CEliachia and gluten sensitivity are two different worlds with the same protagonist. Let’s clarify the experts.
Celiac disease: it is not an allergy or food intolerance
Celiac disease involves the immune system, which reacts in an abnormal way to gluten by damaging the intestinal villi, the small structures responsible for the absorption of nutrients. This condition can manifest itself at any age and mainly affects women. It is not an allergy or food intolerance in the classic sense. According to the latest estimates, in Italy we talk about about 600,000 affected peoplebut i diagnosed are just over 240,000: means that many people they coexist unconsciously with the disease, perhaps attributing the symptoms to other disorders or by living for years with wrong diagnoses.
The symptoms of celiac disease and the difficulty of diagnosis
The best -known symptoms concern the digestive system: chronic diarrhea, swelling, abdominal pain, weight loss. But celiac disease can also occur in an atypical way – explains the Dr. Laura Mazzotta, Specialist in hygiene and preventive medicine, clinical nutrition and aesthetic medicine at the Aesthe Medical Poliambulatorio in Ferrara– iron deficiency anemia, osteoporosis, infertility, chronic tiredness, recurring canops, skin eruptions (such as herpetiform dermatitis). In the children can manifest themselves with little growth and delay in public development. It is precisely this great variety of signals that often makes diagnosis difficult. It is important to underline that the celiac disease not “Heals”: It is a permanent condition. However, it can be kept under control in a very effective way with an adequate diet, which today represents the only real therapy.
The causes of celiac disease: a mix of genetics, environment and immune system
Celiac disease has one genetic base Very precise. About 95% of celiacs have a particular genetic combination, which predisposes to the disease. However, the fact of owning these genes does not necessarily mean that celiac disease will develop. It is estimated that about 30-40% of the Italian population has this genetic predisposition, but only a minority will actually develop the disease.
This makes it clear that the gene alone is not enough. In fact, you need a triggering factor, which can be represented by the introduction of gluten into the diet, but also by events that alter the immune system or intestinal permeability. Some studies – highlights Dr. Mazzotta – showed how viral intestinal infections, use prolonged antibiotics or changes in the intestinal flora can contribute to the onset of celiac disease.
How much the immune system matters
However, the central element is the immune system, which in celiac subjects reacts in an exaggerated way in the presence of gluten. When this protein is ingested, it crosses the intestinal barrier and is “recognized” as a threat. The immune system activates one inflammatory reaction which affects i intestinal villicausing its flattening. Over time, this damage compromises the absorption of nutrients, with all the consequences that derive from it. Even the age and methods of introduction of gluten in the early years of life can play a role, As well as breastfeeding. However, there is no single causal model: celiac disease arises from a combination of genetic, immunological and environmental factors that act together in a complex way.
Diagnosis: how to recognize celiac disease and get to certainty
The first step towards diagnosis is always a clinical suspicion: the doctor, in the presence of certain persistent or recurrent symptoms, or a familiarity for the disease (parents, brothers, sisters affected), can decide to start a specific diagnostic path. The initial reference test is the blood testwhich seeks the presence of specific antibodies: in particular, the Anti-transglutaminase IgA antibodies and, in some cases, the Anti-endomisio IgA antibodies. These antibodies are produced by the immune system in response to gluten and their presence in high quantities is a strong celiac indicator. It is essential that the person follows one Gluten diet on the days preceding the examination: Starting a gluten -free diet before diagnosis can in fact distort the results. In the event that antibody levels are significantly high, especially in children, the most recent guidelines (such as European ones Espghan) allow one diagnosis without intestinal biopsy, provided that other criteria are also satisfied (like positivity to at least two tests and the presence of symptoms).
When gastroscopy is needed with duodenal biopsy
In adults, however, it is still common that the next step is gastroscopy with duodenal biopsy: during this examination, small samples of tissue of the small intestine were taken to evaluate any damage to intestinal villi under the microscope. There Presence of Vilillas atrophy (i.e. the flattening of villi) is an histological confirmation of the disease. In some cases, especially in celiac family members or in patients with very nuanced symptoms, it may be useful to perform the genetic test for HLA-DQ2 and DQ8. This examination is not diagnostic, but can help exclude the disease: If the test is negative, celiac disease is practically impossible. If, on the other hand, it is positive, confirms the genetic predisposition, but not the disease itself.
