Gluten Sensitivity vs Celiac Disease
The Gluten File



What is Gluten Sensitivity/Intolerance/Celiac Disease? 

A Video Presentation by Dr. Peter Osborne


Dr. Peter Green discusses Gluten Sensitivity... YouTube presentation

Check out Part 3, between the 4:30 - 8:00 minute marks

 

 Editorial: The Immunology of Immediate and Delayed Hypersensitivity Reaction to Gluten

                  A. Vojdani, T. O'Bryan, and G.H. Kellermann

 

               The immunology of gluten sensitivity beyond the intestinal tract
                   Aristo Vojdani, Ph.D., M.T.1*; Thomas O’Bryan, D.C., C.C.N., D.A.C.B.N.2

 


    

A DEFINITION!

From:
Neurologic Complications of Celiac Disease
Journal of Clinical Neuromuscular Disease. 5(3):129-137, March 2004.
Chin, Russell L MD *; Latov, Norman MD, PHD *; Green, Peter H. R MD +; Brannagan, Thomas H III MD *; Alaedini, Armin PHD *; Sander, Howard W MD *

"The term "celiac disease" implies a disease characterized by an abnormal small intestinal biopsy with either clinical or histologic improvement following adherence to gluten-free diet.8 These patients may or may not have serologic evidence of the disease.

The term "gluten sensitivity" has been used to describe 2 groups of patients: 1) those with gastrointestinal symptoms responsive to gluten withdrawal9,10 and 2) those with positive antigliadin, antiendomysial, or antitransglutaminase antibodies.11 The presence of HLA DQ2 or DQ8 has been used to suggest that "gluten sensitivity" is related to CD.12 "

 

And another!

From:
The Neurology of Gluten Sensitivity: Science vs. Conviction 
Hadjivassiliou and Grunewald

The term 'coeliac disease' should now be restricted to describe gluten sensitive enteropathy. The term gluten sensitivity describes a spectrum of disease that have in common an immune response to the ingestion of gluten, but with diverse manifestations such as an enteropathy (coeliac disease), dermatopathy (dermatitis herpetiformis) and neurological disorders (e.g. Gluten ataxia). Not suprisingly, the common aetiological trigger (gluten) means that these diseases overlap considerably. For example, the vast majority of patients with dermatitits herpetiformis also have an enteropathy, as do a third of patients with gluten ataxia (Hadjivassiliou et al. 2003b).

ALSO from same article:

"Neurologic manifestations of gluten sensitivity are a scientific fact, not a theological issue. Whilst the debate continues, we owe it to our patients to screen them effectively for gluten sensitivity with the simple widely available antigliadin antibody test so that we do not in the meantime deprive them of a harmless but potentially effective treatment in the form of a gluten-free diet."

 

 

By definition, a diagnosis of Celiac Disease requires biopsy evidence of intestinal villous atrophy.

Gluten sensitivity refers to those who have an adverse immunological response to dietary gluten, but may not show biopsy evidence of villous atrophy.

Both Celiac Disease and Gluten Sensitivity involve an IgA and/or IgG immune system response to dietary gluten. This differs from classic allergy, which involves an IgE response. In Celiac Disease, autoantibodies (anti-tTG, anti-endomysial)are also involved that attack the intestinal villi.

Might there be other gluten related autoantibodies that attack other organs, even in the absense of Celiac Disease? Research is looking~

A gluten free diet is usually only recommended to those who meet the criteria for a Celiac Disease diagnosis. Unfortunately, that leaves many Gluten Sensitive people suffering unneccesarily with very serious symptoms that might resolve on a gluten free diet... if they only knew... and puts them at risk for further complications. 

There are MANY other doctors I could include on this list. As mentioned elsewhere, most DAN! doctors, or doctors practicing orthomolecular or environmental medicine will understand gluten sensitivity can cause serious problems and support a gluten free diet for their gluten sensitive patients.

As of 2008, some of the more prominent celiac research experts, including Dr. Peter Green and Dr. Alessio Fasano are publicly acknowledging gluten sensitivity without celiac disease exists, and that these patients may benefit from a gluten free diet. 

I'm personally so grateful that the Internet provided me access to the research of Dr. Kenneth Fine and Dr. Marios Hadjivassiliou  back in the year 2000 when my family was suffering from a cryptic gluten sensitivity. Our only clue was an isolated IgG antigliadin antibody in both of my daughters.  Despite being told by our local doctors that a gluten free diet was not necessary unless there was biopsy proof of celiac disease, we moved ahead anyway based on the research of these two men.  We haven't looked back.

