Micronutrient therapy
| Definiton | |
| Non-celiac glutensensitivity (NCGS), gluten sensitivity or gluten intolerance is a clinical picture in which affected persons react to the protein gluten. It is found in wheat, rye, barley, oats and their hybrid varieties such as spelt, kamut, single kernel wheat, hulled wheat, green spelt and triticale. In contrast to celiac disease and wheat allergy, patients with gluten sensitivity do not develop antibodies in the blood or damage to the mucous membrane of the small intestine after eating gluten-containing foods. The absence of gluten-containing foods improves the symptoms of those affected. |
|
| Cause | |
|
Experts still disagree on the exact cause of non-celiac gluten sensitivity. In addition to gluten. Amylase trypsin inhibitors (ATI), which are formed by cereal ears as antibodies against pests, fungi or parasites, are another possible cause. Due to the increasing consumption of cereals and the associated desire for resistant varieties, ATI concentrations have multiplied considerably in recent years. ATI may play a more significant role in non-celiac disease gluten sensitivity than gluten. The increased incidence of non-celiac disease gluten sensitivity could be strongly related to this. |
|
| Symptoms | |
|
Affected people often experience physical, psychological or neurological symptoms hours or days after eating gluten-containing foods such as indigestion, diarrhea, constipation, flatulence, nausea, bone and joint pain, headache, migraine, fatigue, weakness, muscle weakness, skin eczema, depressive moods, mood swings, anemia and irritability. The symptoms of non-celiac disease gluten sensitivity are similar to those that occur as classic irritable bowel symptoms after the consumption of FODMAPs (short for fermentable oligo-, di-, and monosaccharides and polyols). |
|
| Diagnosis | |
|
Non-celiac disease gluten sensitivity is an diagnosis of exclusion. If neither celiac disease nor wheat allergy is diagnosed in the patient and the symptoms quickly improve with a gluten-free diet, non-celiac disease gluten sensitivity should be assumed. Serum can be tested for the presence of anti-Gliadin IgA/IgG antibodies and increased values of fatty acid binding protein 2 (FABP2), zonulin and soluble CD14 (sCD14). |
|
| Therapy | |
|
The therapy for non-celiac disease gluten sensitivity focuses on avoidance pf foods containing gluten. In contrast to celiac disease and wheat allergy, however, strict adherence to a gluten-free diet is not necessary. In addition to gluten-free cereals and so-called pseudocereals such as rice, maize, millet, buckwheat, amaranth and quinoa, there are also special dietary foods available which carry the international gluten-free symbol (a crossed-out wheat ear) as a seal of quality. The absence of gluten-containing foods results in a strong relief and reduction of symptoms within a short time. |
|
| Relevant micronutrients | |
| With a gluten-free diet, the lack of cereals such as wheat, spelt, etc. can lead to an undersupply of nutrients. Several long-term studies in different countries have shown that nutrients such as iron, magnesium, vitamin B12, vitamin D, vitamin B6, thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), folic acid, zinc, magnesium and calcium are particularly affected. In addition, a long-term gluten-free diet threatens to supply inadequate fiber if mainly gluten-free finished products are consumed, which often consists primarily of starch. Replacing gluten-free finished products with pseudocereals such as amaranth, buckwheat, quinoa, sorghum and teff is therefore particularly useful. Studies have shown that the consumption of pseudocereals can significantly improve the absorption of protein, iron, calcium and dietary fibers in patients with gluten intolerance. But according to a Swedish study, oats can also significantly increase the nutrient density of dietary fibers, thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3) as well as folic acid and iron in a gluten-free diet.Regular monitoring of the nutrient status in patients on a gluten-free diet is therefore recommended. In several studies the influence of anti-inflammatory probiotics on the composition of the intestinal flora was investigated. It has been shown that probiotics have significant potential in the therapeutic application and treatment of gastrointestinal symptoms associated with NCGS. The reason for this is their ability to positively influence the composition of the intestinal flora and the absence of side effects. Furthermore, probiotics