Maladie cœliaque, Intolérance au gluten ou Syndrome de l'intestin irritable?

 The subject of the microbiome has rarely been so popular, and for good reason!

* Microbiome: cute word ’to designate the intestine, the home of the intestinal microbiota, which is all the bacteria, micro-fungi and other microorganisms in the intestine!!

We hear a lot more about gut health and the various disorders that surround it. Advertising of yogurts with probiotics, cereals with fiber, gluten-free juices (since when has there been gluten in the juice), etc.etc…

Gluten, is it the culprit? It is undoubtedly a subject of controversy, it has been, and still is, the subject of a big fashion! Gluten is made up of two proteins, prolamin and glutein, which we find slipped everywhere, sometimes sneakily, in our food. Many have joined a gluten-free diet to try, to go with the flow. But beware! A gluten-free diet can, on the one hand, interfere with a diagnosis, and lead to nutritional deficiencies if not followed by a doctor or a nutritionist!!

For some, however, this diet is essential, they just cannot eat it! It remains to identify the eating disorder for which they should follow it and it is not always easy, the symptoms and the causes are often similar from one disorder to another..

Here I have made an overview of three fairly common diseases or colopathies, to guide you one in your questions.

Celiac disease

About 1% of the population is thought to have celiac disease. And 9 out of 10 people with HIV may not yet know they have it. On the one hand, a number of people don't think they should see their doctor for abdominal pain and other symptoms. Then, about 75% to 80% of cases would be asymptomatic and are discovered during some investigation. But not feeling any symptoms does not mean safe! This is indeed a lifelong autoimmune genetic disease, where gluten damages the small intestine and decreases the absorption of nutrients from food. Therefore, disease to be investigated in case of evidence of malabsorption, such as anemia, osteoporosis and vitamin D deficiency..

But again, why is it so difficult to identify Because in fact, the symptoms are quite common with other illnesses. How to make it complicated when you can make it simple but in this case, it is not easy. Well not yet, let's hope that it will become so in the future.. 

In general, the symptoms are: stomach ache, being constipated or having diarrhea, bloating, repetitive nausea and vomiting, migraines, anxiety and / or depression, nutritional deficiencies, psoriasis, osteoporosis, etc. The list can still be long, unfortunately.

To make a diagnosis, it is not enough to stop gluten immediately from the diet. In fact, it does should not stop consuming it before the investigation. After discussion with our doctor, it is necessary to check the markers of the disease in the blood. But if we don't havenot consumed gluten before blood tests and for a fairly long period, spanning 2 to 3 months, the markerswill not be there. After the blood test, an intestinal biopsy is needed, which can confirm the intestinal damage.

Once diagnosed, it is not to be taken lightly. Gluten damages the intestinal wall, and nutrients are more adequately absorbed by the digestive system. Hence the complications of nutritional deficiencies and underlying problems that can arise.

No treatment, no vaccine is currently offered on the market, although some advances suggest that one day a vaccine will be offered, because researchers at an Australian university have been working on it for ten years now. By then, at diagnosis , it is important to eliminate all traces of gluten from the diet .

Non-celiac gluten sensitivity or gluten intolerance

About 3 to 6% of people would suffer from non-celiac gluten sensitivity (NCGS). These figures are controversial, as many people claim to be intolerant without first consulting their doctor. The SGNC itself is misunderstood and controversial.

Unfortunately, there is no marker to identify it, NCBS is diagnosed by the exclusion of celiac disease or even a wheat allergy. It is not to be taken lightly, however! Research suggests some consequences, such as a non-autoimmune immune response, disturbed gut flora, and increased gut permeability. We must also think more about whether this intolerance to gluten is in fact irritable bowel syndrome, because gluten also reacts to the digestive system of people with this colopathy.

The symptoms experienced by NCBS are all as varied and similar to celiac disease and irritable bowel syndrome: bowel pain and bloating, diarrhea or constipation, joint pain, eczema or rash, anemia, fatigue, headache, depression, etc.

Also, recent research published in the scientific journal Gastroenterology opens the door to possible aggravating factors, fructans, present in many foods including wheat, onions and garlic, and amylase / trypsin inhibitors, proteins that allow wheat to defend itself against parasites. Future research will be interesting to follow!

Irritable bowel syndrome

Irritable bowel syndrome (IBS), formerly called irritable bowel syndrome (IBS), is, on the other hand, a functional colopathy, not a chronic disease, because the syndrome does not in itself cause damage to the intestines. .

There are 3 forms of the syndrome, distinguished by the main symptoms present in people:

  • Syndrome with pain and diarrhea.
  • Syndrome with pain and constipation.
  • Syndrome with pain, diarrhea and constipation.

Without prejudice, approximately 20% of the population would be affected, or more than 6 million Canadians. Symptoms are varied, and unfortunately again resemble celiac disease and CNS a lot. Many are related to digestion: abdominal pain and cramps, which often disappear with the evacuation of gas or stools, constipation or diarrhea, sometimes alternating, bloating and gas, noisy bowel activity , a sometimes urgent need to have a bowel movement, a feeling of incomplete stool evacuation and mucus in the stool. People with irritable bowel syndrome also have extra-intestinal symptoms, such as headache, nausea, chronic fatigue, fibromyalgia, heartburn, chronic pelvic pain, skin rashes, back pain (lower back) and trouble sleeping, etc.c.

Of course, to identify it, a consultation with your doctor is necessary. Celiac disease or other illnesses should be ruled out as possible diagnoses as well. A gastroenterologist will be able to check, during a colonoscopy, whether the intestine is damaged or not.

The causes are still unknown and range from hormonal changes, an imbalance of the intestinal flora, bowel movements slower or faster than the norm, stress, etc. The treatments are also still nebulous. Probiotics, sport, meditation, hypnosis, diet without fermentable foods, etc.

On this subject, another Australian university has an entire department working to determine what foods can be eaten (gluten is one of them) and in what quantity to reduce symptoms. This diet would also reduce them in about 70% of people who adopt it! But hey, the subject is really more complex than that and will be developed in a future article, I promise!

Consulting a nutritionist to help start an appropriate diet is almost essential for people with IBS. It changes a life!

The important ...

The important thing, if you experience any symptoms, is to go see your doctor and a gastroenterologist. And above all, consult BEFORE starting a gluten-free diet, to avoid a false negative. Once the diagnosis is received, at least we know what to do next! (uhhh ... more but not quite, as a second puzzle begins what to eat now)???)

In summary, there is still so much unknown, there is currently a lot of research in gastroenterology all over the world. It will take a lot more to better tame our famous microbiome ... We are moving forward, one step at a time.


References :

  5. Kristin Verbeke, Gastroenterology, Noncoeliac Gluten Sensitivity: What Is the Culprit, February 2018Volume 154, Issue 3, Pages 47147373
  6. Skodje, G.I., Sarna, V.K., Minelle, I.H. et al. Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology. 2018; 154: 5295399


Article written by Audrée Hogue


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