Gluten Sensitivity, thorough Study.pptx

A full presentation prepared for explaining the causes, pathophysiology, clinical picture and diagnosis of Gluten sensitivity. in addition, comparison between the subtypes of Gluten sensitivities.

1. Gluten Sensitivity P repared for Abood حبيب المجيدي

2. This literature review aims to provide a comprehensive overview of the current state of knowledge on gluten sensitivity, including its epidemiology, clinical presentation, pathophysiology, diagnostic criteria, and management. Introduction

3. Overview Epidemiology Diagnosis Treatment 01 02 04 05 Table of contents 03 06 Pathophysiology Feeding Guidelines & G- free Foods

4. Overview Gluten: “Gluten is a protein found in the wheat plant and some other grains,” explains Rajagopal. Gluten is naturally occurring, but it can be extracted, concentrated and added to food and other products to add protein, texture and flavor. It also works as a binding agent to hold processed foods together and give them shape. Gluten Sensitivity is  a disorder where your body reacts badly to eating gluten , Gluten Sensitivity has some of the same symptoms as celiac disease, but doesn't cause permanent damage to your small intestine . Celiac disease and wheat allergy are well-established conditions involving immune-mediated reactions to gluten, while non-celiac gluten sensitivity (NCGS) is a less well-defined condition.

5. prevalence The prevalence of NCGS is difficult to estimate, as there is no clear diagnostic criteria or biomarkers to identify the condition. However its suggested by many studies that 8.4% of people across the globe suffer from gluten-related disorders and 91.6% of population is safe from these disorders and is non-susceptible for gluten ingestion.

6. Epidemiology

7. 667,182,187 People have Gluten-related disorders worldwide

8. Celiac Disease Wheat Allergy Non-celiac Diseases Types of Gluten Sensitivity Celiac disease and wheat allergy are well-established conditions involving immune-mediated reactions to gluten, while non-celiac gluten sensitivity (NCGS) is a less well-defined condition.

9. Main causes Gluten Sensitivity Autoimmune Not Autoimmune not Allergic (Innate) Allergic The causes are not fully understood but but there are some theories explains .. Wil but discussed later .

10. Clinical Presentation Gluten sensitivity is a complex condition that can present with a diverse range of symptoms. The clinical presentation of gluten sensitivity can vary widely between individuals, and symptoms can affect various body systems, including the gastrointestinal tract, nervous system, and skin.

11. Signs of the disease Central Nervous System Brain fog , Anxiety , Headache Gastrointestinal System A bdominal pain, bloating, diarrhea & constipation Skin Skin Rashes

12. Clinical Presentation As there are many other manifestations affecting other parts of human body it’s better to classify them into two categories : Gastrointestinal Manifestations Gastrointestinal symptoms are among the most common symptoms associated with gluten sensitivity. These symptoms can include abdominal pain, bloating, diarrhea, and constipation. The severity and duration of these symptoms can vary between individuals, and some individuals may experience more severe symptoms than others. In some cases, gastrointestinal symptoms may be the only symptom of gluten sensitivity, while in other cases, they may be accompanied by other symptoms.

13. Clinical Presentation As there are many other manifestations affecting other parts of human body it’s better to classify them into two categories : . 2 Extra-intestinal Manifestations Extra-intestinal symptoms can also occur in individuals with gluten sensitivity. These symptoms can affect various body systems, including the nervous system, musculoskeletal system, and skin. Common extra-intestinal symptoms include headaches, fatigue, joint pain, and skin rashes. These symptoms can be more challenging to diagnose than gastrointestinal symptoms, as they may be nonspecific and can mimic symptoms of other conditions.

14. Clinical Presentation Cardinal Symptoms of Gluten Sensitivity Disorder

15. Clinical Presentation Differences between Celiac and Non-celiac Gluten Sensitivity

16. Pathophysiology The pathophysiology of gluten sensitivity is not well understood but is distinct from celiac disease. Two theories for its underlying mechanisms are as follows: Gluten sensitivity is an immune-mediated response to gluten similar to celiac disease, but without the characteristic autoimmune damage to the small intestine. Evidence to support this includes the presence of elevated levels of cytokines and antibodies. Gluten sensitivity is a manifestation of underlying conditions such as irritable bowel syndrome (IBS) or non-celiac wheat sensitivity (NCWS). IBS is a functional gastrointestinal disorder and NCWS is a condition characterized by symptoms similar to gluten sensitivity. 01 02 Immune-mediated Secondary

17. Pathophysiology

18. Pathophysiology Gluten sensitivity is a complex condition involving multiple factors such as immune-mediated responses, alterations in the gut microbiome, and potential links to other conditions such as IBS and NCWS Studies have shown that individuals with gluten sensitivity have lower levels of beneficial bacteria such as Bifidobacterium and Lactobacillus in their gut microbiome compared to healthy controls Gluten sensitivity may be a component of a broader functional gastrointestinal disorder such as IBS or NCWS Further research is needed to better understand the pathophysiology of gluten sensitivity and develop effective treatments for this condition.

