Gluten - the demon of the 21st century

глутен

Gluten (from Latin gluten-glue) is a generalized name for a group of proteins in cereals that have the function of preserving the integrity and shape of food (such as glue). They are found in wheat, rye, barley, starch, spelled, einkorn and others. They are also found in products you don't expect, such as alcoholic beverages, soy sauce, ketchup, ice cream and more.

The first interest in the effects of cereals dates back to the late 19th century. Then there are papers for celiac disease and ataxia. The next reports are after World War II, when Europe's population was in dire need. Dutch pediatrician noted that morbidity and mortality in children with celiac disease have dropped by 30% compared to pre-war statistics. His scientific work is the first to describe the effect of a grain-free diet on children's health.

In the 21st century, almost every disease is associated to some extent with gluten, which is demonized. In 2013, the FDA (American Food and Drug Administration) imposed the labeling of gluten-free products. Thus, in addition to being of medical interest, gluten-free mania is also becoming a huge commercial one.

I am not a fan of extremes. I know that gluten is harmful. I have seen with my own eyes how people recover when they exclude it from their diet. However, I also believe that fixation brings with it a psycho-emotional burden and the balance must be both in the diet and in the approach to it.

How does gluten damage tissues?

When consuming cereals from gluten releases its fraction gliadin (a complex of proline and glutamine-rich polypeptides). The interaction of gliadin with the digestive tract is a key point for an immunological inflammatory response with the formation of antibodies that damage the lining of the small intestine. Structures called "villas" are injured. This whole cascade unfolds in the disease gluten enteropathy (celiac disease). Thus, indigestion leads to symptoms such as diarrhea, gas, bloating and abdominal pain on the one hand and weight loss and micronutrient and macronutrient deficiencies on the other.

For several years, the term non-celiac gluten sensitivity has also existed, which includes a group of people in whom no specific antibodies are detected. However, they have gastrointestinal symptoms when they eat gluten-containing foods. This form of gluten intolerance is the most common, with statistics ranging from 0.5% to 13% affected by the general population.

The theory of pathological changes in the skin reveals the formation of antibodies against the enzyme tissue transglutaminase in the intestine. These antibodies cross-react with transglutaminase in the epidermis. The deposition of these antibodies in the dermis provokes the characteristic skin rash for a disease called herpetiform dermatitis (or Duhring's disease). It is characterized by the appearance of very itchy small bubbles on the papules on the limbs and body.

It is also common wheat allergy. It can be clinically manifested by anaphylactic and allergic manifestations, ranging from itching, urticaria to swelling of the lips, tongue, shortness of breath and cardiovascular collapse. Cereal allergy is the third most common cause of atopy.

How do you know if you have a gluten intolerance?

First of all, you should monitor yourself if some of the described symptoms appear after eating cereals. It is necessary to examine an enlarged blood count in the direction of anemia, vitamin deficiency, abnormal liver function. Some people also experience cross-intolerance to lactose, which should also be checked.

Tests for specific antibodies are performed when the patient conducts rich in gluten diet. Blood was drawn and tested for antibodies to tissue transglutaminase (anti-TTG) and antibodies to gliadin peptides (anti-DGP). Sometimes it is necessary to take a biopsy of the small intestinal mucosa or skin.

Treatment

Of course, the most important thing is a gluten-free diet. However, this does not only mean avoiding cereals. Patients with intolerance should make it a habit to read the labels of the foods they choose.

In case of activity of any of the diseases, therapy is required. It should be prescribed by an appropriate specialist, aimed at correcting deficits and influencing uncomfortable symptoms.

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