What are the missions and main actions of AFDIAG?
BJ:The AFDIAG – French Association of Gluten Intolerants (governed by the law of 1901) has the mission of informing, helping and defending celiacs, people with dermatitis herpetiformis (dermatological form of celiac disease) , non-celiac gluten hypersensitivity, their family and those around them, health professionals, food, public authorities...
The Association is supported by a Medical Committee, made up of 42 doctors specializing in pathologies linked to gluten, who provide their scientific knowledge and inform celiacs and non-celiacs hypersensitive to gluten about the progress of Research.
AFDIAG informs through numerous publications (four-monthly magazine, Newsletter , annual reports of medical conferences, guides, special editions, etc.). Meetings are organized in the regions, training, nutritional education courses for children, teenagers and adults...
Listening is offered by a hotline and a reception at the head office (5 days a week). The www.afdiag.fr site offers areas reserved for doctors and dietitians. A Members area with a discussion forum is also dedicated to members, without forgetting the social networks (Facebook, Twitter, Instagram) which inform and promote exchanges with members and the general public.
What are the different forms of gluten intolerance?
B.J:There are 3 diseases potentially linked to gluten, which have different mechanisms:
– Celiac disease (MC) or gluten intolerance would affect about 1% of the population, it is often under-diagnosed. CD is an autoimmune disease which is characterized by atrophy of the villi of the small intestine which leads to poor absorption of nutrients:we observe anemia due to iron deficiency or demineralization due to lack of calcium… Among people with CD, some have few or no clinical symptoms which may be atypical (extra digestive). The gluten-free diet must be followed strictly and for life.
– Wheat allergy, rare, is an inappropriate immune response that causes serious and acute reactions such as urticaria, asthma, angioedema, very quickly after ingestion of this cereal. It has nothing to do with the MC.
– Gluten hypersensitivity is a discomfort after ingestion of gluten-containing products in patients with a negative diagnosis of celiac disease and allergy, but without villous atrophy and for which the mechanisms are still unclear and diagnostic criteria are lacking. According to recent studies, its prevalence is close to that of CD.
There are more and more people sensitive to gluten. Can we speak of a real collective awareness?
B.J:It is important to reassure people and I would not speak of collective awareness! Gluten-related pathologies only affect a small part of the general population, but they are now better known. Regarding gluten intolerance, i.e. people with CD, out of 1% of those affected, only 10 to 20% are currently diagnosed. So we have to move forward. But, we are seeing an increase in the number of people who are thought to be gluten sensitive, with a negative diagnosis of MC. The increase in diagnoses of this sensitivity, also called non-celiac gluten hypersensitivity, may have several reasons that remain debated today and are the subject of research. Among the avenues, in addition to the evolution of knowledge on diagnostic tests, the hypothesis of a sensitivity to FODMAPs (fermentable sugars), which are found in cereals containing gluten in the form of fructan, is studied. These same symptoms are evoked in irritable bowel syndrome, which affects 10 to 20% of the general population.
What do you think will be the future of the gluten-free market in France?
BJ:It is important to specify that gluten-free products (breads, pasta, flour and biscuits) have been developed to facilitate the daily life of gluten intolerant people, to allow their celiac child to have their pasta when their brothers and sisters eat it. , bread for breakfast or biscuits for a snack… The profusion of these products has considerably improved the management of the diet for celiacs over the past twenty years. The appearance of the new entity of non-celiac gluten sensitivity may also necessitate the use of these foods. A better knowledge of these pathologies increases the diagnoses and therefore the consumption of these products, but what has caused sales to explode mainly concerns the fashion for gluten-free products. In the absence of scientific data on the benefit of removing gluten from your diet (its toxicity has only been proven for celiacs and allergies) fashion may pass and the market may stagnate. However, for the past ten years, the gluten-free market has continued to grow. At the end of 2017, it was estimated in France at around 60 million euros, with a constant increase of around 20% for five years. This market offers more organic products today in proportion than conventional products.
Interview with Dominique Turck, Head of the Gastroenterology and Pediatric Nutrition Department at the Jeanne de Flandre Hospital (Lille University Hospital), Professor of Pediatrics at the University of Lille.
Could you explain to us how the diagnosis of gluten intolerance is made?
D.T:In children with symptoms, digestive or not, we perform a total immunoglobulin A assay as well as an anti-transglutaminase immunoglobulin assay (anti-Tg IgA). These two examinations are common practice in a city laboratory and are reimbursed by social security.
If the anti-Tg IgA level is more than 10 times the upper limit of normal for the laboratory, the gluten-free diet can be started immediately, without an intestinal biopsy, but if and only if the child has also anti-endomysial IgA (another biomarker for celiac disease) and carries the HLA haplotype DQ2 or DQ8. If these two criteria are not met, an intestinal biopsy is performed by fibroscopy to confirm the diagnosis.
If the biopsy shows villous atrophy, a gluten-free diet is started.
In adults, the increase in anti-Tg IgA, whatever its importance, requires for the moment the realization of an intestinal biopsy. If it shows villous atrophy, the gluten-free diet can begin.
What do you think is the appropriate treatment for gluten intolerance?
D.T:Reference should be made to national, European and international recommendations. In the event of gluten intolerance, the only solution that is intended to apply, and this, in a definitive way, that is to say for life, is the gluten-free diet.
Would you recommend a gluten-free diet for children?
D.T:We have to distinguish between children who suffer from gluten intolerance and those who have no particular sensitivity to gluten. In the first case, the gluten-free diet is of course recommended. In the second, if the child does not suffer from any gluten-related symptoms, there is no particular reason to impose a strict gluten-free diet which can be complicated and costly for families.
