Gluten sensitivity is becoming more prevalent and gaining greater acceptance from the medical community.
Non-coeliac gluten sensitivity (NCGS) is determined in cases where serum and intestinal findings classically found in patients with coeliac disease (CD) are not present, yet signs and symptoms that are commonly attributed to CD are experienced. These reported signs and symptoms occur after ingestion of foods containing gluten and ameliorate within days or weeks of eliminating gluten from the diet.
Clinical manifestations of NCGS can include gastrointestinal pain and discomfort, bloating, constipation and/or diarrhoea, cloudy head, joint pain, fatigue, weight loss and anaemia.
Current emerging evidence demonstrated links between gluten sensitivity and symptomatic reactions from nearly every organ in the body. Several recent studies even suggest a relationship between gluten ingestion and neuropsychiatric disorders such as autism and schizophrenia.
A recent double-blind, placebo-controlled, randomised rechallenge trial observed patients with diagnosed irritable bowel syndrome (who had been excluded from coeliac disease), who experienced symptomatic relief and control on a gluten free diet. Gluten (two slices of bread and one muffin daily) or placebo were given over six weeks alongside a gluten free diet. Effects were measured using a VAS scale and markers of intestinal inflammation and immune activation were observed. In the gluten group 68% reported that symptoms were not satisfactorily controlled during the trial period, compared to 40% of the placebo group. Patients in the gluten group were significantly worse, even after one week of the trial period, for overall symptoms – bloating, pain, stool consistency and fatigue.
Overall exact prevalence of NCGS is hard to measure as many people self-diagnose and eliminate gluten from their diet without medical consultation and without the biopsy to know whether or not they have CD.
New epidemiological studies confirm that this disorder is not uncommon. In New Zealand, 5% of children reported non-coeliac related gluten evasion. A gluten free diet has been associated with non specific behavioural improvement and elimination of gastrointestinal symptoms.
More studies are needed to greater understand NCGS – to understand how to properly distinguish between NCGS, irritable bowel syndrome and wheat allergy; to understand rate of occurrence; and how levels of sensitivity can differ between individuals. But evidence is certainly mounting of the growing rate of gluten sensitivity and its potential health outcomes.
- Catassi C, Bai J, Bonaz B, et al. Non-celiac gluten sensitivity: the new frontier of gluten related disorders. Nutrients 2013;5(10):3839-3853. [Full Text]
- Biersiekierski J, Newnham E, Irving P, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind,randomised, placebo controlled trial. Am J Gastroenterol 2011;106(3):508-514. [Abstract]