Gluten: Effects On The Body

What is gluten

Gluten is heat resistant and has the ability to act as a binding agent, a property that underlies its addition to processed foods to improve their texture, moisture retention, and taste.

Gliadin, the main protein of wheat, contains peptide sequences that are highly resistant to gastric, pancreatic and intestinal juices (in particular, to the proteolytic enzymes they contain), and therefore it is difficult to digest and digest. The average daily intake of gluten in the Western diet is believed to be 5-20 grams per day and is associated with several disorders.

In fact, extra gluten is often added to baked goods in the form of a powdered product called vital wheat gluten to increase the strength, growth, and shelf life of the finished product.

Gluten proteins are very resistant to protease enzymes, which break down proteins in the digestive tract.

Incomplete digestion of proteins allows peptides - the large units of amino acids that are the building blocks of proteins - to pass through the wall of the small intestine and into the rest of your body.

This can trigger immune responses that have been shown in a number of gluten-related conditions such as celiac disease.

Gluten was known as far back as Mesopotamia and appeared in the human diet about 10,000 years ago - at the time when our ancestors began to eat cereals.

The main amino acids in gluten - proline, glutamine and other hydrophobic compounds - all this makes it resistant to complete destruction by digestive enzymes.

Effects of gluten:

1. Violates intestinal permeability - moreover, this happens without activation of the cells of the immune system, namely, by disrupting the contacts between the epithelial cells of the inner lining of the intestine.

2. Increases the release of such a mediator as acetylcholine, in contact between the smooth myocyte of the intestine and the nerve cell - this leads to an increase in the contractility of the muscle layer and, as a result, the development of diarrhea.

3. Gluten peptides penetrate the pancreas, where they influence its morphology and increase insulin secretion. They can stress the beta cells that produce this hormone.

4. Heaviness in the stomach due to a slowdown in the motility of the digestive system leads to the growth of bacterial microflora - in conditions of poorly digested food (and wheat proteins, among other things, are also resistant to the action of digestive enzymes), residents of our intestines feel especially comfortable. SIBO develops - bacterial overgrowth syndrome.

5. Suppresses the growth of epithelial cells - due to inhibition of the processes of synthesis of nucleic acids (DNA and RNA), initiation of self-programmed cell death and damage to them by reactive oxygen species.

6. cytotoxic action.

The occurrence of celiac disease and its forms

However, the relationship with nutrition and the pathogenesis of development was studied to a sufficient extent long after that - only in the twentieth century. It is now reliably known that gluten plays the main role in the development of this disease.

Gluten is a broad concept that combines a group of proteins found in many cereals:

• Gliadins are found in wheat.

• Avenins - in oats.

• Secalins are in rye.

• Hordenins - in barley.

So, one of the components of the major histocompatibility complex receptor, the protein molecule HLA-DQ, is encoded by such gene variants as HLA-DQ2 and HLA-DQ8, patients have celiac disease. This is due to stronger binding of receptors to wheat gliadin proteins.

However, it is also noteworthy that despite the sufficient prevalence of the carriage of these genes, the percentage of occurrence of celiac disease in the population does not exceed 1% - this makes one think that genetics does not play the leading role. Is it true that lifestyle comes first?

Scientists suggest that smoking during pregnancy can also increase the risk of a possible disease in the child. Also important are fetal growth retardation (the so-called intrauterine malnutrition) and the disease in the first months of birth with various infections. But let's dig a little deeper into immunology and see how the previously mentioned processes take place at the molecular level.

So, gliadin, being a substance foreign to the human body, acts as an antigen and forms a complex with the HLA-DQ2 or HLA-DQ8 receptors of the major histocompatibility complex, after which it is presented to immune cells - and these unshakable judges pass their verdict. T-lymphocytes (or rather, their population - T-helpers) beat with a hammer and, interrupting the deathly silence of a protracted trial, and finally announce: "strangers." They are activated: after all, the criminal must be eliminated - in the name of the calmness of other systems and maintaining balance.

In addition to all these complex biochemical interactions and processes, an enzyme such as tissue transglutaminase is also involved in the conversion reactions of gliadin, a gluten protein. In the course of its work, the binding strength of the wheat protein to the corresponding receptor of the major histocompatibility complex increases, as well as the connection of the latter with the oversight T-lymphocyte. It is important to understand that immunoglobulins can also be formed to it - and this “tissue transglutaminase-antibody” complex is detected far beyond the intestines (where, in fact, gluten originally entered as part of the food consumed). In addition, this complex is able to penetrate the placenta - it is even accused of an interrupted pregnancy due to intrauterine death of the fetus.

