G L U T E N S E N S I T I V I T Y
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Gluten (from Latin gluten, “glue”) is a mixture of proteins found in wheat and related grains, including barley and rye. It gives elasticity to dough, helping it rise and keep its shape and often gives the final product a chewy texture.
Gluten is the composite of two storage proteins, gliadin and a glutenin, and is conjoined with starch in the endosperm of various grass-related grains. Worldwide, gluten is a source of protein, both in foods prepared directly from sources containing it, and as an additive to foods otherwise low in protein. It is appreciated for its visco-elastic properties.
Celiac disease (CD) is an autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. When people with celiac disease eat gluten , their body mounts an immune response that attacks the small intestine, causing damage to the villi and severely affecting nutrient absorption. The damage to the intestine also places a huge burden on the immune system. Children with CD will usually have digestive symptoms (abdominal bloating and pain, constipation, diarrhea, vomiting, etc.) and may have fatigue, short stature and failure to thrive. CD can also cause dental problems, behavioral problems and ADHD. Adults with CD may have unexplained anemia, fatigue, joint pain, osteoporosis, depression, anxiety, migraine headaches, seizures, canker sores, skin problems (itching or rash), missed menstrual periods, infertility or PMS.
We are starting to hear more about gluten sensitivity that is not celiac disease (CD). Non-celiac gluten sensitivity (NCGS). NCGS was discussed in a recent issue of the Annals of Nutrition and Metabolism ( s u p p l 2 : 1 6 – 2 6 . d o i : 10.1159/000440990. Epub 2015 Nov 26). It is distinct from either CD or wheat allergy, and is much more common than CD (which only affects about 1% of the population).
NCGS is more common in adults, especially females between the ages of 30 and 50, but there have been pediatric cases. Symptoms include an irritable bowel-like syndrome characterized by abdominal pain, b l o a t i n g , o r b o w e l h a b i t abnormalities (either constipation or d i a r r h e a ) . O t h e r s y s t e m i c manifestation include “brain fog”, headache, fatigue, joint pain, muscle pain, eczema, depression and anemia.
Some studies have explored the relationship between gluten ingestion and neurological and psychiatric disorders. Neuropathy, autism, schizophrenia, depression, anxiety and even hallucinations may be associated with gluten consumption in some patients. The symptoms of NCGS usually abate when gluten is removed from the diet and return when it is eaten again. Unfortunately, no biomarker is sensitive and specific enough for diagnostic purposes; therefore, the diagnosis of NCGS is currently based on establishing a clear-cut cause-effect relationship between the ingestion of gluten and the appearance of symptoms by a standardized double-blind, placebo-controlled gluten challenge.
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