When Gluten is the Reason: Non-Celiac Gluten Sensitivity
Gluten-free diets have exploded in popularity in recent years. For many, shunning gluten provides welcome relief from a range of mysterious symptoms. But you don’t need to have celiac disease to react negatively to this infamous protein. There is a condition known as non-celiac gluten sensitivity (NCGS) that researchers are now taking seriously.
What is NCGS?
NCGS involves experiencing gastrointestinal, inflammatory, neurological or other symptoms that improve when following a gluten-free diet. This occurs in the absence of celiac disease or wheat allergy. Estimates suggest NCGS may affect up to 6% of the population. The symptoms can vary between individuals but commonly include:
- Abdominal pain, bloating, irregular bowel habits
- Headaches, brain fog, tingling extremities
- Fatigue, lower back and joint pain
- Anaemia, recurrent oral thrush, skin issues
- Anxiety, depression and mood disorders
The Link to Autoimmunity
There is an established association between NCGS and autoimmune conditions. About 50% of those with NCGS also have another autoimmune disorder. The reason is unclear, but gluten may help trigger or sustain autoimmune reactions in those with genetic risk factors. Autoimmune diseases strongly linked to NCGS include:
- Hashimoto’s thyroiditis
- Rheumatoid arthritis
- Type 1 diabetes
- Sjögren’s syndrome
Additionally, those with NCGS often have markers of autoimmunity like elevated ANA and thyroid antibodies in the absence of diagnosed autoimmune disease.
The Gut-Brain Connection
There is evidence that the inflammation caused by gluten in those with NCGS can trigger symptoms in the brain as well as the gut. This is due to the gut-brain axis. Gluten can cause intestinal permeability (leaky gut), allowing compounds to enter the bloodstream and affect the nervous system. Neurological manifestations like brain fog, anxiety, and headaches may stem from this process.
Links to Fibromyalgia
NCGS and fibromyalgia share some similar symptoms, such as fatigue, joint pain, and gastrointestinal distress. This overlap in symptoms has led some researchers and healthcare providers to explore potential connections.
Studies show a higher prevalence of NCGS markers in people with fibromyalgia. Eliminating gluten has been found to improve fibromyalgia symptoms in some patients, even without celiac disease. It is hypothesized that gluten-related inflammation may trigger or exacerbate pain pathways and fatigue.
Why the seeming increase in non-celiac gluten sensitivity?
- Hybridization and modifications to wheat over the decades resulting in higher, more immunogenic gluten content seem a plausible contributor. Modern wheat is very different from the ancestral wheat of a century ago. Extensive cross-breeding has occurred to increase yields and gluten content leading to modern wheat varieties that possess higher levels of gluten compared to the older strains. The new proteins may be more immunogenic.
- Changes in dietary habits, including the increased frequency and quantity of gluten consumption, may contribute to the rising prevalence of gluten-related issues.
- Intestinal microbiome – Changes in our GI microbiome composition compared to past generations could increase susceptibility to gluten reactions and inflammation. Causes may include antibiotics, sanitation, and diet.
- Diagnosis bias – We’re simply diagnosing more cases of NCGS now that awareness has increased. But a true increase can’t be ruled out.
- About GMOs – There are concerns about GMO wheat varieties being developed, though none are approved for commercial growing yet. Some research shows GMO food proteins have different immunotoxic effects. This is controversial but GMO wheat could hypothetically increase immune reactivity.
Identifying NCGS
Since there are no definitive biomarkers, NCGS is mainly identified through a patient’s history and response to a strict gluten-free diet. Formal diagnosis involves ruling out celiac disease and wheat allergy first. Those with NCGS usually feel significantly better within weeks to months of gluten elimination. Reintroducing gluten should worsen symptoms if NCGS is present.
The bottom line is that you don’t need to have celiac disease or a wheat allergy to feel unwell from gluten. Pay attention to how you feel after meals containing gluten. If chronic symptoms resolve with gluten elimination, NCGS may be the culprit.