 

Dr. Kenneth Fine

"Early Diagnosis Of Gluten Sensitivity: Before the Villi are Gone." by Dr. Kenneth Fine

Frequently Asked Questions About Gluten Sensitivity

Dr. Marios Hadjivassiliou

Gluten sensitivity as a neurological illness, M Hadjivassiliou, et al.

Gluten sensitivity: a many headed hydra by Marios Hadjivassiliou

More by Hadjivassiliou

Ron Hoggan, M.A.

Celiac Disease—Gluten Sensitivity: What’s the Difference? By Ron Hoggan

www.DangerousGrains.com

Dr. Braly

Dr. Braly's Allergy Relief, The Natural Way

Dr. Kaslow 

Gluten-brain connection

Dr. Mark Hyman

Gluten: What You Don't Know Might Kill You
http://www.ultrawellnesscenter.com/

Dr. John B Symes, DVM  aka "DogtorJ"


DogtorJ.com

Dogtor J on facebook

Dr. Scot Lewey

The Food Doc Website 

The Food Doc Journal Blog

articles

Why Doctors Frequently Miss Celiac Disease and Gluten Sensitivity

Diagnosing Celiac Disease and Gluten Sensitivity

Wheat or Gluten May Be Unrecognized or Undiagnosed Cause of Your Illness

Celiac Disease Versus Gluten Sensitivity: New Role for Genetic Testing and Fecal Antibody Testing?

Gluten Sensitivity: A Gastroenterologist's Personal Journey Down the Gluten Rabbit Hole

Gluten causes brain dysfunction and gluten free diet may be for everyone with neurological and psychiatric symptoms

Other Ezine articles by Dr. Scot Lewey

Dr. Rodney Ford

Dr Rodney Ford – The Gluten Syndrome Expert

Dr. Stephen Wangen

Dr. Stephen Wangen: The Gluten Free Doctor

Dr. Vikki Petersen
Founder of HealthNOW Medical Center
Author of The Gluten Effect
www.healthnowmedical.com
www.glutendoctors.blogspot.com

Dr. Charles Parker

CorePyschBlog by Dr. Charles Parker 

Gluten Notes: Respiration, B12, and Nutritional References

Brain and Bowel: The Gluten Mystery

New Year, New Faces, Remarkably Interesting Information: Gluten Sensitivity

Gluten Sensitivity Beacons: Head, Face and Teeth

A Gluten Sensitivity Journal: Useful Notes with Practical Suggestions

Gluten Sensitivity & Brain Problems: More References

Aphthous Ulcers/Canker Sores, Gluten Sensitivity and Unmanageable Behavior

Hard Evidence: Gluten Sensitivity and Neurologic Impairment

Gluten, Celiac, Candida, Anemia, Osteoporosis and Psychiatric Problems

Celiac Notes: Opiate Withdrawal from Gluten and Casein?

Gluten/Casein Sensitivity: Brain Function Deterioration

Why We Overlook Celiac and Gluten Sensitivity

Brain, ADD, Gluten Are Connected: Dr Tom O'Bryan's Fall Lectures

Gluten/Celiac, Migraine, & ADD/ADHD Connections 1

SPECT Imaging Notes: More On "Celiac Brain" Hypofunction

Schizophrenia and Celiac? SPECT Brain Evidence

Brain Awareness: Milk Addiction/Withdrawal is Real

Celiac Disease: Bowel and Brain Symptoms

Immunity and Chronic Fatigue: Immunosciences on the Radar for '08

Dr. David Perlmutter

Renegade Neurologist Blog 

Page 2 entries on gluten/celiac

Dr. Peter Green
Interview with the People's Pharmacy ~ discusses gluten sensitivity without villous atrophy

Dr. Peter Green discusses Gluten Sensitivity... YouTube presentation
Check out Part 3, between the 4:30 - 8:00 minute marks

Dr. Alessio Fasano 

Here are two interviews where Dr. Fasano discusses gluten sensitivity in 2008

With Tricia Thompson

With Melissa Diane Smith


Dr. Peter Osborne

Dr. Peter Osborne is both a doctor of chiropractic as well as a board certififed doctor of clinical nutrition.

