Monthly Archives: November 2016

Coeliac Disease and Non-Coeliac Gluten Sensitivity

Well this is an area of a lot of interest currently and it is important to separate the science from the speculation/internet sensation.

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Many people the world over find report that they have symptoms ranging from bloating, wind and abdominal distension/pain to diarrhoea and altered bowel habit when they consume a diet rich in wheat-based foods. Wheat (and grain relatives),Rye and Barley contain both gluten and fructans which are both hard to digest for some. It is commonly assumed by most folk that it is the gluten that is the problem because they are unaware of fructans and their potential role.  The assumption is made by these individuals that they have a gluten sensitivity.

The symptoms described above are seen in a range of gut disorders including Coeliac Disease, Diverticular disease or Chrohn’s disease as well as Irritable Bowel Syndrome for example. It is tempting for sufferers to start removing wheat from their diet however the exclusion of Coeliac disease is the important step they miss before doing this. The tests for Coeliac disease will only be accurate if wheat remains in the diet and the body reveals it’s reactions to the wheat in screening blood tests and if required,  biopsies. This will show up as abnormal blood antibody levels which will suggest a biopsy is needed and abnormal biopsy histology results can be discovered if they exist. Without the wheat going through the body the reactions won’t be there in either blood or biopsy and a diagnosis can be missed.

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Once these diseases have been excluded It may be that a trial of a low-wheat/rye/barley diet as part of a more more comprehensive low-FODMAP diet may be used to see if symptoms can be resolved.

It was once thought the exclusion of wheat in non-Coeliacs may aid symptom reduction due to the lower level of fructans. There is now suggestion in the science that it may be a reaction to gluten, different to that shown in Coeliac disease, that may worsen some gastointestinal symptoms in non-Coeliacs and this has been given the term non-Coeliac gluten sensitivity(NCGS).

Watch this space as the story unfolds. Well conducted research trials are few and far between but in the last few years a couple have appeared using subjects with self-reported NCGS that have been well designed to ensure all other causes have been accurately excluded.

The BOTTOM LINE- make sure Coeliac disease is accurately excluded before altering you diet.

If Coeliac disease is confirmed after abnormal blood test results and subsequent biopsy there is a very strict dietary protocol to follow to maintain a 100% gluten-free diet, 99 % is not enough removal for this healing of the gut with this condition.

If excluded the other dietary trials can be started in earnest.