What Is Gluten?
Gluten is a protein found in wheat, barley and rye. Apart from food, it is also found in medicines, vitamins and supplements.
What Is Celiac Disease?
Celiac disease is a condition in which your immune system attacks your own tissues when you eat gluten. This damage can damage the cells in your small intestine, which can prevent your body from absorbing nutrients from food. Celiac disease is a genetic autoimmune disease that primarily affects the intestines. It affects about 1% of the population. It can develop at any age.
It can cause a variety of symptoms. Some of these include abdominal pain, diarrhea, bloating, fatigue, weakness, anemia, headaches, joint and bone pain, neuropathy, swelling, edema, brain fog, constipation, weight loss or weight gain, anxiety, depression, and delayed puberty.
In patients with celiac disease, neurological involvement can be the only clinical manifestation of the disease. Diagnosis requires a detailed physical examination, a complete history, and measurement of antibody levels in blood tests (anti-tissue transglutaminase antibodies IgG/IgA, total IgA, anti-endomysial antibodies IgA, anti-deamine gliadin antibodies IgG/IgA, duodenal and small bowel biopsies with endoscopy).
Celiac disease is associated with many other autoimmune diseases, such as type 1 diabetes, autoimmune thyroiditis, and dermatitis herpetiformis.
Celiac disease is associated with nutritional disorders such as vitamin D deficiency and iron deficiency, anemia, or bone mineralization disorders. The only current treatment is a strict gluten-free diet for life. That’s why it’s important to confirm the diagnosis.
Starting a gluten-free diet before diagnosis can lead to negative antibodies, which can prevent the diagnosis from being made. It is important to start a gluten-free diet after the diagnostic investigation is complete.
What Is Non Celiac Gluten Sensitivity?
Non-celiac gluten sensitivity (NCGS) is a syndrome characterized by the occurrence of intestinal and extraintestinal symptoms when gluten-containing foods are consumed in people without celiac disease or wheat allergy.
It is different from celiac disease, anti-transglutaminase antibodies and endomysial antibodies are negative. The intestinal mucosa is normal or has very mild changes.
In other words, in NCGS, unlike celiac disease, there is no damage to the small intestine. Symptoms typically start shortly after gluten consumption, improve when gluten is removed, and return within hours or days when gluten is reintroduced.
The classic clinical picture is a combination of symptoms similar to irritable bowel syndrome (IBS), such as abdominal pain, bloating, and diarrhea, or a change in bowel habits with alternating constipation and diarrhea. Systemic symptoms have also been reported.
In most cases, it is characterized by vague symptoms such as brain fog, headache, fatigue, joint and muscle pain, and numbness in the arms and legs. More specific complaints such as dermatitis (eczema, skin rash), depression, neurological symptoms, and anemia have also been reported.
What Are The Complaints That May Occur With Gluten Sensitivity Without Celiac Disease?
- Abdominal pain
- Weight loss
- Pain in bones and joints
- Contracture of muscles
- Numbness in hands and feet
- Chronic fatigue
- Attention disorders
- Chronic ulcerative stomatitis
Non-celiac gluten sensitivity (NCGS) is a condition that is thought to be related to the immune system due to its similarities to celiac disease. It is estimated to affect about 5% of the population, which is more common than celiac disease (1%). Selective activation of natural immunity can trigger the inflammatory response in NCGS. It is not clear whether gliadin is the main culprit in the initiation of the autoimmune event. Other components of wheat (such as amylase-trypsin inhibitors, fermentable oligo-di-monosaccharides, polyols (FODMAPs)) may be effective. It is also likely that autoimmune diseases can be seen in patients with NCGS.
The most frequently reported autoimmune disease associated with NCGS is Hashimoto’s thyroiditis. Other diseases include psoriasis (psoriasis), type 1 diabetes, mixed connective tissue disease, and ankylosing spondylitis.
Many studies have explained the link between the consumption of gluten-containing foods and the onset of neurological and psychiatric disorders or symptoms such as ataxia, peripheral neuropathy, schizophrenia, autism, depression, anxiety, and hallucinations.
Many NCGS patients complain of chronic muscle pain, joint pain, numbness in the legs, fatigue, and headaches. These patients may have undiagnosed fibromyalgia syndrome.
Clinical symptom improvement has been observed in some patients with fibromyalgia who follow a gluten-free diet. Many patients with irritable bowel syndrome (IBS) believe that certain foods are more sensitive to them. Wheat is often one of these foods. In addition, certain symptoms of NCGS overlap with IBS. For this reason, many patients tend to remove wheat from their diet on their own, even without medical advice.
It has been thought that gluten-free diet will improve the symptoms of IBS and clinical studies have been planned. However, is gluten really responsible for these symptoms? This is not clear. Fermentable oligo-di-monosaccharides, polyols (FODMAPs) in wheat are considered to be triggering factors for IBS.
Their restriction has been shown to improve the symptoms of irritable bowel syndrome by 74%.
Anaemia, osteopenia and folate deficiency have been reported in non-celiac gluten sensitivity. These patients may have lower calcium, changes in macro and micronutrients due to dietary restrictions.
