Top 10 Frequently Asked Questions About Gluten  : Answered by Immunologist Dr. Genc Sulçebe

1. What is gluten?

A protein found in three grains: wheat, barley, rye.

2. What is celiac condition?

Celiac condition is a systemic disorder of autoimmune nature, triggered by gluten in individuals who are genetically susceptible to it. Celiac is not as rare as is commonly thought. According to data, about 1% of the world’s population may be affected.

Celiac is conditioned by certain genes encoded in the HLA system, which is a specific genetic system that varies from one individual to another. Individuals who carry these genes, which predispose them to this health condition, must avoid gluten—the protein found in grains such as wheat, barley, and rye, among others.

When these individuals consume gluten, their bodies react by producing antibodies, causing inflammation of the enterocytes and intestinal villi, which are responsible for the absorption of nutrients such as vitamins, minerals, electrolytes, etc. This damage can lead to malnutrition and malabsorption.

3. What are the symptoms of celiac?

Individuals suspected of having celiac disease may present different symptoms. Some individuals fail to gain weight, may experience diarrhea, fatigue, anemia, or other signs. It is important to emphasize that these clinical signs vary from person to person.

There are individuals who may show several clinical signs, but there are also individuals who show no symptoms at all. Thus, although they may be affected by this health condition, they show no clinical signs and at a certain point may develop skin diseases or other problems that become concerning.

For this reason, it is important that pediatricians and physicians in general look for this disease even in individuals without clear clinical signs, identify it as early as possible, and avoid serious health consequences.

4. What is the diagnostic protocol for celiac? Can it be diagnosed only through serological tests?

We can say that the simplest and fastest method for diagnosing celiac disease is the serological method. In other words, it is an immunological method through the determination of autoantibodies directed against a specific protein that serves as an enzyme—transglutaminase—as well as against gluten/gliadin itself.

These create antibodies against gluten/gliadin. Therefore, we have anti-gluten antibodies and anti-transglutaminase antibodies, which can be of the IgA or IgG type. These antibodies indicate whether individuals are affected by celiac. This is the simplest method to identify the presence of this health condition.

However, to determine the diagnosis with maximum accuracy, physicians also perform a biopsy of the small intestine. This examination is considered invasive. For example, according to the latest 2020 guidelines for diagnosing celiac in children by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), performing a biopsy is no longer part of the protocol for this very reason.

Alongside serological testing and biopsy, it is also important to perform genetic testing, which highlights the genes that predispose to this health condition.

5. How important is food safety in maintaining a gluten-free diet?

It is important to mention that celiac disease is the ONLY autoimmune disease with a known triggering factor, which is gluten. Therefore, health consequences can be eliminated by avoiding gluten in food products.

To date, there is no other disease that can be treated by eliminating its cause. The cause of other diseases often comes from internal autoantigens, whereas in celiac disease we have autoimmunity caused by an external antigen.

Thus, by avoiding gluten and ensuring a rigorous, 100% gluten-free diet, these individuals can live a very healthy life.

Early diagnosis and, above all, maintaining a permanent and very strict 100% gluten-free diet are essential to ensuring a normal life for these individuals. It is extremely important to emphasize that even a very small amount of this protein is enough to trigger antigenic responses that create cells which damage the intestine. This is ESSENTIAL.

6. What is the difference between gluten sensitivity, allergy, and intolerance?

When we talk about allergy or hypersensitivity to gluten, it should be said that these are conditions that do not have a genetic nature. These individuals do not have antibodies such as anti-transglutaminase or anti-gliadin, but they may have a hypersensitivity condition of a different nature.

In such cases, diagnosing this health condition becomes more difficult and falls under the responsibility of the appropriate specialist.

However, when we talk about celiac disease as an autoimmune disease with the presence of the DQ2 and DQ8 genes, which predispose to this health condition, it is important to emphasize that although there are individuals who carry these genes, only a small percentage of them develop the disease.

Therefore, the presence of these genes does not imply the presence of the disease, but rather a genetic predisposition. Whether or not celiac disease manifests in individuals who have these genes is related to many other genetic factors, such as the presence or absence of other genes, as well as lifestyle.

7. What impact does vaccination have on the immune system in patients with celiac?

During the wave of the COVID-19 pandemic, the question rightly arises as to whether individuals with celiac disease are at risk when receiving vaccines. They absolutely should be vaccinated and have no differences compared to individuals who do not have this condition.

They have no reason to be afraid. On the contrary, they should protect themselves just like everyone else through vaccination.

8. Is it necessary to take nutritional supplements in cases of gluten sensitivity, and if so, which supplements and for how long?

During the wave of the COVID-19 pandemic, the question rightly arises as to whether individuals with celiac disease are at risk when receiving vaccines. They absolutely should be vaccinated and have no differences compared to individuals who do not have this condition.

They have no reason to be afraid. On the contrary, they should protect themselves just like everyone else through vaccination.

9. How important is monitoring celiac?

As mentioned, ensuring a 100% gluten-free diet is essential. Monitoring this health condition is very important and is done through antibody testing.

The result of these antibodies should be negative, which indicates that the individual is maintaining a 100% gluten-free diet. Thus, this test reflects compliance or non-compliance with the dietary regimen.

Additionally, the availability of appropriate food products plays a crucial role in maintaining a gluten-free diet. These products must be completely safe—absolutely 100% gluten-free. As emphasized, even trace amounts of gluten are sufficient to activate immune cells that damage the intestinal mucosa, resulting in harmful effects on the digestive system.

Dr. Sulçebe concludes that ensuring the availability of safe and certified gluten-free foods is a shared public responsibility—helping together to make life healthier for people with celiac and gluten intolerance.