Carlo Catassi, Julio C. Bai, Bruno Bonaz, Gerd Bouma, Antonio Calabrò, Antonio Carroccio, Gemma Castillejo, Carolina Ciacci, Fernanda Cristofori,Jernej Dolinsek, Ruggiero Francavilla, Luca Elli, Peter Green, Wolfgang Holtmeier, Peter Koehler, Sibylle Koletzko, Christof Meinhold, David Sanders, Michael Schumann, Detlef Schuppan, Reiner Ullrich, Andreas Vécsei, Umberto Volta, Victor Zevallos, Anna Sapone, and Alessio Fasano
Nutrients. 2013 Oct; 5(10): 3839–3853
Hey guys, to be honest when I read this article, it certainly put a damper on the landmark article from a few weeks ago that I wrote about that was roughly three years prior that there still continues to be so much debate going on as to the validity of non-celiac gluten sensitivity as an issue.
- Gluten sensitivity (GS) was originally described in the 1980sand a recently “re-discovered” syndrome entity, characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA).
- Following the landmark work by Sapone and coworkers, describing the clinical and diagnostic features of GS in the year 2010, a rapidly increasing number of papers have been published by many independent groups, confirming that GS should definitely be included in the spectrum of gluten-related disorders. However, many aspects of GS epidemiology, pathophysiology, clinical spectrum, and treatment are still unclear.
- GS, which this review will focus on primarily, is a condition in which symptoms are triggered by gluten ingestion, in the absence of celiac-specific antibodies and of classical celiac villous atrophy, with variable Human Leukocyte Antigen (HLA) status and variable presence of first generation anti-gliadin antibodies (AGA)
- The overall prevalence of NCGS in the general population is still unknown, mainly because many patients are currently self-diagnosed and start a GFD without medical advice or consultation.
- Although risk factors for NCGS have not yet been identified, the disorder seems to be more common in females and in young/middle age adults. The prevalence of NCGS in children is still unknown.
- NCGS is characterized by symptoms that usually occur soon after gluten ingestion, disappear with gluten withdrawal and relapse following gluten challenge, within hours or few days. The “classical” presentation of NCGS is a combination of IBS-like symptoms, including abdominal pain, bloating, bowel habit abnormalities (either diarrhea or constipation), and systemic manifestations such as “foggy mind”, headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis (eczema or skin rash), depression, and anemia
- The trigger/s of mucosal events leading to NCGS is not necessarily represented by the same array of gluten peptides responsible for CD development. Unlike the duodenal mucosa from patients with CD, upon incubation with gliadin, mucosa from patients with NCGS does not express markers of inflammation, and their basophils are not activated by gliadin. In vitro studies suggest that wheat ATIs could play a major role as triggers of the innate immune response in intestinal monocytes, macrophages and dendritic cells eventually leading to NCGS.
- The vast majority of celiac experts initially reacted with a great deal of skepticism to the concept of NCGS existence and the fact that it was a separate entity from CD. For those that witnessed the initial struggle of convincing health care professionals that CD was not confined within European boundaries this was a déjà vu. Indeed, we are now with NCGS where we probably were with CD forty years ago. In the 1980s we knew that CD existed, but we had little information on the mechanisms leading to the enteropathy, the genetic component of the disease, what kind of immune response was involved in the pathogenesis of the disease, its multifaceted clinical presentation, and its complication.
This is one of those instances where I don’t believe that we can always wait for science to be proven enough to work past the skepticism for the next fifty-seven years…. Because if this article concludes that they believe that non-celiac gluten sensitivity is where celiac disease was forty years ago and then you add another seventeen years before a researchers work gets put into practice by your local doctor, I’m sorry I don’t have that long to wait for them to have enough scientific date for them to call this a real issue, when I know way to many people who are suffering.
Yes, I’m sure that this just adds to many people’s excuses and they will use articles like this as proof that they do not need to change their diet and/or lifestyle and to those of you who believe that, then you are probably in the wrong place.
This blog and my entire purpose here is about being proactive about your health. To take what makes sense to you, to learn to think outside the box and I can tell you that if your body is reacting to gluten then it is reacting to gluten.
Are you willing to be your life and wait for proof when it is estimated that 83% of Americans who have celiac disease are undiagnosed or misdiagnosed with other conditions? Just something to consider.
* Here’s my little disclaimer, I’m not a doctor, researcher, immunologist, just someone deeply concerned and trying to help as many peeps as I can make conscious, good, healthy choices for their health and their bodies when living life with gluten challenges. I have not been compensated or obligated to write this article, and as always, all thoughts and opinions are honest and my own!