Celiac disease and gluten sensitivity: two different worlds, same protagonist
In recent years, more and more people say they feel better by eliminating gluten from their diet, although not celiacs. This phenomenon led to the growing diffusion of the term “non -celiac gluten sensitivity” (In English Non-Celiac Gluten Sensititivity-NCGS), a condition that, while sharing some symptoms with celiac disease, is very different for origin, diagnosis and treatment. Celiac disease, as we have seen, is a genetic -based autoimmune disease. The ingestion of gluten causes an immune reaction that damages the intestinal mucosa, leading to chronic malabsorption. It is diagnosed through specific blood tests (anti-transglutaminase, anti-endomisio antibodies) and confirmed-in most cases-by an intestinal biopsy showing villi damage.
There Gluten sensitivity, on the other hand, is not an autoimmune disease, nor an allergy, nor a condition that causes permanent damage to the intestine. It is rather an individual reaction to the intake of gluten or other components present in cereals, which causes symptoms similar to those of celiac disease – abdominal swelling, pain, tiredness, headache, difficulty concentration – but without a defined immunological basis and without visible alterations of the intestinal mucosa.
In the list of chronic disabled pathologies
In the last 30 years the incidence of celiac disease and sensitivity to gluten has undergone a strong surge. The significant increase in cases of celiac disease diagnosis pushed the Ministry of Health in 2017 to introduce it to the list of “chronic disabling pathologies”, while previously it was classified as “rare pathology”. Celiac disease has a prevalence in the Italian population equal to 1% while gluten sensitivity is diagnosed with decidedly higher value, between 4 and 6%.
The origin of gluten sensitivity
Since the 1960s, the diet has changed drastically both in the quality and in the quantity of foods we eat- adds the Dr. Alessandra OCANutritionist and pharmacist biologist at the Aesthe Medical Poliambulatorio in Ferrara. Gliadine and glutenal wheat proteins are regardless considered toxins by the human immune system, which for millennia by recognizing them as such, has implemented enzymatic and immune responses to inactivate them.
Until the first years of the last post -war period, the ingestion of these proteins was however limited and above all it happened by original native cereals, there was in fact a condition of supercharging or genetic manipulation.
The human biological system takes many years to analyze the biological changes it is undergoing, and make evolutionary changes. It is therefore understandable as in 50 years it is not possible to have become tolerant of the new types of genetically modified and constantly evolving wheat.
Why then are we not all celiac or gluten sensitivity?
Each of us has a different genetic structure, derived from evolution, which modulates this intolerance, diversifying the intensity of the symptoms from subject to subject. As reported by the data of the Superior Health Institute, 500 thousand people live with the symptoms of gluten sensitivity without realizing it.
What are the consequences of lasting a condition of gluten sensitivity over time?
The continuous contact of the intestinal wall with gluten proteins, gliadine and glutenin, causes a state of chronic silent inflammation- highlights Dr. Oca-chronic because it is continuous over time, and silent because it is silent, from her debut it does not manifest itself with recognizable symptoms, therefore we can have it and not knowing it. The symptoms result in known disorders, but which are only the minor evil, some of which are: pain and abdominal swelling, sleepiness and daytime tiredness, insomnia, digestive difficulties, muscle soreness. The condition of chronic silent inflammation is ascertained as the cause of the onset of metabolic and neurodegenerative diseases.
How to reduce gluten sensitivity
The first question that often ask me when I explain what gluten sensitivity is “but then I have to eat gluten -free?”. The answer is “we have to reduce it!”. The best thing, it is more natural to do, especially for those who present an important symptomatology, is Base on a diet rich in cereals naturally gluten -free such as oats, amaranth, quinoa, mile, buckwheat, corn, rice, and their flour.
For those with a lighter symptoms, it is also possible to introduce other cereals that contain little gluten and original types, such as spelled, barley, all ancient grains such as Senator Cappelli and Timilia, Kamut can also introduce in the diet.
Always read (and well) the label
Of fundamental importance- concludes the expert- pay attention to the nature of the product purchased, reading the food label well. So it is a question of changing habits and returning to a type of “original nutrition”, which respects the biological rhythms of the evolutionary cycle of man and the ambient man system.
A diet of naturally gluten -free or with a reduced intake of gluten, it brings immediate benefits visible in a short time, in terms of: greater speed in weight loss in low -calorie diets (best digestion of the food), resolution of pain and abdominal swelling, greater promptness and lucidity in daily activities, improvement of symptoms related to intestinal and autoimmune inflammatory diseases, improvement of symptoms, improvement of symptoms. allergic asthma
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