Gluten intolerance (Sprue)

In the case of gluten intolerance (called celiac disease in infants and children, sprue in adults), the consumption of gluten-containing foods leads to chronic inflammation of the mucous membrane of the small intestine as a result of hypersensitivity to components of gluten, a gluten protein found in many types of grain (wheat, rye, oats, barley). The intolerance persists for a lifetime and, according to the current state of medicine, cannot be treated causally. The technical term for gluten intolerance is gluten-sensitive enteropathy.

The consumption of gluten-containing foods leads to inflammation and subsequently to the destruction of epithelial cells in the small intestine, which impairs the absorption of nutrients such as vitamins, minerals, carbohydrates and fats. If a gluten-free diet is followed consistently, the intestinal mucosa regenerates and the symptoms disappear.

Gluten intolerance is a chronic disease that affects about one person per 500 inhabitants in Central Europe. All age groups are affected, and the disease occurs more frequently in women. The intolerance often develops in the course of irritable bowel syndrome.

Since relatives of celiac disease or sprue patients also have a higher incidence of the disease, it is assumed that the tendency to develop gluten intolerance in the course of life is, to a certain degree, genetically determined. The risk for first-degree relatives to also develop an intolerance is about 10%.

Furthermore, it is assumed that environmental influences as well as the immune system of those affected and chronic intestinal diseases play a role in the development of an intolerance.

In the case of existing gluten intolerance, the consumption of foods containing gluten leads to inflammation and destruction of the mucous membrane of the small intestine, which significantly reduces the function of the intestine. This manifests itself in the following symptoms:

• severe unwanted weight loss and chronic underweight
• Exsiccosis (dehydration of the body) as a result of severe fluid loss due to chronic diarrhoea.
• Flatulence (bloating)
• Nausea
• Deficiency symptoms (e.g. iron, calcium) due to the impaired absorption of vitamins and minerals - anaemia can be caused by iron deficiency
• In children, the deficiency symptoms can lead to developmental delays and, in the advanced stages, to the development of a bulging belly and skinny extremities.

The diagnosis of gluten intolerance is usually made by taking and examining stool and blood samples, as antibodies against parts of gluten can be detected in the case of intolerance. The special antibodies are only present if the body's immune system overreacts when it comes into contact with gluten, which also causes the symptoms described. In addition, the blood test should also check whether the gluten intolerance may have caused vitamin or mineral deficiencies.

Furthermore, gluten intolerance can be diagnosed by a biopsy (microscopic examination of a tissue sample), which is performed during a colonoscopy. The tissue sample should not be taken after a longer period of gluten-free nutrition, as the typical tissue changes would otherwise be more difficult to detect.

In the event of an intolerance, those affected must consistently follow a gluten-free diet for the rest of their lives. At the beginning of the gluten-free diet, milk and dairy products should also be avoided, as these are relatively difficult to tolerate and represent an additional burden for the already irritated intestine.

Examples of:

• gluten-containing foods: wheat, rye, oats, barley, spelt, green spelt, ancient grain, kamut, triticale, einkorn, emmer
• gluten-free foods: rice, potatoes, corn, millet, quinoa, amaranth, soybeans, meat, milk, eggs, fruit, vegetables

Gluten is often also contained in ready-made products, bread, pasta, muesli, sauces, desserts and many other foods - these must therefore either be avoided completely or special gluten-free products must be purchased. Recommendations and assistance for a balanced diet despite consistent gluten avoidance can be provided by a nutrition coach.

If vitamin and mineral deficiencies have developed as a result of gluten intolerance, these should be compensated for by taking appropriate supplements. In very severe cases of intestinal inflammation, glucocorticoids (e.g. cortisone) can also be taken as prescribed by the doctor - these effectively alleviate the symptoms, but are relatively susceptible to undesirable side effects because they dampen the entire immune system.

Even if a symptom-free life is possible after some time, the gluten-free diet must never be discontinued. Otherwise, there is a high risk that the exact same symptoms will reoccur. Due to the chronic inflammation of the intestines, late consequences and serious secondary diseases such as intestinal cancer are to be expected.

If a gluten-free diet is adhered to, the symptoms and secondary diseases can usually be managed well. The life expectancy of Sprue patients corresponds to that of normal patients. However, if the diet is not or only inconsistently adhered to, there is an increased risk of cancer of the stomach and intestinal tract due to the persistent irritation of the intestines. It also increases the likelihood of developing osteoporosis.

Since the exact mechanism of development of gluten intolerance is not known and it is most likely a genetic disease, there are no recommendations for the prevention of this disease.