Gluten: Understanding the Protein and Its Impact on Health

Gluten is a protein complex (gliadin + glutenin) in wheat, rye, barley, and triticale. It gives dough elasticity and structure.

Gluten-Related Disorders

1. Celiac disease (1%): Autoimmune; gluten triggers villous atrophy → malabsorption. Strict lifelong gluten-free diet required.
2. Non-celiac gluten sensitivity (NCGS, ~6%): Symptoms (bloating, pain, fatigue, brain fog) improve on GF diet, but no celiac/wheat allergy markers.
3. Wheat allergy: IgE-mediated; hives, anaphylaxis, GI/respiratory symptoms. Avoid wheat, not necessarily all gluten.

Common Symptoms (Celiac/NCGS)

• Bloating, gas, diarrhea, constipation
• Abdominal pain
• Headaches, fatigue, brain fog
• Joint pain, skin rash (dermatitis herpetiformis – celiac specific)
• Nutrient deficiencies (iron, B12, D, folate)

Diagnosis

• Celiac: TTG-IgA, EMA, DGP antibodies + duodenal biopsy (gold standard) while on gluten diet.
• NCGS: Exclusion diagnosis after negative celiac/wheat allergy.

Management

Strict gluten-free diet for celiac; individualized for NCGS. Ensure nutritional adequacy (fiber, B vitamins, iron). Cross-contamination avoidance critical for celiac.