Gluten is a protein found in the grains of wheat, barley and rye. It is a protein unique in its structure which gives an elastic consistency to the dough made with the flours of these grains. This is why over the centuries, these grains containing gluten have been used so extensively in the manufacture of bread and other good pastries. The gluten-containing grains we eat today are currently domesticated and are presently hybrid versions of those that originally grew wild in the Tigris-Euphrates Valley. Probably due to famines or the ingenuity of ancient peoples, these grains have become a source of food and calories.

The nature of the toxicity of these grains is largely due to the reaction of the immune system of individuals in possession of certain genes which recognize gluten as foreign and therefore toxic. Immune system genes controlling this reaction are currently not uncommon and may be present in up to 40% of North Americans.

Gluten intolerance implies that there is an initiated immune reaction against the gluten in the food, usually detected by antibodies against a gluten subprotein called gliadin. Recently these antibodies were found in the blood, in 12% of the general American population.

So gluten intolerance involves the immune system forming antibodies or showing other evidence of an inflammatory reaction. When these reactions cause damage to the small intestine that is visible on a biopsy, it is called celiac disease (CD). A 2003 study at the University of Maryland shows that CD is present in nearly 1% of the general American population.

Although there may be no detectable symptoms of the immune system’s response to gluten, the typical symptoms developed occur when the reaction begins to damage the intestines. Symptoms resulting from malabsorption or inadequate digestion of nutrients include abdominal swelling or pain, diarrhea and/or constipation, flatulence, nausea with or without vomiting. It appears that gastric reflux into the esophagus manifested by burning in the retrosternal region may also be a symptom. Other symptoms people experience are fatigue, joint pain, mouth ulcers, bone pain, muscle cramps (tetany), osteoporosis, absence of menstruation in women, spontaneous abortions,

Nowadays, screening for gluten intolerance is actually the same as screening for CD and begins with blood tests to look for the presence of antibodies against gliadin, the toxic subfraction of gluten in wheat, or presence of anti-endomysial antibodies which are produced against an enzyme called transglutaminase present in the intestine and other parts of the body. Until recently, it was assumed that nearly all patients with clinically significant gluten sensitivity had these antibodies detectable in their blood. Some researchers have been saying since 2006 that this is not true. In a study from the University of Tampere in Finland and titled: “Celiac disease without serum anti-endomysial antibodies: clinical features and antibody deposits in the intestine “, researchers report detecting these antibodies directly in the lining of the small intestine even though they were absent in the blood.

The common diagnosis of CD ultimately relies on intestinal biopsy to confirm villous atrophy of the small intestine. In a study also carried out at the University of Tampere in Finland in 2001 and entitled: ” Celiac disease without villous atrophy: call for the revision of the criteria “, researchers believe that the medical standard requiring the presence of villous atrophy for diagnosis of gluten intolerance should be reviewed.

Other studies carried out during the last decade lead certain researchers to consider gluten intolerance from a new angle. These researchers are indeed talking about a new concept, that of gluten sensitivity manifesting across a whole spectrum or range of intestinal damage with, at one end of the spectrum, mild intestinal damage and at the other end of the spectrum , severe damage i.e. intestinal villous atrophy.  

It will be necessary to wait until March 2011 to obtain confirmation of this theory in the form of a study study carried out at the University of Maryland and authored by Dr. Fasano, an expert and world-renowned leader in the field of celiac disease research. This new study, which should achieve consensus within the medical community, demonstrates that gluten sensitivity without MC does indeed exist and affects approximately 6% of the North American population. Gluten sensitivity, defined by Dr. Fasano as a different condition from CD, often causes the same symptoms but cannot be screened and diagnosed with the same tools. The next step will therefore be to create blood tests capable of easily detecting gluten sensitivity. Dr. Fasano anticipates that such tests will be available within a few years.

It is therefore now proven that gluten intolerance encompasses celiac disease and is not limited to this disease.

What conditions or illnesses suggest gluten intolerance?