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Gluten intolerance or celiac disease affects only 1% of the population. However, more and more patients are experiencing the same chronic symptoms without being affected by the disease. They are actually only sensitive to gluten.
In recent years, gluten has been regularly criticized, suspected of being responsible for the slightest intestinal disturbance. In restaurant menus, as well as on supermarket shelves, gluten-free products have appeared to meet the demand of more and more consumers who consider themselves intolerant to gluten. So a real epidemic or just a fad?
In the department of gastroenterology and pancreatology of the University Hospital of Toulouse in Rangueil, “the consultations for this reason are very numerous”, notes Dr. Cyrielle Gilletta de Saint-Joseph, also a member of the French association AFDIAG for gluten intolerance . Among the patients who consult for the first time, many are also those who have placed themselves on a gluten-free diet because they believe they are intolerant. In reality, those who are truly intolerant to gluten represent only 1% of the population ”, adds the specialist.
They suffer from celiac disease, an autoimmune intestinal disease triggered by gluten, a very common protein in foods and in some cereals such as wheat. The others, while showing symptoms, tested negative.
Like many autoimmune diseases, celiac disease primarily affects children and young adults between the ages of 20 and 30 and may be associated with dystyroidism and / or dermatological damage such as atopic dermatitis.
Gluten free diet, the only treatment
So when should you consult? Symptoms, when chronic, should prompt consultation. They can be varied: bloating, transit and digestive disorders, abdominal pain, fatigue, headache, weight loss, etc. “Serology, which allows for the determination of immunoglobulin A (IgA) antibody associated with a biopsy on the lining of the duodenum can detect celiac disease,” describes the gastroenterologist.
But, in the face of the high number of patients (between 3 and 6% of the population) suffering from real symptoms and then negative to the test, a new protocol has been established. “We offer them a 15-day gluten-free diet followed by a gluten reintroduction protocol. If symptoms reappear, they are considered sensitive to non-celiac gluten. Ultimately we do not know if they would have developed the disease over time, because they are a bit ‘on the edge, ”explains the doctor.
Without treatment, intolerant and sensitive to gluten, they are all in the same boat: a gluten-free diet. “A strictly gluten-free diet, accompanied by a dietician, is essential for intolerant people, because the slightest contamination increases the levels of antibodies. For the sensitive, deviations are better tolerated. “
Bruno Lamas, researcher at INRAE Toulouse, is studying the role of the microbiota in gluten intolerance.
In Toulouse, a new therapeutic path thanks to the intestinal microbiota
A new therapeutic avenue that questions the role of the microbiota in gluten intolerance has been highlighted by an international research consortium (1) which includes a team from the Toulouse Toxalim research unit (2). This research could be a game changer for patients diagnosed with gluten intolerance who do not yet have treatment. The first work by this group, published in the journal Science Translational Medicine, shows that supplementing probiotics or a diet enriched with tryptophan (an essential amino acid provided by the diet) reduces intestinal lesions of celiac disease in women. mouse. The next step is the launch of a clinical study in humans in Canada, in collaboration with INRAE Toulouse.
Probiotics to reduce intestinal damage
“We didn’t get interested in the microbiota by chance,” says Bruno Lamas, researcher at the Toxalim unit (INRAE Toulouse). We relied on previous studies, already carried out by INRAE in the Paris region and to which I had contributed. This work had already shown that in patients with other inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, it was an alteration of the microbiota that prevented the metabolization of tryptophan.
However, this amino acid should normally allow the production of new compounds, called indole derivatives, which in turn activate the receptors present in the cells of the intestine. These receptors induce beneficial effects such as reducing inflammation or strengthening the intestinal barrier. In Canada, the consortium researchers analyzed the feces of a cohort of 29 volunteer patients with active celiac disease, or who had been on a gluten-free diet for two years, and healthy volunteers. “Their results clearly showed that the microbiota of celiac disease patients has the same defect as those of Crohn’s disease,” explains Bruno Lamas.
A registered patent
The consortium then studied mouse models showing celiac susceptibility genes. “We observed three groups of mice, the first to which we supplemented with tryptophan, the second to which we gave probiotics capable of producing indole derivatives and the third to which we gave indole derivatives directly. The results show that in all cases the intake of tryptophan and probiotics reduces inflammation when exposed to gluten. “.
This therapeutic approach, which opens up new treatment perspectives, has been the subject of a further patent pending study to confirm these findings in humans.
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