In any case, when the immune system is activated and its defensive measures are launched, the intestine suffers one of the first - in particular, its permeability increases. This causes the components of the bacterial cell wall, in addition to provoking immune cells, to enter the bloodstream.

At the same time, according to the WHO classification, three forms of celiac disease are distinguished:

1. Chronic - usually accompanied by diarrhea, vomiting, bloating, abdominal pain, weight loss.

2. Atypical - there are no symptoms and manifestations from the gastrointestinal tract. Patients may present with osteoporosis and neurological disorders, and nonspecific symptoms are dominated by fatigue, fatigue, and irritability. . The most common complaint is anemia caused by a deficiency of iron, vitamins B12 and B9, much less often - copper.

   It is noteworthy that the “gold standard for diagnosing” anemia, ferritin, is often observed within the normal range or even slightly elevated. It is thought to be related to the anemia of chronic disease. The fact is that iron is the favorite food of pathogenic microflora, with which our body competes for this vital mineral.

3. Asymptomatic - observed in 60% of children and 41% of adults.

Symptoms of celiac disease

• Chronic diarrhea - due to the development of malabsorption syndrome (malabsorption in the small intestine).

• Weight loss.

• Iron deficiency anemia - due to impaired absorption of iron.

• Pernicious anemia - with a lack of folic acid and vitamin B12.

• Distension of the abdomen due to bloating.

• Malaise and weakness.

• Osteoporosis.

• Anomalies of tooth enamel.

• Hypokinesia of the gallbladder.

• Infertility, late menarche (first menstruation), amenorrhea, recurrent miscarriages, premature birth, early menopause, changes in sperm count and motility.

   

• Headaches, paresthesias, neuroinflammation, anxiety, depression and other neurological symptoms, behavioral disorders.

• Sleep disorders.

• Pain in the joints.

• Recurrent miscarriage, spontaneous abortion, stillbirth.

• Atopic dermatitis, type 1 diabetes mellitus, Hashimoto's thyroiditis, autoimmune liver disease.

• Selective deficiency of IgA.

• Chromosomal diseases (Down, Turner and William syndromes).

• Focal alopecia.

• Addison's disease.

In the clinical picture of celiac disease, there is not a single symptom that would occur in 100% of patients - the diagnosis, in fact, is made by trial and error.

However, if there is a violation of the stool and a consistently low level of iron reserves (especially in men - they do not have monthly iron losses with menstruation), it is necessary to exclude celiac disease in the differential diagnosis.

Celiac disease, being an autoimmune disease, is often accompanied by autoimmune thyroiditis, rheumatoid arthritis, and type 1 diabetes.

Diagnosis of celiac disease and associated diseases

Algorithm for diagnosing celiac disease:

1. Determine the total level of IgA - however, it must be borne in mind that patients with a deficiency of this type of antibody will experience a significant distortion of the results.

   Next, there are two options:

   • If the level of this immunoglobulin is normal, then it is necessary to determine IgA to tissue transglutaminase, which was previously mentioned; IgA to endomysium (connective tissue located between the layers of muscle fibers), which have the highest diagnostic accuracy, as well as IgA to deaminated gliadin peptides (a relatively new study, much more progressive than a simple determination of antibodies to gliadin).

   • If the total IgA is reduced, then IgG to tissue transglutaminase, IgG to deaminated gliadin peptides is determined.

2. If the antibodies are positive, then it is necessary to pass a genetic analysis - in particular, HLA DQ2, HLA DQ8.

3. If the genetics are positive, then the doctor, at his discretion, can send for a biopsy of the small intestine.

Algorithm for diagnosing concomitant diseases:

1. Diagnosis of iron deficiency:

   • Ferritin < 20 µg/L.

   • Total iron-binding capacity of serum > 70 µmol/L.

   • Transferrin saturation coefficient < 20%.

   • Decreased concentration of erythrocytes.

   • Decrease in hemoglobin, color index, mean volume of erythrocytes (MCV).

1. Diagnosis of B12 deficiency:

   • Increasing the level of homocysteine.

   • Increase in the average volume of erythrocytes in the general blood test (MCV).

   • The sensitive marker is holotranscobalamin.

   • The “gold standard of diagnosis” is the accumulation of methylmalonic acid in organic acids in the urine.

2. Diagnosis of folic acid deficiency:

   • An early marker of B9 deficiency is formilino glutamic acid.

