptoms.

In some cases, intestinal tissue examination under the microscope is required for confirmation.

Prevention Of Gluten Intolerance

Gluten intolerance cannot be entirely prevented. However, the episodes of allergic reactions can be prevented by adopting the following lifestyle changes:

1. Go Gluten free

Gluten is naturally present in wheat, rye, and barely. Foods made from wheat have the highest amounts of gluten. If you have a gluten allergy, avoid consuming the following food items:

• Flour

• Bread

• Crackers

• Baking mixes

• Pasta

• Cereal

• Sauce

• Processed meat

• Beer

• Malt vinegar

2. Identify the trigger

The quantity of gluten varies in different products. It is not necessary that all gluten containing food items triggers an allergic reaction. 

The trigger can be identified by eliminating all food, beverages, medication, and cosmetics that have gluten in them. It is followed by adding items one by one. The trigger is then identified based on the appearance of symptoms.

3. Be more conscious while dining out  

Most of the people may feel the symptoms while dining out. It is advisable to ask for gluten free options which can be safely consumed. 

4. Check the hidden gluten content

Some food items contain gluten which people are not aware about. These include emulsifiers, dextrin, mono- and di-glycerides, seasonings, and caramel colors.

Sometimes, food can be contaminated with gluten in the process of preparation and packaging. These can be identified through warning labels. Here are some foods and beverages that may contain gluten:

• Brown rice syrup

• Candies

• Wafers

• Cold cuts

• Hot dogs

• Sausage

• French fries

• Readymade gravies

• Fish

• Rice mixes

• Sauces (soy sauce and vegetable sauce)

Specialist To Visit

It is very important to consult a doctor for accurate diagnosis and appropriate management of this condition.

When to see a doctor?

• If you are experiencing severe gastrointestinal symptoms along with other symptoms like joint pain, headache.

• In case you are already aware of your gluten intolerance and your health is not improving even after cutting out gluten from your diet.

Preparation for the appointment 

• Keep track of the number of servings of gluten-containing foods such as wheat

• Prepare a list of medicines and supplements that you are taking

• Maintain a record of symptoms after taking gluten-containing food items

• Record the information regarding the disappearance of symptoms after cutting these products

Doctors who can help you with this are:

• General physician

• Gastroenterologist

• Pediatrician

• Nutritionist
  
  

General physicians help in diagnosing the condition and suggest necessary interventions.

Gastroenterologists specialize in diagnosing and managing digestive disorders like gluten intolerance. They also help to manage conditions such as colitis that may trigger gluten intolerance.

Parents of gluten-intolerant children can seek treatment from pediatricians. While nutritionists can help in optimizing the diet for gluten intolerants. 

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Treatment Of Gluten Intolerance

• Gluten intolerance cannot be treated. However, the symptoms can be avoided through adopting a gluten-free diet. Also, make sure to follow all the points mentioned in the ‘Prevention’ and ‘Living with’ sections.

• Anti-allergic medications and steroids may be given to manage symptoms in some cases.

• Adrenaline is administered in case of anaphylaxis.  

Home-care For Gluten Intolerance

The following home remedies and supplements can help in pacifying the digestive symptoms associated with gluten intolerance. However, make sure to consult your health care provider before initiating any of them.

1. Ginger (adrak): It helps in relieving uneasy stomach and muscle cramps experienced after the ingestion of gluten containing food. It can be consumed in the form of an extract prepared by boiling a few pieces of ginger in boiling water.

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2. Turmeric (haldi): It is a natural anti-inflammatory agent. It is known to ease stomach cramping, bloating, and nausea. One teaspoon of turmeric powder can be swallowed directly with water. It can also be taken as readily available turmeric supplements. 

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3. Fish oil: Celiac disease, one form of gluten intolerance, damages the intestinal lining. Preparations like fish oil help coat the lining of the small intestine and reduce the level of injury. 

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4. Yogurt: It is loaded with good bacteria and aids in digestion by supporting gut health.

5. Apple cider vinegar: It helps in reducing bloating and other intestinal symptoms associated with gluten intolerance.

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Complications Of Gluten Intolerance

1. Nutritional deficiencies:

Avoidance of many food items can lead to malnutrition and nutritional deficiencies. In such cases, it is important to support your diet with dietary supplements. Make sure to take advice from your doctor before taking any supplement.

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2. Weight gain:

Inflammation can block nutrient absorption in the body. When the body thinks it is short of nutrients, it craves for more food to get the nutrients it needs. This is why some patients with Celiac disease can gain weight in spite of being starved.

Living With Gluten Intolerance

Gluten intolerance is a lifetime condition. It is also marked by several relapses and remissions. However, the condition is manageable. Apart from the points mentioned in the “Prevention” section, the following adjustments in daily life may prove to be beneficial:

Know about what to eat

It can be challenging to find gluten-free nutritious foods. Here is the list of food that is not only gluten free but also nutrient abundant. 

• Rice

• Quinoa

• Millet

• Amaranth

• Oats (use oats labeled "gluten-free," as oats are often cross-contaminated with wheat and barley)

• Corn

• Buckwheat

• Potatoes and potato flour

• Sorghum

• Teff
  
  

You can also consult a registered dietitian for a proper meal plan. They will customize the diet and possibly recommend specific dietary supplements such as fiber and calcium.

Other important tips

• Educate yourself with the gluten free dietary options at home

• Make everyone aware about your condition to minimize the accidental exposure

• Keep in mind about the positive effects of gluten free diets such as maintaining optimum weight along with improving bone health. 

• Stay motivated by adding newer gluten free recipes in your kitchen 

• Eat fresh ingredients rather than the processed ready to eat gluten free

• Eat a lot of citrus fruits like orange, lemon and lime to help the body assimilate nutrients and also for their antioxidant content.