Town Center Wellness

Gluten Free facebook

Gluten Free Society

ezine articles by Dr. Peter Osborne

Dr. William Davis

A cardiologist from Milwaukee, WI, who recognizes that gluten sensitivity causes wide ranging disease, including heart disease.

Heart Scan Blog  (check the index or search for the 50+ entries re: wheat)



PubMed:

Patients with noncoeliac gluten sensitivity (NCGS) can experience a range of gastrointestinal and extraintestinal symptoms. A study has now demonstrated that gluten is independently associated with depression in patients with NCGS. NCGS-associated depression might share similar pathophysiological mechanisms to other neurological manifestations observed in gluten-related disorders, such as ataxia and encephalopathy.
Coeliac disease: noncoeliac gluten sensitivity--food for thought.
PMID:24935422  July 2014

Clinical, Serologic, and Histologic Features of Gluten Sensitivity in Children.
PMID:24252792 Nov 2013

Is Gluten a Cause of Gastrointestinal Symptoms in People Without Celiac Disease?
PMID:24026574 Sept 2013
Non-celiac gluten sensitivity: the new frontier of gluten related disorders. PMID:24077239  Sept 2013

CD was defined as 'a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals'. Classical CD was defined as 'CD presenting with signs and symptoms of malabsorption. Diarrhoea, steatorrhoea, weight loss or growth failure is required.' 'Gluten-related disorders' is the suggested umbrella term for all diseases triggered by gluten and the term gluten intolerance should not to be used. Other definitions are presented in the paper.
The Oslo definitions for coeliac disease and related terms.

PMID:22345659 Jan 2013

Intestinal anti-tissue transglutaminase antibodies in potential coeliac disease.
PMID: 23199325  Jan 2013

[Intolerance of gluten--a new disease or undiagnosed celiac disease].
PMID:22830230  2012

Does gluten sensitivity in the absence of coeliac disease exist?
PMID: 23204002  Nov 2012

Non-coeliac gluten sensitivity.
PMID: 23204003 Nov 2012

Among gluten-related disorders, gluten sensitivity is an emerging entity that is characterized by a wide array of manifestations. In particular, patients complain of IBS-like symptoms and extraintestinal manifestations that occur shortly after the ingestion of gluten. Symptoms improve or disappear when gluten is withdrawn from the diet, and recur if gluten is reintroduced. Laboratory tests are usually unhelpful for diagnosis, although ~50% of patients are positive for IgG antigliadin antibodies. The natural history of gluten sensitivity is unknown; in particular, it is still to be clarified whether this disorder is permanent or transient and whether it is linked to autoimmunity. The pathogenesis of gluten sensitivity is unclear; data so far demonstrate a predominant activation of innate immune responses. Further research is necessary to establish the main clinicopathological features of gluten sensitivity, thus enabling physicians to improve their management of the increasing number of patients who are sensitive to dietary gluten.
New understanding of gluten sensitivity.
PMID:22371218   Feb 2012

The rise in gluten consumption over time has led to the increasing recognition of coeliac disease (CD) with associated complications. However, only recently has there been an appreciation that the spectrum of gluten-related disorders is greater than just CD, which may explain the growing global popularity in gluten-free products. Current literature suggests that a newly recognised clinical entity in the form of non-coeliac gluten sensitivity (NCGS) may be the most common gluten-related disorder encountered by healthcare professionals, although its exact prevalence is as yet unknown. This article will review the historical relationship between mankind and gluten as well as the progressive recognition that it is possible for gluten to have a deleterious effect on our health. To this effect we discuss the prevalence, diagnosis and complications of CD including the benefits derived from a gluten-free diet (GFD). Finally, we discuss our current understanding of NCGS, in addition to highlighting the need for further research to determine the extent, clinicopathological features and serological biomarkers to help recognise this emerging condition in clinical practice.
Emerging concepts: from coeliac disease to non-coeliac gluten sensitivity.
PMID:22954208 Sept 2012

Although osteopenia, osteoporosis, and alterations in laboratory parameters are prevalent among patients with celiac disease with mild enteropathy, they are more prevalent and severe in those with villous atrophy. The prevalence of associated conditions is similar between these groups. These results indicate that celiac disease with mild enteropathy is not mild disease, but requires treatment with a gluten-free diet.
Celiac disease with mild enteropathy is not mild disease.

