What is Non-celiac gluten sensitivity?
Non-celiac gluten sensitivity (NCGS) is a disorder that can cause both gastrointestinal and other problems. It is included in the spectrum of gluten-related disorders and is characterized by symptoms that are similar to those of celiac disease, but without the same level of immune system activation and intestinal damage.
History and Diagnosis
The definition and diagnostic criteria of NCGS were debated and established by three consensus conferences. However, as of 2019, there remained much debate in the scientific community as to whether NCGS was a distinct clinical disorder. The diagnosis of NCGS is made by exclusion of other gluten-related disorders such as celiac disease and wheat allergy, as there is no available biomarker for diagnosing this condition.
Symptoms and Pathogenesis
The pathogenesis of NCGS is not well understood, but the activation of the innate immune system, the direct cytotoxic effects of gluten, and probably other wheat components, are implicated. There is evidence that not only gliadin (the main cytotoxic antigen of gluten), but also other proteins called amylase-trypsin inhibitors (ATIs) which are present in gluten-containing cereals (wheat, rye, barley, and their derivatives) may have a role in the development of symptoms. ATIs are potent activators of the innate immune system. FODMAPs, especially fructans, are present in small amounts in gluten-containing grains and have been identified as a possible cause of some gastrointestinal symptoms in NCGS patients.
Prevalence and Recognition
NCGS is the most common syndrome of gluten-related disorders with prevalence rates between 0.5–13% in the general population. However, due to the lack of a clear diagnosis and the "fad component" to the recent rise in popularity of the gluten-free diet, many people with NCGS are often unrecognized by both functional disease and celiac disease specialists, leading to a lack of adequate medical care and treatment. They often have a long history of health complaints and unsuccessful consultations with physicians, and thus many resort to a gluten-free diet and a self-diagnosis of gluten sensitivity.
Relationship to Other Conditions
NCGS has been linked to a range of conditions, including irritable bowel syndrome (IBS), fibromyalgia, neurological disorders, and dermatitis. However, the exact relationship between NCGS and these conditions is not well understood and requires further research.
The Gluten-Free Diet
The gluten-free diet has become increasingly popular in recent years, with many people adopting it as a way to manage symptoms of NCGS. However, the evidence for the effectiveness of the gluten-free diet in managing NCGS symptoms is limited, and more research is needed to fully understand its benefits and risks.
FAQ
What is the prevalence of Non-celiac gluten sensitivity? Non-celiac gluten sensitivity is the most common syndrome of gluten-related disorders with prevalence rates between 0.5–13% in the general population.
How is Non-celiac gluten sensitivity diagnosed? The diagnosis of Non-celiac gluten sensitivity is made by exclusion of other gluten-related disorders such as celiac disease and wheat allergy, as there is no available biomarker for diagnosing this condition.
What are the symptoms of Non-celiac gluten sensitivity? The symptoms of Non-celiac gluten sensitivity can include gastrointestinal problems, as well as neurological disorders, fibromyalgia, psychological disturbances, and dermatitis.