There may be inadequate intake due to lower consumption of carbohydrates, protein, fibre and polyunsaturated fatty acids and avoidance of fruit, vegetables, milk and snack and spicy foods. Since there is little or no inflammation in the intestinal mucosa in non-celiac gluten sensitivity, malabsorption/malabsorption may not be associated with nutrient deficiency in these patients.
The gluten-free diet itself with dietary changes may also cause an imbalance in macronutrients.
Non Celiac Gluten Sensitivity;
- Although it is a different condition from celiac disease, some symptoms are similar
- Fatigue, stomach pains, muscle cramps, numbness in the legs
- Research on gluten sensitivity is still ongoing.
- If it is thought that there may be gluten sensitivity, it is necessary to observe whether the complaints improve by eating gluten-free for a while. However, of course, if there is a suspicion of celiac disease, research on celiac disease should be done first. A differential diagnosis should be made with the necessary examinations to make sure that the complaints are not caused by another cause.
Who Can Benefit from a Gluten-Free Diet and How Long Should They Stay on the Diet to Decide if They Are Benefiting?
It is difficult to predict which patients will benefit from a gluten-free diet. However, it is worth trying if you are still struggling despite all the research and recommended treatments and you think you can stick to the diet.
The duration of this diet is also unclear. In case-based reports in some chronic painful autoimmune diseases, it has been reported that this period varies from 3 months to 1 year. In other words, while some patients find relief after 3 months of a strict gluten-free diet, this period may last up to a year for some patients.
Should Fibromyalgia Patients Go Gluten-Free?
Gastrointestinal symptoms are common in most fibromyalgia patients, whether they have celiac disease or non-celiac gluten sensitivity. There is a strong association between fibromyalgia and irritable bowel syndrome.
There is suspicion that there may be gluten sensitivity in patients with irritable bowel syndrome, and it has been shown that celiac disease is more common in these patients than in the general population.
Should Every Fibromyalgia Patient Be Screened for Celiac Disease or Non-Celiac Gluten Sensitivity?
It is important to question the gastrointestinal system in patients with fibromyalgia. However, the scientific evidence on whether every patient should be screened for celiac disease is conflicting. There is also the opinion that it is not worth the effort. It should be investigated if there are other findings that suggest gastrointestinal disease.
I am a physician who has learned how important nutrition is by experiencing it myself. About four years ago, I started a yoga instructor course that I had dreamed of for over ten years.
I had been suffering from stomach pain for many years, and I had periods of constipation and diarrhea. I was a bread lover, and pastries and desserts, especially syrupy desserts, were essential in my life. During my yoga instructor training, there was a lot of talk about the importance of nutrition and harmful foods.
Even though you know the importance of nutrition, you plug your ears when you are told to give up things you think are indispensable. I did the same at that time and refused to change my diet, saying, “I can’t live without bread and sweets!”
While continuing to practice yoga regularly, I also realized that I could control my will more. This is one of the benefits of regular exercise. In the meantime, I continued to observe myself and read about nutrition.
I had numbness in my hands and feet, which was getting more and more annoying. I was constantly eating bread to suppress my pain because I had stomach pain. I had constipation and I was eating çiğ köfte to solve the constipation problem, and then I had diarrhea for a few days.
I had blood tests and EMG examinations to find out the cause of my numbness. I was very surprised when my EMG examination came back completely normal, because I really woke up from my hand and foot numbness every night.
When I did high-intensity exercise other than yoga, my numbness was much worse and I felt incredibly swollen. In the meantime, I had joined a WhatsApp group of doctors who were also researching nutrition, and I was bombarded with information.
Everyone had their own story about nutrition. After about a year, I had finally convinced myself to try a gluten-free diet. Finally, I had started eating gluten-free and avoiding packaged foods.
Within two weeks, I had gotten rid of all my hand and foot numbness. I was incredibly energetic, I didn’t feel tired, and I wasn’t swollen after intense exercise. My goal wasn’t to lose weight, but I had already lost two pounds even though I didn’t restrict what I ate.
It was probably the weight that went away because my swollen body got rid of edema. I experienced firsthand that gluten can be a cause of neuropathy. My bowel problems had completely cleared up. When I make occasional detours, I realize that my old eating habits were really unhealthy for me.
Question to ask ourselves:
Do we want to live a healthy life? Or do we want to live a life without complaints by not changing our current habits?
When we say “I don’t want to have complaints,” we are looking for a drug or treatment that will eliminate the complaint. But when I question what I can do to regain my health, I have to accept that I need to change my lifestyle.
While the first-line treatment for hypertension or diabetes is to regulate nutrition and include exercise in daily life, unfortunately, the perspective of many people with these diseases is “I’m taking my medication, so I can eat whatever I want.” A similar situation is true for chronic pain and rheumatic diseases.
Unfortunately, most of our patients continue with their daily lives without making any additions or subtractions to their activities, taking their painkillers or other medications.
However, there is a list of things that need to be done to permanently treat these diseases, such as correcting the mistakes made, adding regular exercise, and taking care of the quality and regularity of sleep.
It is up to us to protect our health and regain it if we are sick. Let us move towards the days when we will listen to our body and realize what it needs and create the necessary environment to provide it.