   • Increasing the level of homocysteine.

   • Increase in the average volume of erythrocytes in the general blood test (MCV).

    

3. Assessment of inflammation: ESR, C-reactive protein, transferrin.

4. Vitamin D.

5. Thyroid panel: TSH, T3 light, T4 light, antibodies to thyroperoxidase, antibodies to thyroglobulin.

6. Coprogram - assessment of steatorrhea (presence of excess fat), blood in the stool, enzyme deficiency, bacterial overgrowth.

7. Adrenal stress index (assesses daily fluctuations in saliva of cortisol and DHEA).

8. Food allergy testing - IgE, IgG, IgG4 (IgG4 antibodies are a more clinically relevant marker of chronic food immune responses and possible increased intestinal permeability).

9. Evaluation of changes in the chemical composition of the blood in electrolytes (usually calcium is reduced).

10. total protein.

Non-celiac gluten sensitivity

One of the prerequisites for the diagnosis is the absence of manifestations on the part of the body on a gluten-free diet. Notably, NCCG is often accompanied by intolerance to common food allergens such as cow's milk protein and eggs.

Symptoms of non-celiac gluten sensitivity include:

• Pain in the abdomen (usually in the epigastric region).

• Bloating.

• Diarrhea and / or its combination with constipation.

• Migraine.

• Loss of energy and fatigue.

• Numbness of limbs.

• Violation of cognitive functions.

• SIBO is bacterial overgrowth syndrome.

In addition, there is such a thing as wheat allergy - in this case, a characteristic increase in IgE will be noted in the blood.

8 tips for treating celiac disease

1. Currently, the only treatment for celiac disease and the prevention of its complications is a strict lifelong gluten-free diet - and it is recommended for both asymptomatic and typical course of this disease.

2. Bakery products, dairy and confectionery products, sauces and cereals should be bought only if there is a specific marking with a crossed spikelet of wheat.

1. It is necessary to eliminate the deficiencies associated with celiac disease - in particular, iron, calcium, folic acid, vitamin D, vitamin B12.

2. The use of probiotics is recommended: in patients with celiac disease, there is a general decrease in the number of bifidobacteria (especially B. longum), as well as a decrease in the following strains of lactobacilli: L. casei, L. paracasei, L. rbamnosus.

   Study: The role of the gut microbiota in the development of celiac disease

3. Against the background of severe diarrhea, adsorbents-mucocytoprotectors can be prescribed.

4. Correction of digestion processes is carried out by prescribing preparations of highly active microencapsulated pancreatic enzymes. It is especially worth considering a decrease in the activity of prolyl endopeptidase and, as a result, the accumulation of the amino acid proline.

5. Correction of stress and decrease in the activity of the Sympathetic nervous system.

6. Moderate use, and preferably a complete exclusion of alcohol and non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, aspirin, analgin.

Benefits and popularity of a gluten-free diet

Advantages:

1. Improvement of reproductive functions.

   Thus, the relationship between menstrual irregularities and celiac disease is still poorly understood, and scientists are forced to rely more on statistics. For example, a study of Italian women in 2010 showed that more than 19% of patients suffering from celiac disease also had irregular menstruation. Some doctors suggest that failures occur even at the level of impaired absorption of micronutrients - this entails disturbances in the axis of the hypothalamus - pituitary gland - ovaries.

    

   In another study, which described a survey of 120 women with common gynecological diseases such as endometriosis and infertility, celiac disease was detected and diagnosed in 9 patients.

   Premature depletion of the ovarian reserve is also seen as the result of an autoimmune process.

2. Prevention of other autoimmune diseases.

   It is well known that celiac disease, being a consequence of the developed autoimmune process, is often accompanied by other pathologies caused by disorders of the immune system - when its cells declare war on their own tissues or their structures.

   It is noteworthy that in the treatment of, say, autoimmune thyroiditis, significant improvements were observed with the introduction of a gluten-free diet - in particular, antibodies to thyroperoxidase were significantly reduced and the need (and in patients with subclinical hypothyroidism it completely disappeared) in replacement therapy decreased.

   Research: Celiac disease: is there a link with autoimmune thyroid disease and reproductive disorders in women?

   Quite controversial is the issue of the severity of a gluten-free diet. For example, patients who received 100 mg of gliadin per day (approximately 2-5 grams of wheat flour) had minimal morphological changes in the histology of the small intestine mucosa, in contrast to those who consumed 500 mg or more.

