Mechanisms of gluten sensitivity not yet well known

Submitted on Fri, 04/06/2018 - 12:24
Katri Kaukinen/ Kuva: Jonne Renvall
According to professor Katri Kaukinen, there is no evidence that a gluten-free diet would have positive health effects for people who do not suffer from the coeliac disease or allergies. On the contrary, there is evidence that if patients avoid gluten, they often leave out all the grains in their diet. This can increase the risk of cardiovascular diseases.

Grains containing gluten are not suitable for all, but the reason may be other than the gluten they contain

Text: Jaakko Kinnunen
Photo: Jonne Renvall

1-2 percent of Finns suffer from the coeliac disease. Gluten is present in wheat, barley and rye, which coeliac patients do not tolerate. There is no cure for the disease, and the only treatment option is to abstain from foods containing gluten.

Researchers at the University of Tampere are studying gluten sensitivity as well as the coeliac disease. According to Katri Kaukinen, professor of internal medicine, the term gluten sensitivity is problematic because the scientific community has not yet established that gluten is the only ingredient in grains that causes the symptoms of some non-coeliac patients.

“‘Gluten sensitivity’ has been used as a term on e.g. social media from which it has spread to everyday language. There is evidence that some non-coeliac patients really get symptoms from gluten. But it has also been shown that in some patients the symptoms are caused by the other compounds in grain, such as fructan,” Kaukinen says.

Kaukinen herself would prefer the expression ‘sensitivity to grains containing gluten’, because ‘gluten sensitivity’ connotes that gluten is the only cause for non-coeliac symptoms.

Grain allergy, coeliac disease and
gluten sensitivity are different conditions

Some people suffer from grain allergies. In their case, the symptoms are caused by proteins, not by the gluten in the grain. Grain allergy is most commonly found in children.

Unlike coeliac disease and grain allergy, the mechanisms of gluten sensitivity are not yet known.

“The symptoms involve a lot of questions: Is it a chronic disease? How strict must the diet be? Is the disease dangerous if left untreated?” Kaukinen lists issues related to gluten sensitivity.

An extra challenge to research is that the symptoms of the disease do not differ from those in coeliac disease and grain allergy. If a patient seeks help because of abdominal and intestinal tract problems, coeliac disease and grain allergy must be ruled out first.

“At this stage, only educated guesses can be made about the prevalence of gluten sensitivity. In fact, I would say that about 0.5 - 8 percent of the population is affected by gluten sensitivity. I want to emphasise that this is my own educated guess,” Kaukinen points out.

Do not change
your diet just in case

What should patients do if they begin to suspect that grains are causing their functional stomach problems? Kaukinen’s first tip is that they should not start a particular diet on their own, as this may make it more difficult to diagnose the disease.

“They should not avoid grains before first talking to their doctor, because the first step is usually to test for coeliac antibodies in the blood. If the result is positive, a biopsy of the small intestine is taken endoscopically,” Kaukinen explains.

When coealic disease has been ruled out, the patient will be further examined for grain allergy. If there is still no clear reason for the symptoms, the possibility of gluten sensitivity may be considered.

However, there is no simple and easy test to diagnose the disease. At present, gluten sensitivity may be detected through oral food challenges, which are more difficult to do.

Gluten-free has
become a dietary fad

Many gastrointestinal problems are currently blamed on gluten. Kaukinen has noticed that in some circles, gluten-free has become a dietary fad. However, she emphasises that a healthy person does not need to avoid grain products.

“There is no evidence that a gluten-free diet would have positive health effects for people who do not suffer from the coeliac disease or allergies. On the contrary, there is evidence that if patients avoid gluten, they often leave out all the grains in their diet. This can increase the risk of cardiovascular diseases,” Kaukinen points out.