What is Celiac Disease?
Celiac disease is an autoimmune disorder triggered by ingesting gluten, a protein found in wheat, barley, and rye. The pathogenesis of celiac disease involves both genetic and environmental factors. Individuals with specific genetic markers, such as HLA-DQ2 and HLA-DQ8, are predisposed to developing the disease. When these individuals consume gluten, their immune system mounts an abnormal response.
Gluten fragments, particularly gliadin, are modified by the enzyme tissue transglutaminase (tTG) in the small intestine. This modified gliadin is then presented by antigen-presenting cells to CD4+ T cells, triggering an inflammatory immune response. The resulting inflammation damages the intestinal villi, leading to malabsorption, nutrient deficiencies, and gastrointestinal symptoms.
In addition to the immune response, other factors, such as changes in the gut microbiome and increased intestinal permeability (often referred to as “leaky gut”), contribute to the pathogenesis of celiac disease. In some cases, environmental triggers like infections may also influence the onset of the disease. Over time, the chronic inflammation caused by repeated gluten exposure can lead to more severe complications, including an increased risk for certain cancers and other autoimmune disorders. The only effective treatment for celiac disease is a strict, lifelong gluten-free diet, which helps prevent further immune activation and allows the intestinal lining to heal.
What is Gluten Sensitivity?
Gluten sensitivity, also known as non-celiac gluten sensitivity (NCGS), is a condition in which individuals experience symptoms related to gluten consumption despite not having celiac disease or a wheat allergy. People with NCGS may experience gastrointestinal symptoms such as bloating, diarrhea, abdominal pain, and extra-intestinal symptoms like headaches, fatigue, joint pain, and brain fog. Unlike celiac disease, gluten sensitivity does not involve an autoimmune response or damage to the intestinal lining. The exact mechanism of NCGS is not well understood. Diagnosis is typically made after ruling out celiac disease and wheat allergy, and symptoms usually improve on a gluten-free diet, although some may tolerate small amounts of gluten.
How to test for this?
Functional medicine offers many tools that can help to explore GI function, intestinal permeability, IgE, IgG, IgG4, and complement reaction.
