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    Do you have questions about celiac disease or the gluten-free diet?

Warrior Woman

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What does non-celiac gluten sensitivity mean?

How is it different from celiac?

I am confused and need to know

TIA

Lorraine

You are not the only one confused....

It all hinges on the definition of celaics disease.

Prior ro the 50's celaics was non specific and basically referred to people who were ill when they ate wheat, barley, rye etc.

Then they invented a new endoscope that wnet into the intestine and they saw damaged villi and decided that was the cause.

Today many researchers see many symptoms of people who react in different ways to gluten but depending where you are and who you ask this is either celaic disease or not. Ask a enterologist and they will likely say it is damaged villi, ask a neurologist and they will have a different answer.

I have a page I made about this which summarises my thoughts....but I can't post it directly because it would break board rules ..

Sunday, 12 March 2006

Coeliacs disease was first diagnosed by Galen a Roman physcian to the emperors in 2AD or his contempory Aretaeus of Cappadocia.

Exactly what is it and what is accepted or not as coeliacs disease is rather dependent where you live.

Galen 131-201AD

Image

Many commercial interests seek to control what is and what is not considered coeliacs disease but the most inclusive and simple defintion remains that of Galen. which is an intollerance to eating wheat, barley or rye.

Francis Adams translated the presenved works of Aretaeus and reprinted them for the Sydenham Society in 1856. The original Greek Text of the sections on "The Coeliac Affection" suggests that Aretaeus may possibly have understood a remarkable amount about the coeliac condition or to put it another way we don't know much more now.

From the writings of Dr James S. Steward, Consultant Physician, West Middlesex University Hospital, Isleworth, Middlesex.

"After the 1939-45 war came a fundamental discovery which proved to be the main advance in the treatment of coeliac children and adults alike. This discovery was made and described in detail by a Dutch paediatrician, Professor Dicke, in his doctoral thesis for the University of Utrecht in 1950. He showed how coeliac children benefited dramatically when wheat, rye and oats flour were excluded from the diet. As soon as these were replaced by wheat starch, maize flour, maize starch or rice flour the children's appetite returned and their absorption of fat improved so that the fatty diarrhoea disappeared."

The next step was the isolation of various parts of wheat and identification of one of its two main proteins (gluten) as the culprit.

This is where things start to get confused.

" The original observation which, together with Processor Dicke's discovery, led to our present understanding of the nature of the coeliac condition was made by Dr. J. W. Paulley, a physician in Ipswich, and reported to the British Society of Gastroenology in Birmingham in the same year as Professor Dicke's discovery. Dr. Paulley described an abnormality of the lining of the small intestine found at the operation in an adult coeliac patient. This abnormality consisted of an inflammation, the exact nature of which is still being investigated.

The existence of this inflammatory change was confirmed in several patients by Dr. Paulley and was then found by many doctors in this country, the United States and elsewhere to be the most essential single feature on which the diagnosis of the coeliac condition could be based. Its importance to the patient is that it results in a loss of the microscopic projections or villi which are partly responsible for providing the lining membrane of the small intestine with a large surface area. It is from this mucous membrane lining that the absorption of food into the bloodstream takes place." Fig 1 Healthy ViliImage

From this point on research and diagnosis of coeliac disease focused largely on the intestine and the degradation of the villi which line it. The invention of the gastric biopsy and subsequent modification for the intestine provided a easily measurable metric. The destruction of the villi can be clearly seen in the photomicrographs opposite. However According to netdoctor.co.uk "Half of adults with coeliac disease do not have any symptoms from the bowel." Other common symptoms include depression and damage to the nervous system. Ultimately several other autoimmune diseases are also linked with coeliac disease. The focus on the villi has caused a certain neglect of other areas and most of those who do have recognisable damage to the villi also suffer other symptoms. The common digestive symptoms are summarised below.

Common (classic) disgestive related symptoms

* Anaemia (iron deficiency)

* Bloating and flatulence

* Diarrhoea and/or constipation

* Fatigue, weakness and lethargy

* Nausea and vomiting

* Stomach cramps

* Weight loss

Fig 2 Villi being destroyed Image

However a large percentage of people who react to the protein in wheat, barley and rye also suffer wide ranging autoimmune and neurological problems.

Ataxia is caused by damage to the nervous system. It manifests itself as poor muscle coordination or earlier loss of feeling usually beginning in extremeties.

Depression is also well documented but another difficult to measure property.

A good summary is available here:http://www.nutramed.com/celiac/celiacbrain.htm

In the end the distinction is actually quite simple: The difference between an alergy and an intollerance is defined by the type of anti-bodies produced. An allergy is defined as IgE antobodies being produced by the body. In coeliac disease specific anti gluten IgA and IgG antobodies are produced.

The interested reader is directed to this article on antibody types http://en.wikipedia.org/wiki/Antibody

Fig 3. Villi completely dissapearedImage

In the end not every biopsy diagnosed coeliac has symptoms they have recognised, many are diagnosed after relatives are diagnosed for instance. Equally many coelaics who suffer neurological or other symptoms do not have the classic damaged villi. Ultimately under a strict Gluten Free diet most coeliacs will repair the damage to the villi but still remain susceptible to further damage by eating gluten.

Last Updated ( Thursday, 27 April 2006 )

Sorry, the photo's and formatting get lost when I cut/paste.

In the end I see no reason for us the sufferers to argue over who is celaic, who is non-celiac gluten sensitivite etc. because we are all in the same boat with our requirements which is to avoid gluten

hope that helps but since the Dr's are confused its only natural we should be!

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Yeah, my understanding is that non-celiac gluten sensitivity is an inability to digest gluten that manifests itself in ways other than intestinal damage.

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Thanks for the links-

They were very helpful

gfp- that is a great page. I love the history!

Thanks both of you....

edits: Sorry rest is cut to comply with board rules

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