Gluten intolerance: signs, what to do?

Gluten intolerance

What are the signs of gluten intolerance? What are the alternatives when it should be avoided and the consequences in the body?

Photo Karolina Grabowska in Pexels

The point with Dr. Evelyne Chartier, general practitioner and nutritionist, and Florence Thorez, dietitian nutritionist.

Definition: what is celiac disease?

Also known as celiac disease, "gluten intolerance is a chronic autoimmune intestinal disease linked to the ingestion of gluten," explains Dr. Evelyne Chartier, a general practitioner and nutritionist, member of the Union of Liberal Doctors.

In detail, people who suffer from it are intolerant to gliadin, a protein contained in gluten.

Note that gluten is present in certain cereals, such as wheat, barley, oats or rye.

Intolerance, allergy or Crohn's disease?

Be careful not to confuse intolerance with allergy: "Allergy to wheat or gluten is more rare, but it causes an immediate reaction.

Like an edema of Quincke" In addition, "along with gluten intolerance and gluten allergy, hypersensitivity to gluten is described in a large number of people who, in principle, try to be non-celiac and non-allergic and who say they feel better if they stop eating gluten.

It would be a hypersensitivity due to intestinal hyperpermeability," says Dr. Evelyne Chartier.

In the case of Crohn's disease, things are more complex. "When you have this disease, you can go through three phases: a relapse phase / one in which the patient gets better / a remission phase.

Gluten exclusion may have a beneficial effect on the first two phases, but this is not certain. What is certain is that during these phases the patient is offered a diet free of residues and lactose," emphasizes Florence Thorez, dietitian nutritionist, member of the AFDN.

Foods containing gluten

Gluten is found in some cereals. There is a way to remember the 5 main cereals that contain it, thanks to the word SABOT :

S: Rye

A: Oats

B : Wheat (wheat, kamut, spelt...)

Or: Barley

T: Triticale (hybrid cereal of rye and wheat).

Gluten is found in most flours and therefore in foods prepared with flour:

• the pasta,
• bakery products (bread, sandwich breads, cookies, cakes, rolls, pancakes, waffles, rolls, doughnuts, etc.)
• most breakfast cereals,
• malted beers,
• quantity of prepared dishes (pizzas, quiches, breaded meat and fish...)
• sauces, soups and desserts joined with wheat flour,
• certain condiments and seasonings.

Gluten can also be found in other foods: sausages, pâtés, sausages, soy sauces, surimi, powdered sugar, garlic powder, certain natural and artificial flavours based on the aroma of malt, etc.

Risk Factors

Specifically, gluten attacks and destroys the villi of the duodenum, the inner lining of the small intestine, thus preventing the correct assimilation of food. This causes chronic inflammation of the intestine, which leads to malabsorption of many nutrients.

"It is estimated that in Europe, the United States, North Africa, the Middle East and India, coeliac disease affects between 0.7 and 2% of the population.

The frequency is probably underestimated due to the existence of forms with few symptoms," says the specialist. Intolerance to gluten is two to three times more frequent in women than in men.

Celiac disease can occur at any age. It can appear in young children from 6 months to 2 years after the introduction of cereals in their diet, as well as in adults between 20 and 40 years old.

The presence of certain diseases in the family is a risk factor, such as diabetes, autoimmune diseases (such as trisomy 21) and psoriasis.

Finally, "the close family of people with gluten intolerance develops the disease more frequently: 10% risk in first-degree relatives, i.e., father, mother, siblings and possible children".

Symptoms: How does gluten intolerance manifest itself?

Gluten intolerance is complicated to diagnose because its symptoms are very diverse and not specifically related to this disease. In addition, symptoms differ whether the disease occurs in children or adults.

In infants and young children, symptoms only appear after the introduction of gluten-containing flours with diarrhea classically described as fat, fatigue and abdominal pain.

These manifestations may be more or less important, they may follow one another, or sometimes they may not occur for several weeks.

The diagnosis then becomes more difficult. A break in the growth curve responsible for stunting and short stature can in this case alert parents and the physician.

Delayed puberty may also occur in older children. Good psychomotor development can also be affected by gluten intolerance.

The presence of a slightly larger abdomen associated with this broken curve may also be indicative of gluten intolerance.

In adults, on the other hand, it is frequent to find forms without frank symptoms, or even completely asymptomatic, but in the typical picture there are intestinal manifestations (abdominal pain, weight loss, diarrhea, swelling and fatigue).

Celiac disease is also manifested by other possible manifestations such as "weight loss, fatigue and irritability, pallor in case of anemia, depression, bone and joint pain.

Muscle cramps, infertility or absence of menstruation, numbness or neuropathic pain in the extremities, skin rashes, mouth sores or canker sores," lists Evelyne Chartier.

Symptoms such as epilepsy, bone pain, osteoporosis, hepatitis, thyroiditis and deficiencies of vitamins (A, D, E, B12, K), iron, folate, calcium, magnesium can be found.

"In adults, the disease is diagnosed on average more than ten years after the appearance of the first symptoms," adds our specialist.

Diagnosis: how to detect gluten intolerance?

"To diagnose gluten intolerance, a blood test must be performed to check for the presence of disease-specific antibodies (antitransglutaminase) in the blood.

If positive, an endoscopy is performed with samples (biopsies) from the upper part of the small intestine (duodenum). Finally, observe a remission of symptoms after following a gluten-free diet," explains Evelyne Chartier.

Indeed, the effectiveness of the gluten-free diet in improving and disappearing symptoms and restoring intestinal villi (between 12 and 18 months) is an element that confirms the diagnosis of gluten intolerance.

In addition, "some celiac patients have negative antibodies and, in cases of strong suspicion, an endoscopy may be necessary to make the diagnosis," he says.

Gluten-free diet: what to eat?

Celiac patients must "eliminate all foods based on wheat (wheat) and its derivatives (spelt and kamut), but also foods based on barley, oats and rye such as bread, pasta, cake batter, cookies, semolina, ravioli, couscous, breadcrumbs, fritters, puff pastry.

Evelyne Chartier recommends "reading labels because gluten is present in products that we don't necessarily think about, such as chocolate bars, ice cream, sauces, instant soups, preserves, ready meals, delicatessen, beers".

Gluten-free recipes

Treatments

The treatment is based on the total and definitive elimination of the foods that contain gluten.

The treatment is based on the total and definitive elimination of the foods that contain gluten. Many food products, especially those intended for infants, are now available without gluten.

It is also possible to "take probiotics or dietary supplements that are anti-inflammatory for the intestinal wall," adds Evelyne Chartier. There are no other treatments for celiac disease.

Effects on the body

Gluten intolerance can develop in more severe forms if a strict gluten-free diet is not followed.

The most common complications are the consequences of malabsorption of nutrients in the intestine, such as proteins, vitamins, minerals (like iron) and fats.

Because nutrients are poorly absorbed in the intestine, a form of malnutrition can occur that causes fatigue, muscle weakness, weight loss and dietary deficiencies.

In addition, when iron is poorly absorbed, the body's reserves are diminished, causing anemia. This leads to great fatigue, weight loss, shortness of breath, lack of appetite, pallor, tachycardia...

Lactose intolerance, arthritis and urinary lithiasis may occur.

Finally, celiac disease can promote the development of osteoporosis. It is a disease that weakens bones by reducing their resistance, thus exposing those affected to the risk of fracture.

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