Dr. Robert F. Kidd    

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Gluten sensitivity

Gluten is a protein found in wheat, barley, protein, spelt and triticale. When ingested, it can provoke an immune reaction in the small intestine that can have profound effects on health. In 50% of sensitive people, the reaction is silent, i.e. no gastrointestinal symptoms are experienced.

Gluten sensitivity (GS) is in a class of its own, when it comes to food sensitivities. Not only is it common (40% of the population carry genes making them susceptible), but also reaction to gluten often underlies other food sensitivities.

In addition, GS can impair the body's ability to absorb nutrients (i.e. causes malabsorption - more on this below). And it can create an auto-immune reaction, where the body's immune system attacks its own tissues. When auto-immunity is provoked, antibodies to specific tissues or organs are produced, e.g. to the skin, the pancreas (Type 1 diabetes), the nervous system (neuropathy), connective tissue (hernias and aneurysms) etc. This helps explain why gluten sensitivity comes in so many forms.

Because of the complexity of gluten's effects on the body, GS has been a confusing subject, even within the medical profession. Gluten sensitivity was first discovered when dietary gluten was identified as the cause of coelic disease in the 1950s. Its connection with an uncommon skin disease (dermatitis herpetiformis) was discovered in the 1960s.

However its importance in coeliac disease has made it the "territory" of gastroenterologists and coeliac disease has been the reference point in research since its discovery. Over the years, association of coeliac disease has been noticed with a variety of other diseases, including cancers, autoimmune disease, psychiatric diseases, osteoporosis, iron deficiency, neurological conditions, other disorders of the gastrointestinal tract, etc. However, the profession has been slow to realize that coeliac disease is only one manifestation of gluten sensitivity. Many of these other conditions can occur without any hint of coeliac disease.

To summarize: Gluten sensitivity is common; Coeliac disease is relatively rare. Coeliac disease is one form of gluten sensitivity.

From the standpoint of the patient, the important thing to remember is that both conditions benefit from a gluten-free diet. Even the non-coeliac gluten-sensitive patient should be on a "coeliac diet".

The Gluten-free diet