Celiac disease is a debilitating condition. It is characterized by the damage of the intestinal villi, or the tiny hair-like structures that line your intestines. Since most nutrient absorption happens in the small intestines, this damage leads to extreme nutrient deficiency and severe consequences if the patient continues to consume gluten. The damage sometimes is very difficult to reverse even if the patient stops eating gluten. Celiac disease is not common but, usually, the patient WILL seek medical care when they suffer from this condition. What about people who don't react vigorously to gluten? They don't seek medical attention because their symptoms are "mild"? What if they don't know that their eczema, IBS, or autoimmune symptoms are exacerbated by non-celiac gluten sensitivity?
There is a big controversy in the nutrition world when it comes to NCGS: Non-Celiac Gluten Sensitivity. Experts who spent decades studying gluten have reached some interesting conclusions that I'm hoping to clarify in this article.
First, let's distinguish between an allergy and a sensitivity. An allergy is an acute response. It is usually a vigorous reaction that requires immediate interference. Wheat allergy is an example. However, a "sensitivity" is usually non-specific and less severe than an allergy. It could present as many different symptoms. This makes a sensitivity more difficult to correlate with the food in question. Experts agree that non-celiac gluten sensitivity is not the correct terminology for this condition because the sensitivity could be a result of the exposure of other components in wheat, not only gluten. They require that this label be changed in the future.
Symptoms
The "classic symptoms" of NCGS are gastrointestinal. They include abdominal pain, bloating, and constipation or diarrhea. The systemic symptoms include brain fog, skin rash or eczema, general fatigue, joint pain, muscle pain, and numbness in the extremities (1). These symptoms occur a few minutes to a few days after gluten ingestion, subside when the person stops gluten and re-occur soon after gluten-reintroduction.
Mood disorders have been associated with gluten sensitivity since the 1950s (2). Scientists have discovered an association between gluten and schizophrenia, bipolar disorders, autism (3), and even anxiety and depression (4). However, studies in this area have not been conclusive.
Testing
There is currently no available gluten sensitivity test that is 100% conclusive or reliable. The most famous test, the IgG food sensitivity panel, gives an indication of some of the foods a person might be sensitive to. However, it does not give the full picture; and the results may not be correct if the patient is already avoiding the food in question. There are other immune reactions in the body. For example, IgA-mediated responses happen in the mucous membranes like the lining of the gut. Some tests combine both IgG and IgA; but those are quite expensive. IgE responses happen in the presence of an allergic reaction. Your body might react to proteins in wheat other than gluten. Reactions to chemicals like glyphosate, or mycotoxins will not show on a food sensitivity panel.
Wheat amylase trypsin inhibitors (ATIs) are a family of proteins that are difficult to digest by the intestines. Wheat ATIs have also been studied in vitro for the possibility of contributing to the immune response in NCGS. (5)
Irritable Bowel Syndrome
It is currently unknown if NCGS is a permanent condition or a treatable one. However, the interest in studying this condition is becoming more prevalent. Irritable Bowel Syndrome (IBS) is one of the diseases that has been studied in connection with NCGS (6). Other studies confirmed the possibility of the exacerbation of IBS by FODMAPS (Fermentable oligo-, di-, monosaccharides, and Polyols) or sugars that are found in wheat and other food components (7). These studies indicate that dietary interventions are safe and effective in the treatment or alleviation of diseases that affect the quality of life.
Autoimmune Conditions
NCGS has also been linked to autoimmune conditions like Hashimoto's thyroiditis, rheumatoid arthritis, and ulcerative colitis. The mechanism involves the increase in intestinal permeability induced by gliadin, the main gluten antigen (8).
Baker's Asthma
Baker's asthma is a condition characterized by inflammation in the eyes and the skin, runny nose, cough, and difficulty in breathing. It affects bakers who work with wheat flour and inhale its dust on a daily basis (9).
In my opinion, the best way to know if you're sensitive to gluten or wheat, in general, is an elimination diet. Eliminate wheat completely for at least one month and then reintroduce it again. If gastrointestinal or systemic symptoms reappear, you know for sure that you are sensitive to a certain ingredient in the wheat you consume. In that case, it won't matter which ingredient! And in that case, avoiding the food that causes inflammation in your unique body will allow your body to relax, lose weight, and fight diseases.
Finally, you need to know that not everyone is sensitive to gluten. If you have an autoimmune disease or are suffering from a chronic condition, it doesn't hurt to try and eliminate gluten to see how your body feels. If you are looking for more research on this subject, read Dr. Alessio Fasano's research. His team is focused on researching this subject in particular.
If you suspect NCGS and don't know where to start, book your first consultation session here.
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References:
1. Catassi C, Bai JC, Bonaz B, et al. Non-Celiac Gluten sensitivity: the new frontier of gluten-related disorders. Nutrients. 2013;5(10):3839-3853. Published 2013 Sep 26. doi:10.3390/nu5103839. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820047/
2. Casella G, Pozzi R, Cigognetti M, et al. Mood disorders and non-celiac gluten sensitivity. Minerva Gastroenterol Dietol. 2017;63(1):32-37. doi:10.23736/S1121-421X.16.02325-4
3. Alonso Canal L, Isasi Zaragoza C, Colmenero Blanco I, Martínez Gómez MJ, Arcas Martínez J. Rasgos clínicos sugestivos de trastorno del espectro autista como manifestación de sensibilidad al gluten no celíaca [Clinical features suggesting autism spectrum disorder as a manifestation of non-celiac gluten sensitivity]. An Pediatr (Barc). 2014;81(6):409-411. doi:10.1016/j.anpedi.2014.02.021
4. Lionetti E, Leonardi S, Franzonello C, Mancardi M, Ruggieri M, Catassi C. Gluten Psychosis: Confirmation of a New Clinical Entity. Nutrients. 2015;7(7):5532-5539. Published 2015 Jul 8. doi:10.3390/nu7075235
5. Makharia A, Catassi C, Makharia GK. The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity: A Clinical Dilemma. Nutrients. 2015;7(12):10417-10426. Published 2015 Dec 10. doi:10.3390/nu7125541 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690093/
6. Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011;106(3):508-515. doi:10.1038/ajg.2010.487
7. Molina-Infante J, Santolaria S, Montoro M, Esteve M, Fernández-Bañares F. Sensibilidad al gluten no celiaca: una revisión crítica de la evidencia actual [Non-celiac gluten sensitivity: a critical review of current evidence]. Gastroenterol Hepatol. 2014;37(6):362-371. doi:10.1016/j.gastrohep.2014.01.005 https://www.elsevier.es/es-revista-gastroenterologia-hepatologia-14-articulo-sensibilidad-al-gluten-no-celiaca-S021057051400051X
8. Aaron Lerner, Yehuda Shoenfeld, Torsten Matthias, Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease, Nutrition Reviews, Volume 75, Issue 12, December 2017, Pages 1046–1058, https://doi.org/10.1093/nutrit/nux054
9. Stanisław Kwiatkowski , Grzegorz Czerwiński , Elżbieta Poniewierka , Ewa Waszczuk, Spectrum of gluten-related disorders: celiac disease, wheat allergy, baker’s asthma and non-celiac gluten sensitivity, Worl Scientific News, Volume 11, P. 154-164, 2018, http://yadda.icm.edu.pl/yadda/element/bwmeta1.element.psjd-c981d1f5-856d-46a9-ae83-434fbf85c22d
