What is GLUTEN?
GLUTEN is a protein found in grains such as wheat, barley, oats, and rye.
What is Protein?
Protein is an organic molecule that forms the basic building blocks of organisms. Proteins are formed by the combination of various amino acids. There are millions of different proteins, and each has its own unique and indispensable function.
Why is GLUTEN Important?
Gluten constitutes 80% of the protein in bread wheat. Gluten enables leavened products to rise and take shape. Gluten gives elasticity to dough. Gluten is not only found in flour products; beer, ice cream, ketchup, soy sauce, and vegetarian foods, etc. contain gluten intensively. The fact that 50% of people’s daily energy needs worldwide are met from flour-based foods is noteworthy in emphasizing the importance of gluten. 14% of wheat consists of proteins.
What is Celiac Disease?
Celiac Disease is a hereditary, AUTOIMMUNE disease characterized by an excessive reaction of the absorptive surface of the small intestine to GLIADIN, which is a subunit of GLUTEN. Its prevalence in society is between 0.5-1.5%. Most of these complete their lives without being diagnosed.
What are the Symptoms of Celiac Disease?
In early childhood, the most important symptoms are persistent diarrhea, abdominal pain, excessive gas, growth retardation, anemia, and food allergies. In later ages, in addition to these findings, it may present with many conditions such as elevated liver enzymes, fatty liver, autoimmune hepatitis, infertility, psychiatric disorders, Vitamin B12, iron and folic acid deficiency, autoimmune dermatitis, chronic fatigue, depression, fibromyalgia, etc.
How is Celiac Disease Diagnosed?
A definitive diagnosis is made after endoscopy and duodenum (beginning of the small intestine) biopsy, followed by pathological examination of the biopsy material.
What is the Pathology in Celiac Disease?
As a result of celiac disease, damage to the structures called “VILLUS” which form the absorptive area on the inner surface of the small intestine (VILLUS ATROPHY) results in irreversible loss of absorptive surface area, along with disruption of selective permeability in the intestines and triggering of autoimmune reactions.
Why is VILLUS ATROPHY Important?
The inner surface of the human small intestine, thanks to its folded structure (villus and microvilli), is approximately 20,000 m2 in area, which is as large as the area occupied by a large Olympic stadium. One of the most important parameters affecting human health, quality of health, and lifespan is how wide and healthy the small intestine surface area is. Here, in addition to the digestion and absorption of foods, many enzymatic and hormonal functions take place.
ARE ALL GLUTEN ALLERGIES CELIAC DISEASE?
A very small portion of those with gluten allergies have Celiac Disease. 98% of those with gluten allergies DO NOT have Celiac Disease. These are called Non-Celiac Gluten Sensitivity (NCGS).
What does Non-Celiac Gluten Sensitivity (NCGS) mean?
Patients who are found NOT to have Celiac Disease in endoscopic duodenal biopsy and have gluten sensitivity are defined as Non-Celiac Gluten Sensitivity (NCGS).
What is the Main Difference Between NCGS and CELIAC DISEASE?
Non-Celiac Gluten Sensitivity (NCGS) is a completely curable disease. In Celiac Disease, only REMISSION (partial recovery) is possible with treatments and dietary applications. Celiac Disease is a genetic and autoimmune disease and CURATIVE (complete and permanent) treatment is not possible.
Non-Celiac Gluten Sensitivity (NCGS) is a Completely Curable Disease
Is There a Factor That Triggers Non-Celiac Gluten Sensitivity?
The most important factors in the emergence of NCGS cases are:
- Decrease in digestive system microbial biodiversity (Flora Damage)
- Intestinal absorptive surface damage due to flora damage
- Intensive use of gluten in the food industry
- The share of genetically modified products such as wheat, barley, and oats rising above 95% in total consumption.
Each of these topics is worth focusing on. While these factors cause the formation of NCGS, they are also factors in the emergence and exacerbation of Celiac Disease.
What is FLORA? What Does Flora Damage Mean?
We live together with our single-celled friends who live in peace with us in certain parts of the human body, do not harm us, contribute to the moisture and acidity vital balances of the area they are in, have enzymatic, hormonal and neurotransmitter activity, form the first line of defense in microbial attacks from outside, contribute to mucus production, live in their own specific areas throughout the digestive system, are constantly in motion and are discarded and regenerated several times even within a day, in thousands of varieties and in numbers that can be expressed in tens of trillions. The general name for these is MICROBIOTA (Flora). It is not possible to live without our flora. Names such as digestive system flora, genital area flora, or external ear canal flora are made according to the area where they live.
There are 1054 species of flora bacteria identified in the digestive system to date. Our flora is not only composed of bacteria; there are also viruses, yeast, and other subgroups. The more we can host of the digestive system flora diversity identified to date, the higher quality our digestive system functions will be.
The higher the digestive system flora biodiversity, the healthier, higher quality, more productive, successful, happy, disease-free, and longer life we live.
Digestive system flora biodiversity begins to form while in the womb. Our birth method, nutritional adequacy, breast milk intake, flora biodiversity of people in close contact, illnesses experienced, industrial product consumption, industrial pollution, surgical interventions undergone, medications used (antibiotics, corticosteroids, chemotherapy), pesticides, etc., many factors are involved in flora acquisition, preservation, and loss.
If our flora biodiversity decreases or certain parts are completely destroyed, pathogenic microorganisms invade their place.
Our flora is one of the most important factors in protecting the intestinal absorptive surface. If the flora barrier is disrupted, it causes disruption of digestive functions and disruption of the selective permeability of our intestines, which is a very important function.
NCGS is unusual in people with healthy microbial flora. Disruption of the flora barrier prepares the ground for other factors in the development of NCGS to be effective.
