What are the missions and main actions of AFDIAG?
B.J.: The AFDIAG – French Association of Gluten Intolerants (a 1901 law nonprofit) – aims to inform, support, and advocate for people with celiac disease, dermatitis herpetiformis (the skin form of celiac disease), non-celiac gluten sensitivity, their families, caregivers, healthcare professionals, the food industry, and public authorities.
Backed by a Medical Committee of 42 gluten-related pathology specialists, the association shares cutting-edge research to guide those affected.
AFDIAG disseminates information via its quarterly magazine, Newsletter, annual medical conference reports, guides, and special editions. We host regional meetings, training sessions, and nutritional education programs for children, teens, and adults.
Our hotline and headquarters office (open five days a week) provide dedicated listening support. The www.afdiag.fr website features restricted areas for doctors and dietitians, plus a members-only forum and social media channels (Facebook, Twitter, Instagram) for community engagement and public outreach.
What are the different forms of gluten intolerance?
B.J.: Three distinct gluten-related conditions exist, each with unique mechanisms:
– Celiac disease (CD), or true gluten intolerance, affects about 1% of the population but is often underdiagnosed. This autoimmune disorder causes villous atrophy in the small intestine, impairing nutrient absorption and leading to issues like iron-deficiency anemia or calcium-related demineralization. Symptoms can be atypical or absent. A strict, lifelong gluten-free diet is essential.
– Wheat allergy, which is rare, triggers an immediate immune reaction (e.g., hives, asthma, angioedema) shortly after wheat consumption. It differs entirely from CD.
– Non-celiac gluten sensitivity involves discomfort after eating gluten-containing foods in those without CD or allergy, and no villous atrophy. Mechanisms remain unclear, with no established diagnostic criteria. Recent studies suggest its prevalence rivals CD.
There are more and more people sensitive to gluten. Can we speak of a real collective awareness?
B.J.: Let's reassure: these conditions affect only a small fraction of the population, though awareness has grown. For CD (1% prevalence), just 10-20% are diagnosed – much work remains. Rising reports of non-celiac gluten sensitivity (negative CD tests) spark debate. Factors under study include improved diagnostics and FODMAP sensitivity (fermentable sugars like fructans in gluten grains), which overlap with irritable bowel syndrome symptoms (affecting 10-20% of people).
What do you think will be the future of the gluten-free market in France?
B.J.: Gluten-free products (breads, pastas, flours, biscuits) were developed to simplify life for those with CD – enabling a celiac child to enjoy pasta alongside siblings, or bread and snacks safely. Over 20 years, these innovations have transformed dietary management. Non-celiac sensitivity may expand their use. Better diagnosis drives demand, but trends fuel explosive growth. Without evidence of gluten's harm to the general population (proven only for CD and allergies), fashion may fade, yet the market – valued at ~€60 million in France by late 2017, with 20% annual growth for five years – persists and increasingly offers organic options.
Interview with Dominique Turck, MD, Head of Gastroenterology and Pediatric Nutrition at Jeanne de Flandre Hospital (Lille University Hospital), Professor of Pediatrics at the University of Lille.
Could you explain how the diagnosis of gluten intolerance is made?
D.T.: For symptomatic children (digestive or otherwise), we test total IgA and anti-transglutaminase IgA (anti-Tg IgA) – routine, reimbursed blood tests.
If anti-Tg IgA exceeds 10x the lab's upper normal limit, plus positive anti-endomysial IgA and HLA-DQ2/DQ8 haplotypes, start a gluten-free diet without biopsy. Otherwise, endoscopy with biopsy confirms villous atrophy, triggering the diet.
In adults, elevated anti-Tg IgA always requires biopsy for villous atrophy confirmation before diet initiation.
What do you think is the appropriate treatment for gluten intolerance?
D.T.: Per national, European, and international guidelines, the sole, lifelong treatment is a strict gluten-free diet.
Would you recommend a gluten-free diet for children?
D.T.: Only for those with confirmed gluten intolerance. For others without symptoms, no need for a restrictive, expensive diet absent medical indication.
