Gluten intolerance is emerging in research as a truly systemic allergy with some possibly catastrophic symptoms. There has been a lot of stigma associated with gluten allergy, as there seemed to be a sudden rise in people identifying themselves as gluten intolerant (presumably) since the from 2009 to 2013 gluten-free diet popularity tripled, while diagnosis of celiac disease remained constant, affecting about 0.7% of the population. This trend faced a lot of backlash, mostly on Facebook with people becoming avid anti-gluten-free proponents, bashing those who claimed to have brilliant results from going gluten free. They cited the fact that only about 1% of the population has Celiac Disease yet it seemed as if all their Facebook friends suddenly claimed to have it!

The main issue here, which is just beginning to come into clear vision in the medical research community and not even necessarily into the sights of practicing physicians, is that celiac disease is distinctly different from gluten sensitivity, which is indeed a condition. The reason why gluten sensitivity has been flying under the radar is that it doesn’t produce the gastrointestinal symptoms (villous atrophy) that Celiac Disease does nor does it produce the characteristic antibodies found in celiac disease; Gluten sensitivity can be directed at a variety of epitopes found on the wheat (or other grain), mainly gliadin, and is therefore harder to diagnose. These facts do not in any way discredit it as a genuine issue. The reason why gluten sensitivity is such a serious issue is because it shares the symptoms of Celiac Disease which are extra-intestinal. These symptoms have received little acknowledgment even within the Celiac community, and certain not in terms of gluten sensitivity, where the whole disease is often overlooked and the symptoms are not well categorized.

Estimates find that gluten sensitivity is six times as common as celiac disease: that’s about 6% of the population (almost 20 million individuals in the United States)! This means there are countless individuals that may be suffering from severe symptoms without any knowledge to the fact that they may be alleviated by a diet change which is quite simple nowadays. The issue in identification and numerical data supporting the prevalence of extra-intestinal symptoms of gluten sensitivity stems from the fact that all previous research has failed to separate Celiac disease from Gluten sensitivity, therefore there is no existing data on the prevalence of symptom’s distribution between the two. This gap will, thankfully, begin to be filled with the current rising knowledge of gluten sensitivity prevalence and significance. Another reason that there may be an under diagnosis of gluten sensitivity is the production of morphine-like gluten exorphins in gluten metabolism, which have opiate effects which may “mask” the symptoms of the intolerance, as proposed by Pruimboom and Punder. There has been insight to gravity of the situation, “as 57% of people with neurological dysfunction of unknown origin test positive for anti-gliadin antibodies.” And the neurological and psychiatric symptoms are absolutely devastating. It’s a shame that social media may have hindered the procession of research regarding gluten sensitivity and is living proof that you should always do your own research on anything claimed to be scientific found in a social media setting, especially when it concerns your own health.

The neurological symptoms of Gluten sensitivity and Celiac disease include gluten ataxia, epilepsy, peripheral neuropathy, inflammatory myopathies, myelopathies, headache, gluten encephalopathy, and white matter abnormalities. Gluten ataxia is the most thoroughly studied symptom, caused by anti-gliadin antibodies. Cerebellar dysfunction and disfigurement manifest as issues walking and involuntary movements (ataxia). The inflammation caused by the anti-gliadin antibodies is postulated to create an inflammatory environment in which antibodies to Purkinge cells, cortical neurons, and deep cerebellar nuclei brainstem and cortical neurons are generated. Studies have found that using a gluten free diet to treat gluten ataxia, as well as epilepsy, were largely successful. This carries huge implications for a condition such as epilepsy, where there are large numbers of patients that are resistant to medical treatment (physiologically) who may have not been screened for anti-gliadin bodies just based off the assumption that they couldn’t be the culprit in the patient isn’t experiencing the gastrointestinal symptoms associated with Celiac Disease.

The psychological complications carry such weight as do the neurological, with schizophrenia being an incredibly hard mental disease to treat, often due to drug resistance. Schizophrenia also carries and incredibly strong correlation to gluten sensitivity and Celiac Disease, which was identified as early as 1953. One study found that] reported 19% of a schizophrenia group and 0% of a control group were found to possess anti-gliadin antibodies. If a gluten-free diet (or ketogenic: see https://scienceandrhetoric.wordpress.com/2017/08/11/the-mystery-of-schizophrenia-lipodimics-and-the-possibility-of-treatment-via-a-ketogenic-diet/) is the key to end someone’s persistent schizophrenic symptoms, it is absolutely critical that physicians be more aware of the possible implications gluten sensitivity brings. Another major area of psychiatric disorders that may have a huge impact by awareness of its relation to gluten sensitivity is the prevalence of anxiety and depression (18.1 and 6.7 percent of the U.S. population suffers from these, respectively). Distinct biological links, of L-tryptophan and serotonin, have been identified as the etiological connection between gluten sensitivity and depression. Attention deficit hyperactive disorder and autism spectrum disorders have been proven in research to be related to gluten sensitivity, yet more research needs to be conducted before a strong case is made for an etiological relationship.

It’s clear that much research is left wanting to produce more data and to investigate the exact mechanisms which cause the correlation between gluten sensitivity and extra-intestinal symptoms. The fact that the medical community is becoming aware of the huge gap in care cause by dismissal of gluten sensitivity (which may be greatly influenced by social media and popular opinion inciting fear of ridicule amongst the medical community) is promising, as hopefully this elucidates the devastating effects of misdiagnosis, lack of diagnosis, and unidentified comorbidities have on unknowing and suffering patients. There is a need for greater awareness of how the entire body interacts and its systems interdigitate to produce symptoms that are not always clearly indicative of their origin.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641836/

http://physrev.physiology.org/content/91/1/151.long

https://www.ncbi.nlm.nih.gov/pubmed/?term=gliadin+opiate

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2547202

https://academic.oup.com/brain/article/124/5/1013/309958

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115436/

https://chriskresser.com/3-reasons-gluten-intolerance-may-be-more-serious-than-celiac-disease/

https://adaa.org/about-adaa/press-room/facts-statistics

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025969/

 

 

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