- Non-celiac gluten sensitivity - causes
- Non-celiac gluten sensitivity - symptoms
- Non-celiac gluten sensitivity - diagnosis
- Non-celiac gluten sensitivity - treatment
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Non-celiac gluten sensitivity is a type of gluten intolerance that we don't know much about at the moment, except that its symptoms are similar to those of another gluten-intolerant disease. Non-celiac gluten sensitivity also causes diagnostic problems, as there are currently no laboratory markers that could help in its diagnosis. Find out what the symptoms of non-celiac gluten sensitivity are, how to recognize it and how to treat it.
Contents:
- Non-celiac gluten sensitivity - causes
- Non-celiac gluten sensitivity - symptoms
- Non-celiac gluten sensitivity - diagnosis
- Non-celiac gluten sensitivity - treatment
Non-Coeliac Gluten Sensitivity (NCGS) is a new disease entity from the group of gluten-related diseases.
Gluten-dependent diseases result from intolerance to gluten - a protein found in grains. Until recently, they included two diseases: celiac disease and allergy to wheat (and specifically wheat proteins), but recently they were joined bynon-celiac gluten hypersensitivity.
Although the exact incidence of NCGS is unknown, it is believed that it may be much more common than celiac disease, and may be as high as 6%. Western populations.
Non-celiac gluten sensitivity - causes
The causes of non-celiac gluten sensitivity are not fully understood. Many scientists believe that NCGS may be a common name for many different disease entities.
It is believed that, in addition to gluten, other wheat proteins, such as alpha-amylase and trypsin inhibitors and agglutinins, which may activate the immune system to release pro-inflammatory cytokines, may be involved in the development of the disease. However, it is not fully known whether the immune system is involved in the NCGS pathomechanism at all.
The causes of NCGS also include the contribution of non-protein components of wheat, such as small fermentable oligosaccharides and polyols (FODMAPs, monosaccharides and polyols).
It has been found that some people with NCGS respond well to the olow FODMAPs content, which applies, among others, to in the treatment of irritable bowel syndrome.
People suffering from NCGS experience a significant reduction in symptoms after implementing such a diet. Researchers explain that the clinical picture of NCGS very often resembles irritable bowel syndrome, which may partly explain the response to a diet low in FODMAPs.
According to another hypothesis, NCGS may be a transient disease that disappears after the causative agent is eliminated, such as viral and bacterial infections, stress or pregnancy.
In this context, more and more is said about intestinal dysbiosis, i.e. disturbance of the microbiological balance of the intestines, e.g. bacterial overgrowth syndrome in the small intestine (SIBO).
Research shows that commensal bacteria can "aid" the digestion of gluten, and too little of them can result in symptoms of gluten intolerance.
Some researchers cite the nocebo effect as the cause of NCGS, in which the symptoms are psychosomatic, resulting from a negative attitude towards gluten and belief that it causes chronic symptoms.
Non-celiac gluten sensitivity - symptoms
The symptoms of NCGS appear in the patient several hours or days after contact with gluten. Symptoms can be divided into intestinal and parenteral. The intestinal symptoms include:
- flatulence (87%)
- stomach pains (83%)
- diarrhea (50%)
- nausea and vomiting (44%)
- bouncing (36%)
- heartburn (32%)
- constipation (24%)
Parenteral symptoms are:
- not feeling well (68%)
- chronic fatigue (64%)
- headaches (54%)
- anxiety and anxiety (39%)
- problems with concentration (38%)
- numbness in the limbs (32%)
- joint and muscle pains (31%)
- skin problems (29%)
- weight loss (25%)
- depression (18%)
Characteristic for gluten-dependent diseases, such as celiac disease or NCGS, is the presence of extraintestinal symptoms related to the nervous system. Scientific research links the incidence of NCGS to autism, schizophrenia and bipolar disorder.
Gluten (specifically gliadin, i.e. proteins that are part of gluten) in its biochemical structure resembles endorphins, i.e. hormones that affect opioid receptors in the nervous system.