In Celiac Disease, if the intestinal microbial flora is adequate and healthy, the destructive effects of the disease will be limited. With flora damage, complications in Celiac Disease appear rapidly and uncontrollably.
What Does Absorptive Surface Damage Due to Flora Damage Mean?
The inner surface of the digestive system is formed by a community of single-row cells that we call mucosa (inner skin). Digested nutrients pass between these cells and enter the bloodstream. This mucosal surface has a selectively permeable property. It is not possible for everything we eat and drink to cross this mucosa layer and reach the bloodstream. This selectively permeable property is vital. Some specialized cells among our mucosal cells produce a secretion we call mucus, which is gelatinous and slimy. Mucus covers the entire mucosa like a film layer. Thanks to mucus, direct contact of the mucosa with intestinal contents is prevented and the mucosa is protected. If the mucus shield disappears, our mucosa is damaged by digestive secretions, foods, and pathogenic microbes and loses its selective permeability.
Our flora, which has special functions living in each part of the digestive system, is extremely important in maintaining this balance. Since sustainable and quality mucus cannot be produced after damage to our flora, mucosal damage and disruption in the selective permeability of our intestine also occur. Diseases that progress with disruption of the selective permeability of our intestine are defined under the name LEAKY GUT SYNDROME. And thus, the way for autoimmune diseases is opened.
INCREASING GLUTEN USE IN THE FOOD INDUSTRY
The use of gluten has been gradually increasing over the last 50 years due to its properties of shaping leavened flour products and providing elasticity. Gluten is being used increasingly not only in flour products but also in many sectors (beer industry, vegetarian product preparation, etc.).
Increase in GMO Grain Use
GMO (Genetically Modified Organism) grain production is a process that started after the 1950s. Although it was initially done to produce animal feed, today GMO products constitute more than 95% of the grain products we use. In addition to wheat, the same proportions of GMO production occur in barley, oats, rye, corn, lentils, beans, peanuts, and oilseeds.
The purpose of GMO production is to obtain much more product per unit time and per unit area, which is more resistant to natural conditions (cold, heat, drought, etc.) and to reduce costs.
However, with the change in genetic codes in GMO products, changes also occur in the amino acid sequences that make up the proteins in the products. But when viewed with the naked eye, it is impossible for us to distinguish a GMO product from an original product.
Thanks to our genetic memory, through the genetic codes passed down to us from our ancestors for thousands of years, the relevant areas of our body can distinguish GMO products from original products within seconds, more sensitively than highly advanced laboratories. Our genetic memory still recognizes the genetic codes of wheat from 5000 years ago very well.
Under normal circumstances, if the biodiversity of our digestive system flora is sufficient and there is no disruption in the selective permeability of our intestines, no abnormal reaction is observed in our body when we consume GMO products (bloating, excessive gas, abdominal pain, allergies, etc.). However, if there is damage to our flora and disruption of the selective permeability of our intestine, dormant Celiac Disease begins to activate. With flora damage and disruption of the selective permeability of our intestines, even if there is no Celiac Disease, NCGS occurs with excessive gluten consumption and especially with GMO gluten consumption.
HOW IS IT DIAGNOSED?
It is not very easy to distinguish Celiac Disease from NCGS with clinical findings. The same findings are detected in both.
Celiac Disease is diagnosed with endoscopic duodenal biopsy. However, in more than 98% of cases, it is seen that there is no Celiac Disease in the biopsy result and all of these are defined as NCGS.
We get information about our flora through microbial analysis of feces (stool) (FMA). In FMA, disruption of microbiota and other parameters is seen in both diseases. In Celiac Disease, clinical findings are observed even if there is no flora damage. However, without flora damage in NCGS, the clinical findings listed above are not observed.
HOW ARE THESE DISEASES TREATED?
In both Celiac Disease and NCGS, the main point to focus on should be the elimination of FLORA DAMAGE. It is very difficult to get results from other treatments without restoring flora damage.
If flora damage is limited, it is possible to get results by taking some precautions and regulating eating habits. However, if flora damage is at an irreversible stage, the only treatment is to plan FLORA TRANSPLANT without delay.
Absorptive surface damage (villus atrophy) that develops due to flora damage in our intestines results in irreversible loss of intestinal absorptive surface area. The inner surface of our intestines is approximately 20,000 m2. It is not possible to regain the surface area lost after villous atrophy. After a certain stage, the response to Flora Transplant treatment will also be limited. A decrease in the small intestine surface area below 4,000 m2 not only causes serious nutritional disorders but also limits the response to treatments.
What Happens if NCGS and Celiac Disease Are Not Treated?
If these diseases are not treated, patients are condemned to live with the disease symptoms mentioned above, and the emergence of other autoimmune diseases is also facilitated and accelerated. Both diseases are AUTOIMMUNE diseases. The formation of any autoimmune disease facilitates and accelerates the formation of other autoimmune diseases. At the same time, irreversible intestinal surface area loss occurs. Intestinal surface losses that have been lost with treatment cannot be regained; only the remaining reserve can be protected.
What Does AUTOIMMUNE DISEASE Mean?
AUTOIMMUNE diseases are chronic diseases that progress with our defense system attacking and destroying some tissues and organs of our body, perceiving them as foreign-harmful due to the perception disorder that occurs as a result of excessive fatigue and loss of coordination of our body’s defense system. (Diabetes, Hashimoto’s Disease, Rheumatoid Arthritis, Depression, Vitiligo, Psoriasis, Food Allergies, Autoimmune Dermatitis, etc.)
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stay healthy
Assoc. Prof. Dr. Murat Kanlıöz