Symptoms of NCGS can include bloating, abdominal pain, diarrhea, constipation, headache, fatigue, joint pain, and a "foggy mind." These symptoms typically improve when gluten is removed from the diet and return upon reintroduction of gluten. Unlike celiac disease, NCGS does not cause damage to the small intestine, and there are no specific biomarkers for its diagnosis.
The exact cause of NCGS is not well understood, but it is believed to involve an immune response to gluten or other components of wheat, such as amylase-trypsin inhibitors (ATIs) and fermentable carbohydrates (FODMAPs). The condition is more common in females and can occur at any age.
Diagnosis of NCGS is made by excluding celiac disease and wheat allergy through appropriate testing and observing symptom improvement on a gluten-free diet. While the condition remains controversial and debated within the scientific community, it is recognized as a legitimate clinical entity that requires proper management and care.
Recent research has provided new insights into NCGS. A study from Columbia University revealed that individuals with NCGS exhibit a distinct immune response, different from that seen in celiac disease, suggesting a unique inflammatory process in the gut in response to gluten.
The role of FODMAPs in NCGS has also been explored. Some studies suggest that symptoms attributed to gluten may actually be due to FODMAPs, which are poorly absorbed carbohydrates found in various foods, including wheat. This has led to discussions about whether a low-FODMAP diet might be beneficial for some individuals diagnosed with NCGS.
The prevalence of NCGS varies widely, with estimates ranging from 0.49% to 14.9% in different populations. This variability may be due to differences in study methodologies and the subjective nature of symptom reporting.
The diagnosis of NCGS remains challenging due to the lack of specific biomarkers. The Salerno Experts' Criteria recommend a double-blind placebo-controlled gluten challenge to confirm the diagnosis, involving a one-week gluten challenge followed by a one-week washout period and then a crossover to a placebo or gluten challenge. A symptom variation of at least 30% between the gluten and placebo phases is considered indicative of NCGS.
Management of NCGS primarily involves adherence to a gluten-free diet, which has been shown to alleviate symptoms in affected individuals. However, the strictness of the diet may vary among individuals, and some may benefit from a low-FODMAP diet if FODMAPs are identified as symptom triggers.
In conclusion, while NCGS is a recognized condition with a range of symptoms, its exact mechanisms and optimal management strategies continue to be areas of active research. Individuals experiencing symptoms suggestive of NCGS should consult healthcare professionals for appropriate evaluation and personalized dietary guidance.
Non-Celiac Gluten Sensitivity: Symptoms and Causes