- Duhring's disease, i.e. a cutaneous manifestation of gluten intolerance
It is believed that gluten can similarly bind to opioid receptors in the brain and stimulate it adversely, responsible for symptoms such as fatigue, anxiety,problems with concentration. Very often gluten is referred to in this context as "gluteomorphine" or "gliadorphine".
Although this hypothesis is extremely interesting and may explain the formation of extraintestinal symptoms in NCGS, it still requires scientific verification.
Non-celiac gluten sensitivity - diagnosis
Currently, there are no diagnostic markers for NCGS, which makes it difficult to make a correct diagnosis. Difficulties in diagnosis result from the not entirely clear cause of NCGS. Research by Branchi et al. Showed that gastroenterologists in 44% of cases are not able to make a clear diagnosis of NCGS.
Additionally, celiac disease and NCGS are not distinguishable by symptoms alone. The first step in the NCGS diagnostic process is to rule out celiac disease and wheat allergy.
The determination of anti-tissue transglutaminase (anti-tTG) antibodies, wheat-specific IgE antibodies and intestinal biopsy are used in this case. The above-mentioned antibodies are absent in NCGS, and no histopathological changes are found in the intestinal biopsy.
- Celiac disease: genetic tests
Then, after excluding other gluten-related diseases, the patient should go gluten-free for at least 6 weeks and monitor their symptoms. After a minimum of 3 weeks, gluten can be challenged by reintroducing it into the diet.
If a patient does not respond to the NCGS gluten-free diet, the NCGS is excluded. Of course, it is ideal to conduct such diagnostics in controlled clinical conditions to exclude the placebo effect. However, such a procedure is quite expensive and not always available.
Despite the lack of laboratory markers for NCGS, there are studies that can be helpful in making the diagnosis. Half of people with NCGS have G-class antibodies (anti-AGA IgG).
In addition, the HLA-DQ2 and DQ8 genetic polymorphisms used in the diagnosis of predisposition to celiac disease are more common in people with NCGS than in the general population.
Non-celiac gluten sensitivity - treatment
At the moment we don't know if NCGS is curable. The only available method of relieving NCGS symptoms is a strict gluten-free diet.
In addition, research indicates that some people may benefit from a diet low in FODMAPs.
References
1. Volta U. et al. Study Group for Non-Celiac Gluten Sensitivity. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. "BMC Med" 2014; 12: 85.2.Igbinedion S.O. et al. Non-celiac gluten sensitivity: All wheat attack is not celiac. "World J Gastroenterol." 2022 Oct 28; 23 (40): 7201-7210. 3. Branchi F. et al. Management of Nonceliac Gluten Sensitivity by Gastroenterology Specialists: Data from an Italian 4. Survey. "Biomed Res Int." 2015; 530136.5. Leonard M. M. et al. Celiac Disease and Nonceliac Gluten Sensitivity: A Review. "JAMA" 2022, 15, 318 (7), 647-656.6. Karabin K. Diagnostics of gluten-dependent diseases "Contemporary Nutritionist" 16 / 2018.
About the author
Karolina Karabin, MD, PhD, molecular biologist, laboratory diagnostician, Cambridge Diagnostics Polska A biologist by profession, specializing in microbiology, and a laboratory diagnostician with over 10 years of experience in laboratory work. A graduate of the College of Molecular Medicine and a member of the Polish Society of Human Genetics. Head of research grants at the Laboratory of Molecular Diagnostics at the Department of Hematology, Oncology and Internal Diseases of the Medical University of Warsaw. She defended the title of doctor of medical sciences in the field of medical biology at the 1st Faculty of Medicine of the Medical University of Warsaw. Author of many scientific and popular science works in the field of laboratory diagnostics, molecular biology and nutrition. On a daily basis, as a specialist in the field of laboratory diagnostics, he runs the content department at Cambridge Diagnostics Polska and cooperates with a team of nutritionists at the CD Dietary Clinic. He shares his practical knowledge on diagnostics and diet therapy of diseases with specialists at conferences, training sessions, and in magazines and websites. She is particularly interested in the influence of modern lifestyle on molecular processes in the body.
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