How common is a real gluten allergy

Hypersensitive to gluten?

Prof. Dr. med. Wolfgang Holtmeier

More and more people think that they cannot tolerate wheat and other grains. However, celiac disease or allergy cannot be proven. Is there really such a thing as hypersensitivity to the cereal protein gluten?

Recently there have been an increasing number of reports and observations from patients who do not have celiac disease and still cannot tolerate gluten. Until a few years ago, this phenomenon was denied by most doctors and the patients dismissed as "weirdos". However, this assessment has fundamentally changed. The majority of experts today agree that there is a so-called gluten sensitivity that has nothing to do with celiac disease. Scientists at Charité Berlin, for example, suspect that up to 20 percent of irritable bowel patients could actually suffer from gluten sensitivity. In 2010 and 2012, internationally recognized experts met to characterize the previously neglected clinical picture of gluten sensitivity in more detail.

Unfortunately, doctors do not yet have any markers or blood values ​​with which this medically relevant intolerance could be proven directly. Therefore, gluten sensitivity is basically a diagnosis of exclusion. If there are suspicious symptoms, which, for example, irritable bowel patients often show, the first diagnostic step is to reliably rule out the autoimmune disease celiac disease. It must also be clarified whether there is a real food allergy to wheat. This is done with an IgE antibody determination in the blood serum. Patients are then recommended to follow a gluten-free diet for about two weeks. If the symptoms subsequently improve significantly or go away completely, there is probably gluten sensitivity. To be on the safe side, the patient should reappear gluten after a few months to see if symptoms return. Only then does a wheat or gluten restriction make medical sense.

Reaction still unclear

Which metabolic defects or immune reactions are responsible for the disease “gluten sensitivity” has not yet been researched in detail. However, it is known that the antibodies typical of celiac disease or allergies do not develop. The intestinal mucosa of these patients looks completely normal and, unlike those with celiac disease, is not damaged. It is true that different reactions of the immune system to old types of grain and new breeds can actually be demonstrated. However, it has not yet been scientifically proven that this results in a higher risk of celiac disease or gluten sensitivity.

Ultimately, gluten sensitivity is a disorder with symptoms that disappear again after a few days on a gluten-free diet. Only imprecise information can be given about the frequency. In the case of celiac disease, scientists estimate that 0.2-1 percent of the population in this country is affected; the rate for gluten sensitivity is still unknown. However, it is believed to be more common than celiac disease. However, according to the current state of knowledge, it does not leave any consequential damage. Real food allergies to wheat are much less common.

Usually no strict diet necessary

An important difference between celiac disease and gluten sensitivity lies in dietary requirements. Celiac disease patients must have a strict gluten-free diet for life. But if celiac disease has been ruled out medically and the patients respond positively to a gluten-free diet, then they usually do not have to adhere to it as strictly in the long term. This means that you don't have to pay attention to every “crumb” everywhere and at all times, as celiac patients do. However, the threshold up to which gluten is tolerated can only be tested individually. It is helpful that in the course of food labeling, ingredients made from wheat and other types of cereals containing gluten must be indicated on the packaging. For gluten-free foods, it is also stipulated across the EU that they may contain a maximum of 20 milligrams per kilogram of gluten. There is also the symbol of the crossed-out ear of wheat, the gluten-free seal of the German Celiac Society.

Diagnosis by the doctor is indispensable

A diet “according to books”, however, cannot be a substitute for a careful medical diagnosis as the basis for a long-term effective therapy. In addition to wheat and gluten, there are a number of possible food intolerances or intolerances. The symptoms are partly similar, but the causes are very different, such as lactose or fructose intolerance or "real" food allergies, for example to nuts, soy, fish and shellfish, cow's milk or chicken eggs.

Don't just leave out gluten

For the reasons mentioned, a gluten-free diet as a thoughtless dietary recommendation for healthy people who want to lose weight is completely superfluous. There is no evidence whatsoever that a gluten-free diet helps you lose weight or prevents obesity - as some diet coaches or celebrities proclaim in the media.

It also makes no sense to avoid wheat, which is particularly popular in the USA. Although it is said to be to blame for both obesity and cardiovascular disease, our heart attack rate has almost halved in the last 20 years. And that despite the increased consumption of grain products. And a very important point that the anti-wheat and anti-carbohydrate parliamentary group does not take into account: How can we feed the seven billion people on our planet as needed without grain? Wheat is one of the staple foods worldwide and indispensable as the number one energy supplier.

Anyone who argues against carbohydrates or grains completely disregards the fact that whole grain products in particular make an indispensable contribution to a needs-based supply of vitamins, minerals and fiber. The latter in particular are apparently primarily preventive: as protection against colon cancer, for blood pressure control, for the prevention of cardiovascular diseases or as a contribution to immune function. There is undoubtedly a need for research to better understand how and why celiac disease or gluten sensitivity develop so that affected patients can be given even better help - however, unqualified stirring up of gluten or wheat hysteria is not helpful here.

Source: Holtmeier, W .: UGB-Forum 4/13, pp. 204-205
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