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Gluten Sensitivity

What is Gluten Sensitivity?

Gluten sensitivity or Non Celiac Gluten Sensitivity (NCGS) is a condition where people who ingest gluten experience symptoms similar to those found in Irritable Bowel Syndrome or Celiac Disease. These symptoms usually improve when gluten is removed from the diet.[1] Symptoms can include “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, headaches, and chronic fatigue.[2]

Unlike celiac disease, this condition does not cause damage to the small intestines. Therefore, a small intestine biopsy will not show damaged villi. Since NCGS is not an autoimmune related disorder, there is no increase in tissue transglutaminase (tTG) antibodies. Also people who have this disorder do not have to posses the HLA-DQ2 and/or DQ8 genes that must be present for celiac disease to exist.

NCGS should not be confused with a wheat allergy as there is no immune response by the body typically seen in an allergic response.

There has been some controversy as to whether NCGS actually exists. However, Stefano Guandalini, MD, director of the University of Chicago Celiac Disease Center states, “These patients absolutely do exist; they do have real symptoms. We have to believe the patient when they tell us that they actually have experienced side effects when they eat gluten.”[3] There is also mounting evidence that this condition is to be taken seriously.[4]

Diagnosis Of Non-Celiac Gluten Sensitivity

A process of exclusion is used to diagnose NCGS. Celiac experts recommend that a wheat allergy and celiac disease be ruled out first. Dr. Joseph Murray of the Mayo Clinic in an upcoming book titled Mayo Clinic Going Gluten Free lists the essential requirements for diagnosis of non-celiac gluten sensitivity.[5]

  • Negative blood tests for celiac disease and no sign of damage on an intestinal biopsy.
  • Symptom improvement when gluten is removed from the diet.
  • Recurrence of symptoms when gluten is reintroduced.
  • No other explanation for the symptoms.

Dangers to a False Diagnosis of Non-Celiac Gluten Sensitivity

Celiaccentral.com provides this quote from Daniel Leffler, MD, MS, Director of Clinical Research, The Celiac Center at BIDMC, Director of Quality Assurance, Division of Gastroenterology, Beth Israel Deaconess Medical Center:

“Since the only treatment for NCGS is a gluten-free diet, as long as you receive proper nutritional counseling and keep a healthy balanced diet, there is no danger to this treatment. However, it is important to recognize that many gastrointestinal diseases present with similar symptoms, so the real danger is that in assuming a person has NCGS, they are not evaluated appropriately and a more serious illness is missed and allowed to progress untreated.” [6]

Treatment Of Non-Celiac Gluten Sensitivity

The only treatment available for NCGS is following a gluten-free diet, which excludes all wheat, barley, rye and cross-contaminated oats.

Non-Celiac Gluten Sensitivity and FODMAP’s

There appears to be some research that NCGS may be associated with poor digestion of FODMAP’s. FODMAP’s is an acronym for “Fermentable Oligo-, Di, Mono-saccharides and Polyols.” These carbohydrates are commonly found in the modern western diet. Wheat, barley and rye are high in FODMAP’s. There is one research study available here.[7]

Footnotes  

[1] https://www.biomedcentral.com/1741-7015/9/23

[2] https://celiac.org/celiac-disease/non-celiac-gluten-sensitivity/#AvDgS78TUXEX257g.99

[3] https://www.webmd.com/digestive-disorders/celiac-disease/features/gluten-intolerance-against-grain

[4] https://www.jgld.ro/2013/4/12.pdf

[5] https://well.blogs.nytimes.com/2014/10/06/when-gluten-sensitivity-isnt-celiac-disease/

[6] https://www.celiaccentral.org/non-celiac-gluten-sensitivity/testing-and-diagnosis/

[7] https://www.ncbi.nlm.nih.gov/pubmed/23648697

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