PMID: 23022697  Sept 2012


Both CD and GS may present with a variety of neurologic and psychiatric co-morbidities, however, extraintestinal symptoms may be the prime presentation in those with GS. However, gluten sensitivity remains undertreated and underrecognized as a contributing factor to psychiatric and neurologic manifestiations. This review focuses on neurologic and psychiatric manifestations implicated with gluten sensitivity, reviews the emergence of gluten sensitivity distinct from celiac disease, and summarizes the potential mechanisms related to this immune reaction.
Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity.
PMID:21877216  Mar  2012

The Oslo definitions for coeliac disease and related terms. 
PMID:22345659  Feb 2012

ABSTRACT: A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals. In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide. Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010. This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns. This review will summarize our current knowledge about the three main forms of gluten reactions: allergic (wheat allergy), autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia) and possibly immune-mediated (gluten sensitivity), and also outline pathogenic, clinical and epidemiological differences and propose new nomenclature and classifications.
Spectrum of gluten-related disorders: consensus on new nomenclature and classification.
PMID: 22313950  Feb 2012

Among gluten-related disorders, gluten sensitivity is an emerging entity that is characterized by a wide array of manifestations. In particular, patients complain of IBS-like symptoms and extraintestinal manifestations that occur shortly after the ingestion of gluten. Symptoms improve or disappear when gluten is withdrawn from the diet, and recur if gluten is reintroduced. Laboratory tests are usually unhelpful for diagnosis, although ∼50% of patients are positive for IgG antigliadin antibodies.
New understanding of gluten sensitivity. 
PMID:22371218  Feb 2012

Gluten sensitivity appears to be emerging as a separate condition from celiac disease, yet no clear definition or diagnosis exists. As a result, patients with gluten sensitivity experience delayed diagnosis and continuing symptoms if they consume gluten. This emerging medical problem may involve human genetics, plant genetic modifications, gluten as a food additive, environmental toxins, hormonal influences, intestinal infections and autoimmune diseases. The treatment is similar to that for celiac disease - a gluten-free diet. The use of a gluten-free diet or an elimination diet is encouraged in assisting people to determine whether or not they are gluten sensitive. It is time to not only recognize, but to treat and further research gluten sensitivity, as unconfirmed environmental factors continue to spread this problem further into the general population.
Gluten sensitivity: problems of an emerging condition separate from celiac disease.
PMID 22149581  Feb 2012

As the gluten-free diet (GFD) gains in popularity with the general public, health practitioners are beginning to question its real health benefits. For those patients with celiac disease (CD), the GFD is considered medical nutrition therapy, as well as the only proven treatment that results in improvements in symptomatology and small bowel histology. Those with wheat allergy also benefit from the GFD, although these patients often do not need to restrict rye, barley, and oats from their diet. Gluten sensitivity is a controversial subject, where patients who have neither CD nor wheat allergy have varying degrees of symptomatic improvement on the GFD. Conditions in this category include dermatitis herpetiformis (DH), irritable bowel syndrome (IBS), and neurologic diseases such as gluten-sensitive ataxia and autism. It is important for patients and healthcare practitioners to understand the differences between these conditions, even though they may all respond to a GFD.
Celiac disease, wheat allergy, and gluten sensitivity: when gluten free is not a fad.
PMID 22237879  Jan 2012

Recent studies support the existence of a new condition, nonceliac gluten sensitivity, which manifests as intestinal or extraintestinal symptoms that improve or disappear after gluten withdrawal in individuals with normal small-bowel mucosa and negative results on serum antitransglutaminase and antiendomysial antibody testing. Although the clinical value of this concept is under debate, the prevalence of nonceliac gluten sensitivity in the general population is supposed to be many times higher than that of celiac disease. The lack of an unambiguous definition of nonceliac gluten sensitivity, a major pitfall, is primarily related to the heterogeneous cause of this condition, whose symptoms are presumed to be caused by different mechanisms. If nonceliac gluten sensitivity is an etiologically heterogeneous syndrome, then management options should vary according to the predominant or concomitant underlying pathogenic pathways.
Nonceliac gluten sensitivity: sense or sensibility?  
PMID:22351716  Feb 2012