can reduce the foreign colonization of the intestinal mucosa with pathogenic germs and restrict their growth. As a result, they are highly effective against diarrhea, gastroenteritis, non-specific, viral and antibiotic-induced diarrhoea in both adults and children. The barrier function of the intestinal mucosa is also promoted, so that fewer pathogenic germs can penetrate into the body. This is particularly important for critically ill persons. The ingestion of antibiotics or radiation or chemotherapy can also cause considerable disturbances in the microbial colonization of the intestine, which in turn enables an increased colonization of pathogenic germs. A targeted support of the intestinal flora during the drug intervention can prevent or minimize this. The gastrointestinal mucosal epithelium represents a structural and immunological barrier against a broad spectrum of harmful substances. Impaired intestinal mucosa integrity and gastrointestinal mucosal barrier function disorders ("Leaky Gut Syndrome") are associated with hunger, injury, infection, immunosuppression, chemotherapy, lack of enteral nutrition, radiation, trauma, burns and other types of stress. Disruption of the integrity of the intestinal mucosa and the mucosal barrier function lead to increased permeability for allergens, toxins and pathogens - the result is an immunological stress reaction and inflammation. Glutamine is considered the most important nutrient for the healing of "Leaky-Gut syndrome", as it is the preferred fuel for enterocytes and colonocytes. A low level of serum glutamine correlates with disorders of the intestinal barrier, inflammation and diarrhea in children. Parenteral and enteral diets enriched with glutamine significantly improve intestinal condition and function. Dysfunction of the intestinal barrier and endotoxemia are associated with the pathogenesis of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Glutamine supplementation significantly reduces clinical and endoscopic values in patients with ulcerative colitis. Both experimental studies and clinical observations show that glutamine plays a decisive role in maintaining and restoring intestinal barrier function. Dietary fiber are indigestible food components that some kinds of intestinal bacteria use as food source and contribute an important part to the intestinal health. American researchers have found that these bacteria use an alternative source of nutrition when faced with an extremely low-fiber diet and break down polysaccharides of the mucus lining the inner wall of the intestine. A mouse experiment showed that brief restriction of dietary fibers led to a degradation of the mucous layer of the intestine, which led to an increase in the risk of infection. This is an indication that an insufficient intake of dietary fibers could be a cause of chronic inflammatory bowel disease. Aspergillus Niger-Prolyl-Endopeptidase (AN-PEP) has been shown to be effective in the degradation of gluten in several studies. It has been shown that AN-PEP has significantly improved the digestion of gluten in the stomach of healthy people. In a dynamic system similar to the human gastrointestinal tract (TIM system), AN-PEP accelerated the breakdown of gluten in the gastric chamber to such an extent that hardly any gluten reached the duodenum. Serious side effects of AN-PEP could not be observed in a double-blind, placebo-controlled pilot study in patients. In contrast to other enzymes studied, AN-PEP is not irreversibly inactivated by the pepsin present in the stomach and the acid pH value prevailing there. It was observed that AN-PEP works optimally at a pH of 4-5, remains stable at a pH of 2 and is completely resistant to pepsin digestion. On average, AN-PEP reduced gluten peptides 60 times faster than a prolylologopeptidase and efficiently degraded intact gluten molecules. These studies indicate that the addition of AN-PEP to gluten-containing meals may reduce the effects of gluten. Thus, AN-PEP could be used as an oral supplement to reduce gluten uptake in patients.
|
|
| Celiac disease, non-celiac disease gluten sensitivity, wheat allergy | |
| Although there is an intolerance to gluten in coeliac disease as well as in non-celiac disease gluten sensitivity and wheat allergy, the 3 diseases differ in their reaction to gluten. 1. Wheat allergy is an IgE antibody-associated food allergy to gluten. 2. Celiac disease is a T-cell-mediated reaction with the corresponding IgA antibodies. 3. In Non-celiac gluten sensitivity no antibodies are formed. |