Gluten intolerance, celiac disease

by Abdullah Arif · June 16, 2024

Gluten intolerance has some features of both allergy and autoimmune disease . If gluten intolerance appears already in childhood, we are talking about celiac disease . In adults, this disease is sometimes referred to as non-tropical sprue. An exaggerated immune reaction to gluten takes place in the intestines of the affected person, which leads to chronic inflammation and subsequently damage to the intestinal mucosa , especially in the area of the duodenum . A person may have a genetic predisposition to gluten intolerance , which affects not only the risk of developing the disease, but also the individual severity of the clinical picture , as well as the age at which the disease develops.

Gluten is contained in some types of grain and is added in bakeries and bread to increase the elasticity of the dough . In people suffering from celiac disease, gluten provokes an immune reaction that results in severe damage to the mucosa of the small intestine and its outgrowths ( intestinal villi ), which ultimately leads to a reduction in the total surface area of this mucosa.

The consequence is a significantly reduced intake of nutrients that can be absorbed into the bloodstream through the intestinal mucosa . This can then be manifested by a serious lack of various vitamins or minerals and associated diseases . Individual problems can be very different and non-specific , so many years often pass before a correct diagnosis is made .

What symptoms can occur with gluten intolerance?

Typical physical symptoms of gluten intolerance mainly concern the digestive tract . It can be, for example:

diarrhea
constipation ,
flatulence,
abdominal pain ,
intestinal bleeding .

Various other symptoms of gluten intolerance arise as a result of general malnutrition , as the affected person suffers from a lack of proteins and vitamins. Symptoms may include general nausea accompanied by fatigue, nervousness, headache or weight loss . A lack of vitamins can be manifested, for example, by night blindness or inflammation of the mucous membranes . In young children, celiac disease presents with diarrhea, bloating and failure to thrive; these symptoms typically appear after the introduction of the first cereal foods, i.e. most often from the sixth month of life.

Gluten in food

Gluten is contained in the following cereals:

wheat,
rye,
barley,
spelled,
green spelled,
single-grain wheat, durum wheat,
old varieties of cereals,
kamut (type of wheat),
triticale (cross between rye and wheat),
wild rice (black brown).

People suffering from gluten intolerance must strictly avoid all types of grains mentioned above. Caution is also needed with grain products, such as bulgur (broken wheat) or couscous (semolina made mostly from overgrown durum wheat or barley).

Different types of cereals contain gluten of very different composition. Therefore, people suffering from gluten intolerance usually tolerate other types of cereals well, such as corn, brown rice (natural rice), millet, amaranth, quinoa and buckwheat. These cereals are easily digestible and help cover the need for carbohydrates in case of gluten intolerance . Legumes, soy, nuts or seeds do not cause problems either. The offer of gluten-free grain products is currently very extensive, so people suffering from gluten intolerance can eat a relatively varied diet.

Even people suffering from celiac disease can follow the principles of a balanced diet . A large number of foods are naturally gluten-free. You can be inspired by the food pyramid , of course taking into account the existing allergy . You can also find a number of tips in the article Diet for celiac disease ( gluten-free diet ) . Quality information is provided on its website by the Society for a Gluten-Free Diet [1]. A qualified nutritional therapist can also help you with creating a balanced diet .

Oats and a gluten-free diet

The content of gluten in oats and its products is covered by EU legislation [2]: Most people with gluten intolerance can include oats in their diet without experiencing adverse effects on their health. This question is the subject of ongoing study and research by scientists. However, contamination of oats with wheat, rye or barley, which can occur during harvest, transport, storage and processing, is a major problem. Therefore, the risk of contamination of products containing oats with gluten should be taken into account when it comes to the relevant information on these food products provided by food business operators. […] Oats contained in foods labeled as “gluten-free” or “very low gluten” must be specially produced, prepared and/or processed in such a way as to avoid contamination by wheat, rye, barley or their hybrids, while the content gluten in oats must not be higher than 20 mg/kg.

In 2016, research was conducted on 20 samples of oatmeal purchased in Czech stores, which dealt with the gluten content in these samples. The conclusion of the research authors was that 70% of the samples did not meet the requirements for gluten-free foods. Therefore, patients on a gluten-free diet should carefully read the labels on product packaging [3].

Food labelling

According to Regulation (EU) No. 1169/2011 of the European Parliament and of the Council on the provision of food information to consumers [4], grains containing gluten and products derived from it must be labeled and highlighted in the list of ingredients, e.g. by font or background color. This extended labeling obligation has been mandatory since December 2014 for both packaged and unpackaged (open, bulk) goods.

Attention: Cereals (or gluten) are used as additives or so-called carriers in many foods, therefore even food products that at first glance have nothing to do with grains can be problematic.

You can find more detailed information in the articles Mandatory labeling of foods containing allergens and What the label of a food product tells us .

How is the diagnosis made?

The diagnosis is made by a gastroenterologist , pediatrician or clinical immunologist . The first diagnostic step is a laboratory blood test , which detects the presence of antibodies against gluten and against tissue transglutaminase (tTG); this enzyme was described in 1997 as a celiac disease autoantigen. If these antibodies are detected in the blood, a biopsy of the small intestine follows. The diagnosis of celiac disease can only be definitively confirmed by histological findings, i.e. microscopically verified mucosal changes.

Celiac disease is a hereditary disease , which is why the doctor thoroughly asks about the occurrence of gluten intolerance in the family during the anamnestic interview. The patient’s notes about the food consumed and the subsequent symptoms can also help in the diagnosis, thanks to which the doctor can detect any connections between the reported problems and the food eaten.

Note: General information can be found in the article Food allergies : prevention , diagnosis and treatment .

How is gluten intolerance treated?

In affected people, gluten causes an immune reaction, especially in the small intestine, which strongly damages the intestinal mucosa. People suffering from celiac disease must therefore follow a strict gluten-free diet for life. If the affected person continued to consume gluten, even in minimal amounts, villous atrophy (destruction of intestinal villi) could occur, which would have serious health consequences. By following the diet, it is possible to achieve a complete restoration of previously damaged intestinal villi, and to prevent further damage. It should be remembered that even the smallest amount of gluten has very serious consequences for celiacs.

Lactose intolerance or fructose malabsorption often occurs at the same time as gluten intolerance . As soon as the condition of the intestinal mucosa improves (thanks to the fact that a person avoids gluten), lactose intolerance disappears in most cases.

Useful tips for celiacs

If you have been diagnosed with gluten intolerance, the following recommendations may help:

Avoid bread, pastries, cakes, dumplings, muesli, pasta, deep-fried foods (etc.) that have been made from gluten-containing grains.
Also be careful with some dairy products (e.g. cheese fondue, skimmed milk products or processed cheeses), industrially processed foods (e.g. soups, sauces), beer, cereal coffees and flavored teas (gluten is used as a flavor carrier in them) .
Also be careful with mold cheeses (e.g. cheese with blue mold or Roquefort).