3. A gluten-free diet is a well-established and effective treatment for malabsorption syndrome and osteoporosis.

1. Reducing the risk of developing neurodegenerative pathologies and mental disorders.

   The researchers note that children with schizophrenia are much more likely to develop celiac disease than their healthy peers. During World War II, intriguing work was done showing a strong correlation between average annual wheat consumption and the number of women hospitalized with schizophrenia.

   In addition, patients with psychosis are diagnosed with elevated concentrations of anti-gliadin antibodies.

   Study: Use of a Gluten-Free Diet in Schizophrenia: A Systematic Review

2. Reducing the size of fat cells and their inflammation, which is one of the markers for the development of insulin resistance.

Studies have shown that even those patients who did not suffer from celiac disease, but at the same time adhered to a gluten-free diet, significantly reduced their weight. They had a smaller waist circumference, as well as higher levels of “good” HDL (high-density lipoprotein) cholesterol.

Some authors, on the contrary, question this effect - they argue that this diet is rich in carbohydrates and fats, thereby causing the development of the metabolic syndrome. Obviously, the truth, as always, is somewhere in between: definitely, a gluten-free diet improves intestinal absorption and suppresses inflammation in adipose tissue, but all these beneficial effects are possible only with proper, balanced nutrition.

In addition, a gluten-free diet significantly prevents the development of autoimmune diseases. For example, the prevalence of celiac disease among people with Hashimoto's disease, an autoimmune thyroid disease, is estimated to be four times higher than among the healthy population. Gluten is a powerful trigger, and cutting it out is an important step in reducing your risk.

In addition, this type of nutrition is also recommended for patients with neurodegenerative disorders, cognitive disorders and psychoses. It is noteworthy that although the relationship between gluten and infertility, as well as other common diseases of the reproductive system, is still not fully understood and understood, the diet with its elimination has already borne many fruits.

Nutrition on a gluten-free diet

The following foods must be strictly excluded from the diet:

• wheat flour

• Spelled

• Semi-finished products

• Ready sauces (ketchup, mustard and mayonnaise)

• Pasta and bread made from wheat flour

• oats

• Rye

• Barley

• Bulgur

• Semolina

• Kamut

• Couscous

• Triticale

Hidden sources of gluten:

• Shop candy and cookies.

• Canned food.

• Pate.

• Baking powder.

• Sausages and ham.

• Dumplings.

• Bouillon cubes.

• potato and corn chips.

• frozen potatoes - "fries".

• some types of tea, coffee and cocoa mixes for instant preparation (instant).

• corn flakes when using barley molasses.

• Breadcrumbs.

• Soy sauce.

• Chocolate.

• Beer and kvass.

• Ice cream.

• Yoghurts.

• Granule and breakfast cereals.

• Dyes, emulsifiers and other food additives (annatto extract E-160b, caramel dyes E-150a - E-150d, maltol E-636, isomaltol E-953, maltitol and maltitol syrup E-965).

• Packaged juices and sweet drinks.

A gluten-free diet includes the following foods:

• Vegetables and fruits.

• Berries.

• Meat, fish and seafood.

• A small number of cereals, including buckwheat, millet, corn, amaranth, quinoa).

• Starch, buckwheat, rice, soy flour (and any pastries from these types of flour).

• Flax seeds.

Compiling a diet should be purely individual and is complicated in many respects by such a mechanism as cross-reactivity - this is the reaction of the immune system in response to the ingestion of foreign molecules (antigens) that are similar in structure and function to allergenic substances.

Some cross-reactive products may include:

• gluten-free grains;

• milk/dairy products (lactose intolerance is common in celiac disease due to decreased production and release of lactase from damaged enterocytes.);

• soy;

• coffee;

• chocolate;

• eggs.

These brands offer their customers a wide range of gluten-free options (look for "gluten free" on the products) to help you create a varied diet. We assure you, with a little imagination, you can easily recreate your usual and favorite dishes by replacing a few ingredients in them:

• Food products from the company "Di&Di".

• Products from cereals and beans of the Mistral company.

• Products from "Nutbutter" made from nuts.

• Large selection of baby and diet food from the Russian manufacturer Zdorovei.

• Products from the Polish manufacturer "BEZGLUTEN".

• Harmless food from the company "All for the benefit".

• Gluten-free flour and butter produced by Butter Krol.

• The Russian network of retail outlets "Dietika" (stores are located only in the largest cities), where, among other things, there are products that do not contain gluten.