Gluten Intolerance Versus Celiac Disease
People often assume gluten intolerance and celiac disease are one and the same. While celiac disease is a gluten sensitivity, it is possible to exhibit clear signs of a gluten sensitivity without testing positive for celiac sprue disease. One accurate way to look at it is to view celiac disease as a severe and more clearly diagnosed subset of a gluten intolerance. Let's walk through some of the similarities and differences between gluten intolerance vs celiac disease.
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Brain And Neurological Problems Affect Almost Half Of Celiacs Even With A Gluten Free Diet
There is reasonable evidence of neurological problems in Celiac disease (CD) even those well treated on a gluten-free diet should undergo periodic neurological screening. Peripheral neuropathy is found in almost half of people with CD. Previously, neurological complications in Celiac disease were reported to be as high as 36% or more than a third. Some unexplained neurological problems are present but not recognized by the patient or their doctor in many patients and some have several problems. Unfortunately, since brain imaging is not routinely done or recommended in those who are newly diagnosed we don't really know how high these numbers may be really be. More staggering is the fact that we are still learning about people who fail to meet diagnostic criteria for Celiac disease but are being found to have gluten related neurological problems that respond to a gluten-free diet.
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Celiac Oat Intolerance: The Molecular Basis
Celiac disease is a chronic inflammatory condition caused by an inappropriate immune response of intestinal T-cells reactive to gluten proteins of wheat and similar prolamin proteins of related cereals [1]. The majority of the peptides recognized by intestinal T-cells are more immunogenic following deamidation by tissue transglutaminase (TG2). These peptides are invariably presented by HLA-DQ2 or -DQ8, the same HLA molecules that confer genetic predisposition to celiac disease [1]. Gluten-reactive intestinal T-cells can be isolated from virtually all patients with celiac disease but not from normal individuals. The disease goes into remission when harmful cereals are avoided. A gluten-free diet is thus the standard treatment of this disorder.
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Oats Intolerance In Celiac
Most patients with celiac disease can eliminate their symptoms—at a price: life-long adherence to a gluten-free diet. This means no wheat, rye, barley, and, until recently, no oats. Then some recent studies suggested that oats did not cause the intestinal inflammation characteristic of the disease, and thus oats are now often included in the celiac disease diet. This is good news for patients coping with severe restrictions on what they can and must not eat, but a study by Ludvig Sollid and colleagues suggests that oats are not safe in all cases.
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Measuring Gluten Toxicity
The gluten analysis of foods has long had limitations, which have precluded food standards authorities from issuing standards for gluten-free foods based on final gluten content. The Codex Alimentarius and the Food and Drug Administration have taken steps towards such standards in which they favour the R5-enzyme-linked immunosorbent assay for gluten analysis. If this method is to be widely employed, its limitations should be recognised. Above all, it should be noted the ability of R5-enzyme-linked immunosorbent assay, and other methods, to measure gluten's toxicity toward celiac disease patients is not validated clinically. Gluten is a complex mixture of proteins and its toxicity is not fully understood. Analytical methods are a valuable tool in the definition of gluten-free foods, but they should be employed with appropriate caveats in ensuring the safety of the foods.
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