19. How is it diagnosed? Clinical suspicion Biopsy Serology Gluten-free diet By signs and symptoms Negative celiac disease serology Presence of gluten-specific antibodies From Skin or intestine to Exclude Celiac Disease Positive response to a gluten-free diet The lack of clear diagnostic criteria for gluten sensitivity has been a challenge for clinicians and researchers alike. Recently, a set of proposed criteria for diagnosing gluten sensitivity was published in the journal Clinical Gastroenterology and Hepatology in 2013. These criteria include: Positive response to a gluten-free diet 2. Negative celiac disease serology 3. Presence of gluten-specific antibodies

20. The Diagnosis Criteria

21. How is it diagnosed? Continue These criteria aim to provide a more specific and sensitive approach to diagnosing gluten sensitivity. However, they have not yet been widely adopted in clinical practice, and further research is needed to validate their utility. ◇some tips about the diagnostic criteria. Gluten sensitivity diagnosis criteria need to be improved in order to understand the condition better. 2. Researchers are exploring biomarkers and other diagnostic tools to aid in the diagnosis of gluten sensitivity. 3. One example of this is gluten challenge tests, which involve reintroducing gluten into the diet and monitoring symptoms. 4. More research is needed to establish the safety and efficacy of this approach.

22. Treatment The current approach for managing gluten sensitivity is a gluten-free diet, which involves the elimination of all sources of gluten from the diet. More personalized and targeted approaches to the management of gluten sensitivity may involve the identification of specific triggers or the use of dietary supplements or medications to manage symptoms. There is a growing interest in the use of probiotics and other microbiome-targeted interventions for the management of gluten sensitivity.Much more research is needed to develop more effective diagnostic and management strategies for gluten sensitivity. It is hoped that more targeted and personalized care will be able to provide for individuals with this condition.

23. How to feed a Gluten- sensitive person ? The answer is Gluten-free diet, but how can people know gluten-free foods? the FDA set a limit of less than 20 ppm (parts per million) for the unavoidable presence of gluten in foods that carry this label. In addition to limiting the unavoidable presence of gluten to less than 20 ppm, the FDA allows manufacturers to label a food “gluten-free” if the food does not contain any of the following: an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains, an ingredient derived from these grains and that has not been processed to remove gluten, or an ingredient derived from these grains that has been processed to remove gluten, if it results in the food containing 20 or more ppm gluten Foods that are inherently gluten-free, for example bottled spring water, fruits and vegetables, and eggs can also be labeled “gluten-free” provided any gluten that came in contact with the food is less than 20 ppm.

24. How to feed a Gluten- sensitive person ? We can make the previous informations more practical in two points: Instruct those people about what and when to eat. Giving them charts or lists of available and nonavailable foods and their amounts.

25. The Instructions Avoid wheat, barley, and rye Look for gluten-free alternatives Read labels Cook at home Consider gluten-free grains Watch out for cross-contamination Check medications and supplements Be cautious when eating out Consider working with a registered dietitian Be aware of hidden sources of gluten Choose naturally gluten-free foods Be aware of cross-reactivity Consider nutritional deficiencies: Be mindful of social situations Stay up-to-date on food labeling regulations

26. Some Charts Th is chart is based on the Food Quintity

27. Some Charts Th is chart is based on the Time Interval between eating Food and the next allowed time for it.

28. Some Charts Th is chart is based on the Time Interval between eating Food and the next allowed time for it.

29. Some Charts Th is chart is based on the Necessary body requirements and also on daily meals or Eating Times .

30. Gluten-Free Foods List Bread/Grains  gluten-free pasta  corn tortillas  rice crackers  gluten-free cereal  buckwheat  quinoa  rice  flax  ______________   Meat/Protein  fish/shellfish  hot dogs  canned tuna  tofu  poultry  lunch meat  beef  ______________   Beverages  coffee/tea  gluten-free beer  juice  water  ______________                   Dairy  milk  whipped cream  cheese  sour cream  butter/margarine  eggs  yogurt  gluten-free pudding  ______________   Snacks  rice cakes  rice or soy crackers  sunflower seeds  popcorn  dried fruit  corn chips  Jello  ______________   Frozen  vegetables  fruits  gluten-free ice cream or sherbet  gluten-free waffles  gluten-free frozen dinners/pizzas  ______________   Cans/Jars  vegetables  fruits  beans  gluten-free soup  applesauce  pasta sauce  canned milk  nut butters  jam  honey  ______________ Condiments and Baking  white or red wine vinegar  shortening  olive, canola, or vegetable oil  salad dressing  spices  cornstarch/meal  gluten-free flour  cocoa  syrup  Xanthan gum  arrowroot powder  ______________   Fruits/Veggies  fruits  vegetables  herbs  ______________

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