RESULTS: IgG AGA were positive in 56.4% of GS patients and in 81.2% of celiac patients, with high antibody titers in both groups. IgA AGA were detected in 7.7% of GS patients and in 75% of celiac patients, showing lower enzyme-linked immunosorbent assay activities in GS than those found in celiac disease. Only 1 of the 78 patients with GS was positive for IgG DGP-AGA (detected in 88.7% of patients with celiac disease). IgA tTGA and IgA EmA were negative in all GS patients, whereas their positivity in celiac patients was 98.7% and 95%, respectively. Patients with GS displayed a variegated clinical picture with intestinal and extraintestinal symptoms (abdominal pain, bloating, diarrhea, constipation, foggy mind, tiredness, eczema/skin rash, headache, joint/muscle pain, numbness of legs/arms, depression, and anemia) together with normal or mildly abnormal small intestinal mucosa.CONCLUSIONS: The serological pattern of GS is characterized by IgG AGA positivity in more than half of cases associated to IgA AGA in a few patients, but without EmA, tTGA, and DGP-AGA, which are the specific markers of celiac disease.
Serological Tests in Gluten Sensitivity (Nonceliac Gluten Intolerance).
PMID 22138844  Dec 2011

Symptoms and intestinal anti-TG2 antibodies respond to a gluten free-diet. The detection of intestinal anti-TG2 antibodies by the phage-antibody libraries has an important diagnostic and therapeutic impact for the subjects with gluten-dependent intestinal or extraintestinal symptoms.
Cryptic genetic gluten intolerance revealed by intestinal antitransglutaminase antibodies and response to gluten-free diet.
PMID:21471568  April 2011

Coeliac disease (CD) is a systemic immune-mediated disorder elicited by gluten in genetically susceptible individuals. The common factor for all patients with CD is the presence of a variable combination of gluten-dependent clinical manifestations, specific autoantibodies (anti-tissue transglutaminase/anti-endomysium), HLA-DQ2 and/or DQ8 haplotypes and different degrees of enteropathy. Recently gluten sensitivity has received much interest, although the limits and possible overlap between gluten sensitivity and CD remain poorly defined. At present, a number of morphological, functional and immunological disorders that are lacking one or more of the key CD criteria (enteropathy, associated HLA haplotypes and presence of anti-transglutaminase 2 antibodies) but respond to gluten exclusion are included under the umbrella of gluten sensitivity. The possible immunological mechanisms underlying these conditions are discussed. Emphasis is given to specific autoantibodies as markers of the coeliac spectrum, and to the hypothesis that innate epithelial stress can exist independently from adaptive intestinal immunity in gluten sensitivity.
Coeliac disease and gluten sensitivity.
PMID: 21481018  April 2011


Testing for gluten-related disorders in clinical practice: The role of serology in managing the spectrum of gluten sensitivity.

PMID:21523259  April 2011


CONCLUSIONS:Non-coeliac gluten intolerance does exist. Future studies need to identify issues of the dose of gluten needed and mechanisms of action.
Does gluten cause gastrointestinal symptoms in subjects without coeliac disease? 
PMID:21443726  April 2011


CONCLUSIONS:
This study shows that the two gluten-associated disorders, CD and GS, are different clinical entities, and it contributes to the characterization of GS as a condition associated with prevalent gluten-induced activation of innate, rather than adaptive, immune responses in the absence of detectable changes in mucosal barrier function.
Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity.
PMID:21392369  Mar 2011

Background: The aim of this study was to determine the occurrence of gluten sensitivity (GS) in a group of allergic patients and to assess the efficacy of a gluten-free diet (GFD) on the improvement of the symptomatology in those who were diagnosed with GS. Methods: 262 unrelated allergic patients with gastrointestinal symptoms of obscure origin were tested for GS condition by biopsy. All patients were also genotyped for the typical celiac DQ2 and DQ8 molecules and investigated for several hematological parameters such as antigliadin and antiendomysial antibodies. Patients displaying mucosal lesions were invited to follow a GFD. Results: Seventy-seven of the 262 allergic patients were positive to mucosal lesions, but negative to the antiAGA, antiEMA and to DQ2 and DQ8 molecules. We found, instead, a prevalence of the DQA1*05 allele, whereas anemia of inflammatory origin represented the predominant complaint in our subjects. The positive patients, who, after the GS diagnosis, followed a GFD, exhibited control of symptoms as well as stabilization of the hematological parameters even if allergic manifestations were not abated. Conclusions: A nonceliac gluten-sensitive enteropathy (NCGSE) commonly occurs in allergic patients. Based on the high prevalence of NCGSE in allergy, it is recommended that biopsy should be part of the routine investigation of allergic disease to offer the benefits of treatment with a GFD to the patients.
Occurrence of Nonceliac Gluten Sensitivity in Patients with Allergic Disease.
PMID: 21346369   Feb 2011