Mark Bennett is a functionally trained Nutritional Therapist with a a private clinic near Reading in Berkshire specialising in complex chronic conditions mainly consisting of autoimmunity, gluten related disorders (coeliac disease, non coeliac gluten sensitivity), cancer, dementia and chronic fatigue. With a host of qualifications to his name, Mark is a Certified Gluten Practitioner and has a wealth of knowledge on this subject.
What is Gluten and How Can it Create Problems?
Gluten is a collective name for the proteins (prolamins and glutelins) found in all grains. The general consensus (although this simplistic view is flawed) is that the gluten contained in wheat, barley and rye is the trigger for a series of conditions called gluten related disorders (GRDs) which consist of coeliac disease (CD), non-coeliac gluten sensitivity (NCGS) and wheat allergy (WA). Gluten related disorders are fundamentally caused by the inability of the body to properly digest the gluten, typically driven by dysbiosis and genetic predisposition. Anyone with a GRD should completely eliminate gluten from the diet permanently in order to repair the damage that has been done and regain health and wellbeing.
The Specifics of Coeliac Disease
CD is autoimmune and is one of the most common lifelong disorders in North America and Europe. This condition is grossly misunderstood in the wider medical community and hence only 1 in 8 coeliacs are ever diagnosed, with it often taking more than 10 years to get a diagnosis. The classical symptoms of abdominal pain and diarrhoea occur in less than 50% of coeliacs, and a large number are totally asymptomatic. However, other common signs of CD included migraines, skin problems, depression, fertility issues, chronic fatigue, joint pain, liver and cardiovascular disease, osteoporosis, other autoimmune conditions (especially type 1 diabetes and autoimmune thyroiditis) and neurological problems. In children you typically see ‘failure to thrive’, but now the average age of diagnosis is now between 40 and 60 years old!
The truth of the matter is that undiagnosed and mismanaged coeliac disease is dangerous and can lead to the development of serious health conditions. Wheat allergy is overt in nature with symptoms developing in minutes to hours and involves a measurable IgE response. Both CD and WA are thought to affect approximately 1% of the population. Standard NHS blood tests for CD can also be very unreliable with false negatives being presented up to 70% of the time when there is only partial villous atrophy present. Cyrex offer a comprehensive combined IgA and IgG wheat and gluten peptide sensitivity panel (which includes transglutaminase 2,3 and 6 antibodies) with their Array 3. Gluten should not be removed from the diet until blood tests have been done and remember that corticosteroids and/or anti-inflammatories are likely to cause false negative results. Genetic testing for HLA DQ2 and DQ8 alleles is a very useful adjunct to the overall picture.
Non Coeliac Gluten Sensitivity
NCGS (characterised by feeling rapidly better on a gluten free diet) on the other hand is neither allergic nor autoimmune in nature, often involving a mixture of both CD and WA symptoms and is currently diagnosed by exclusion, as there are no current agreed laboratory tests. NCGS frequency is still unclear but might be as high as 6% of the population. Typical symptoms of NCGS include: IBS, weight loss, bone/joint pain, leg numbness, muscle cramps, foggy head, headaches, dermatitis and anaemia. NCGS is not associated with the existence of other autoimmune conditions and the gut lining does not express markers of inflammation or permeability (as with CD). Our precise understanding of how NCGS evolves as a condition is currently lacking, but there is a clear connection between IBS and NCGS. It is therefore likely that a subset of those presenting with IBS who have not got WA or CD may in fact have NCGS and would still benefit from a gluten free diet. This group of individuals are at risk of falling into a ‘no man’s land’ between allergists and gastroenterologists with the explanation of their condition sometimes being connected to psychosomatic triggers, rather than gluten itself.
The Importance of the Gut
The gut undertakes a plethora of functions other than simply the digestion and assimilation of foods. The gut is our first line of defence against ingested pathogens, through a very carefully controlled transport regulation process across the gut lining (involving transportation of molecules both through and between the cells). This process may, however, become compromised causing both para and transcellular hyperpermeability due to dysbiosis and the initiation of the zonulin pathway by both pathogenic bacteria and the presence of alpha gliadin in gluten. An inappropriate immune response to zonulin is connected with intestinal hyperpermeability, which means our defences are weakened and leave us more vulnerable to food antigens, toxins and pathogenic bacteria.
Although the majority of newly diagnosed coeliacs will experience substantial improvements in their symptoms within the first few weeks of cutting out gluten, research shows that between 10 and 15% of coeliacs continue to experience health problems even when following a ‘gluten free’ diet. These are called ‘non-responsive coeliacs’. Research shows that maintaining a gluten free diet (excluding the issues associated with foods that directly cross react with alpha gliadin and non dietary exposure) is very difficult to do, accounting for around 36% of this group. Gluten is omnipresent in modern day foods and cross contamination is prevalent. Anyone with a gluten related disorder needs to be very vigilant to maintain gluten freedom. It only takes one eighth of one teaspoon of flour contamination to reignite the immune response and with refractory coeliac disease (between 1 and 5% of those diagnosed with coeliac disease) there is no acceptable limit of gluten (even gluten free products).
Maintaining a Gluten Free Diet
So given the importance of adhering 100% to a gluten free diet, how can you practically monitor compliance without relying on invasive monitoring and subjective assessments? The answer is the detection of gluten immunogenic peptides (GIP) which are effectively digestive left overs from peptides of gluten, found in both stool and urine. This technology is now available as a cost effective home test kit that will provide an accurate answer within 15 minutes in the comfort of the client’s home. GlutenDetect.co.ukprovides both urine and stool test kits. The stool test is more sensitive than the urine test and will pick up any potential contamination over the past 6 days. The urine kit detects contamination over the past 24 hours. This technology is rapidly becoming a mainstay of my clinical practice, providing clients with a non-invasive, easy to use and affordable process to identify gluten contamination, hence improving health outcomes.
To go deeper into the topic of gluten and the problems that consuming it can create, you can watch the replay of our February webinar with Mark by clicking here.
If you wish to find out more about the subject of gluten related disorders, you might want to consider accessing the recordings of The Gluten Summit organised by Dr Tom O’Bryan at www.glutensummit.com as well as maybe considering becoming one of his ‘certified gluten practitioners’. Gluten Freedom by Alessio Fasano MD is also an excellent resource.