08 May Am I Coeliac Or Just Sensitive To Gluten?
Coeliac disease and non-coeliac gluten sensitivity (NCGS) are on the rise in my clinic and often patients are unaware that this may be contributing to the multitude of symptoms they are experiencing. In Australia, there are approximately 355,000 people currently diagnosed with Coeliac disease. That’s 1 in 70 people and alarmingly, 80% of these cases didn’t know they had it. The prevalence rate of non-coeliac gluten sensitivity is not accurately measured due to the incidence of self-reporting, but it is suspected to be higher than that of coeliac disease.
Coeliac disease is a condition whereby your immune system attacks and damages the tiny tubules that line your small intestine, promoting inflammation and destroying the villi that are essential to you absorbing your nutrients. This is because your immune system is responding abnormally to gluten, a protein found mainly in wheat, barley and rye products. If left undiagnosed and untreated, this condition can have serious consequences on your health.
What are the types of symptoms I may experience?
The severity and type of symptoms can vary greatly from patient to patient. I see patients that experience intense reactions to minuscule amounts of gluten, while others experience only mild symptoms. How you react to gluten is not always indicative of your gluten susceptibility or the extent of damage to your villi. Often patients have very little understanding of how varied symptoms can be and that they may not just be limited to those coming from the gut. Below is a list of some of the type of symptoms you may experience:
- IBS type symptoms e.g. diarrhoea, constipation, bloating, abdominal cramping/pain, excessive flatulence/wind, nausea and vomiting
- Persistent and unexplained fatigue
- Joint pain
- Malnutrition and nutritional deficiencies e.g. iron, B12, folate
- Osteopenia and Osteoporosis
- Unexpected weight loss
- Unexplained fertility issues
- Severe or persistent mouth ulcers
- Failure to thrive in children
- Autoimmune conditions e.g. Type 1 Diabetes, Thyroid conditions such as Graves or Hashimotos
- Unexplained persistently raised serum liver enzymes
- A loss of co-ordination or balance
- Associated peripheral neuropathy e.g. tingling, numbness, pins & needles sensation in arms or legs
- Brain fog
- Skin rashes, eczema, psoriasis
How can I be tested?
This is where I find my patients are unclear about their diagnosis. There are several tests that you can do but they may not be conclusive as a standalone test, and you may require multiple tests to confirm whether you have Coeliac disease or not.
Coeliac serology blood test – This is the most common test undertaken by doctors routinely and measures your Transglutaminase IgA (tTG-IgA) & Deamidated gliadin peptide IgG (DGP-IgG) antibodies. These are markers in the blood that are produced by the immune system against an enzyme that repairs damage in your body (tTG-IgA) and against the main protein contained in gluten called gliadin (DGP-IgG). This test can have a low sensitivity rate and ideally you must be consuming 3-6gms of gluten daily for at least 4 weeks before doing the test for it to be validated. On its own, it is not diagnostic but one I often see my patients refer to as their only screening for this condition. In these cases, more investigation is usually required.
HLA-DQ2 & HLA-DQ8 genotyping – Everyone inherits HLA-DQ genes from their parents when they are conceived. There are many different types of HLA-DQ genes but currently research indicates it’s the HLA-DQ2 and HLA-DQ8 gene variants, that increase your risk of developing coeliac disease. The HLA DQ2 gene is the most common one with 90% detected in coeliac patients and only 8% of patients are positive to the HLA DQ8 gene.
There are also different versions of the HLA-DQ2 gene that further increases your risk for developing coeliac disease such as HLA-DQ2.5. This HLA variant has the highest genetic risk for developing Coeliac disease. The good news is though, if you are negative for the DQ2/DQ8 holotypes you have a <1% chance of developing Coeliac disease. As genetics can be complicated, it is best to work with a qualified health professional to determine your actual risk and what you can do to about it.
Small bowel biopsy via endoscopy – this is the gold standard test to diagnose Coeliac disease and involves a simple procedure whereby a flexible tube is inserted through the mouth into the stomach and intestines. During the procedure a small tissue sample is taken and sent to the lab for analysis to check for damage to your villi. If the results come back positive this means you have Coeliac disease and will need to start treatment.
Non coeliac gluten sensitivity testing – There currently is no biological marker for diagnosing non-celiac gluten sensitivity and it is generally diagnosed through a process of elimination. A formal diagnosis however can be done via a labour‐intensive double-blind, crossover dietary challenge with gluten or wheat and a placebo phase over a course of 8 weeks. As this is rarely undertaken patients are diagnosed after screening for Coeliac disease and if still undiagnosed filtered into similar treatment options as Coeliac patients to determine if symptoms resolve.
What if it’s not Coeliac disease?
If your results rule out Coeliac disease or are unclear, the following conditions should also be investigated as they can cause similar symptoms;
- Inflammatory bowel disease e.g. Crohn’s disease and Ulcerative colitis
- Irritable bowel syndrome
- Dysbiosis and intestinal infections
- Small Intestinal Bowel overgrowth (SIBO)
There are various testing options for the above conditions that can be undertaken which are outside the scope of this blog but can be discussed further with me or your health professional if required.
What are the treatment options?
Treatment for Coeliac disease entails a strict lifelong gluten free diet, as this is the only way to reduce inflammation and further damage to the villi in the small intestine. This means taking out completely foods that contain the following grains because even minuscule amounts of gluten can be damaging, even if they don’t cause symptoms;
- Graham flour
- Spelt (an ancient form of wheat)
- Oats – these are processed in factories with oats so can be cross contaminated
Gluten can also be hidden in foods, medications and other products we are exposed to. They can be disguised as modified food starches, preservatives, food stabilizers, prescription and over-the-counter medications, vitamin and mineral supplements, make up such as lipstick products, toothpaste and mouthwash, hair care products and even play dough. It is important to read your labels and understand the many faces of gluten to help reduce your exposure and symptoms.
So…where to from here?
If you would like to explore your relationship with gluten and how it relates to your symptom picture you contact me on 9339 1999 to book a free 15-minute scoping session to discuss how I can help you.