Food and Behaviour Research

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Nonceliac Gluten Sensitivity

Vazquez-Roque M, Oxentenko AS. (2015) Mayo Clin Proc.  90(9):1272-7. doi: 10.1016/j.mayocp.2015.07.009. 

Web URL: View this and related abstracts via PubMed here.

Abstract:

Nonceliac gluten sensitivity (NCGS) is the clinical term used to describe gastrointestinal (GI) and/or extraintestinal symptoms associated with gluten ingestion.

The prevalence of NCGS is unknown. The condition has clinical features that overlap with those of celiac disease (CD) and wheat allergy (WA). The pathophysiologic process in NCGS is thought to be through an innate immune mechanism, whereas CD and WA are autoimmune- and allergen-mediated, respectively. However, dietary triggers other than gluten, such as the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, have been implicated.

Currently, no clinical biomarker is available to diagnose NCGS. Exclusion of CD and WA is necessary in the evaluation of a patient suspected to have NCGS. The onset of symptoms in patients with NCGS can occur within hours or days of gluten ingestion. Patients with NCGS have GI and extraintestinal symptoms that typically disappear when gluten-containing grains are eliminated from their diets. However, most patients suspected to have NCGS have already initiated a gluten-free diet at the time of an evaluation.

A gluten elimination diet followed by a monitored open challenge of gluten intake to document recurrence of GI and/or extraintestinal symptoms can sometimes be helpful. If NCGS is strongly suggested, then a skilled dietitian with experience in counseling on gluten-free diets can provide proper patient education.

Additional research studies are warranted to further our understanding of NCGS, including its pathogenesis and epidemiology, and to identify a biomarker to facilitate diagnosis and patient selection for proper management.

Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

FAB RESEARCH COMMENT:

This review from the Mayo clinic represents further welcome acknowledgement from the medical establishment that non-coeliac gluten sensitivity (NCGS) is a real phenomenon.

However, as the authors emphasise, there still remain no reliable diagnostic biomarkers. Thus the only reliable assessment is the careful evaluation of symptoms in relation to dietary gluten consumption, and its exclusion.  

Gluten-free diets are not easy to achieve or follow - and furthermore, if not carefully planned, they can create or enhance nutritional deficienies or imbalances. For this reason, specialist dietary advice from a suitably qualified professional is usually needed if such diets are not to run the risk of causing additional health problems.

FAB Research followers will be aware that gluten sensitivity has long been linked to a wide range of mental health conditions and symptoms, and yet many healthcare professionals remain either unware of these links, or do not have the knowledge and expertise to advise patients on nutrition and diet.

See also