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Institute for Specialized Medicine offers a comprehensive program for diagnosis and treatment of gluten intolerance and gluten-associated metabolic, inflammatory and autoimmune diseases. Gluten intolerance is a genetically-predisposed chronic inflammatory condition initiated and mediated by consumption of certain grains including wheat, rye and barley. The troublemaker is gluten "a composite of the proteins gliadin and glutenin " which represents the dominant component of wheat grain endosperm. Due to the lack of appropriate enzymes in the human body, gluten cannot be completely digested. This results in the creation of a large amount of protein fragments (called peptides) which then interact with immune cells of genetically susceptible individuals and start a chain of inflammatory reactions. It has been demonstrated that gluten fragments can penetrate from intestinal lumen into blood stream and even into breast milk, causing systemic effects. The undesirable consequences of gluten consumption typically occur in genetically predisposed individuals. Several genes associated with gluten intolerance have been identified. The two main genes, HLA DQ2 and HLA DQ8, encode proteins which are localized on the surface of immune cells (macrophages, lymphocytes, etc.) and serve as specific receptors for gluten fragments. Biochemical reaction between the gluten fragments and the receptors is the key event in the initiation of gluten-mediated inflammatory reactions. Not all individuals carrying the HLA DQ2 and HLA DQ8 genes will eventually develop gluten intolerance. There are quite a few factors involved in this complex process including density of HLA DQ2 and 8 molecules on the membrane of immune cells, presence of particular subtypes of these molecules, activity of the enzymes modifying gluten fragments (transglutaminase is one of them) and presence of the modifying genes. One of the important modifying genes for gluten intolerance has been identified recently. This gene, called myosin IXB, is responsible for increased intestinal permeability (also known as "leaky gut syndrome") and has a strong association with inflammatory bowel disease, systemic lupus erythematosus and rheumatoid arthritis. The vicious cycle of gluten intolerance is not limited to immunological and inflammatory disturbances, it also has a profound effect on various metabolic pathways and intestinal ecology. The majority of individuals with gluten intolerance have problems with absorption of vitamins and minerals even in the absence of clinically visible inflammation in the intestinal wall. The most common problems include iron deficiency, zinc and copper deficiency, malabsorption of vitamins D and A as well as folic acid deficiency. Gluten intolerance is a diverse condition with manifestations that range from mild intestinal discomfort and irritable bowel syndrome to life-threatening celiac disease and lymphomas. Quite a few patients with gluten intolerance have no gastrointestinal involvement and their problems have systemic character. Other problems associated with gluten intolerance include pancreatic insufficiency, and intolerance toward dairy products, soy proteins and egg albumin. Gluten intolerance is a diverse condition with manifestations that range from mild intestinal discomfort and irritable bowel syndrome to life-threatening celiac disease and lymphomas. Quite a few patients with gluten intolerance have no gastrointestinal involvement and their problems have systemic character. Conditions Associated with Gluten IntoleranceThe list of conditions associated with gluten intolerance includes but is not limited to:
Autoimmune and rheumatic diseases:
Endocrine diseases:
Hematologic diseases:
Skin diseases:
Neurologic diseases:
Obviously, not all patients with the aforementioned diseases have gluten intolerance. However, patients with these conditions should be aware that gluten may be a potential driving force behind their illness. |
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