The group of disorders related to gluten also includes gluten sensitivity (celiac disease) in the traditional sense, which was first accurately described in the 1980s, but nowadays it has become the focus of interest again and more and more research is being published on the topic. Non-celiac gluten sensitivity (NCGS), on the other hand, is an entity characterized by intestinal and extraintestinal symptoms associated with gluten consumption in individuals where celiac disease and wheat allergy have been ruled out. The frequency of occurrence of NCGS in developed countries can be put at 6-13 percent, however, there are no exact data, because many people start eating gluten-free after self-diagnosis, without having previously undergone a medical examination. In order to prevent associated diseases, it would be important to know whether someone suffers from celiac disease or NCGS. Because in celiac disease of autoimmune origin, damage to the small intestine can be detected, and in most cases associated diseases can also occur (e.g. thyroid insufficiency, diabetes or lactose sensitivity).
The diagnosis of NCGS is complicated by the fact that it does not have markers that can be detected by blood tests, it does not cause changes that can be verified by intestinal biopsy, and there are no associated diseases. The marked symptoms characteristic of non-celiac gluten sensitivity usually appear within a short time – up to 20 minutes – after consuming gluten, which is not so typical of the classic celiac version. These complaints decrease when gluten is removed, but they return again when gluten-containing foods are reintroduced into the diet. Some people also suspect a wheat allergy because of these complaints.
Bowel symptoms of NCGS include abdominal pain, bloating, diarrhea and/or constipation, loud bowel movements, frequent belching, nausea, and stomachburn. NCGS can also cause well-being complaints: headaches, fatigue, difficulty concentrating, muscle and joint pain, mood swings or even depression. Furthermore, sensitivity to gluten can manifest itself in skin symptoms, such as skin rashes or eczema. In children, NCGS is most often associated with abdominal pain and chronic diarrhea, and non-gastrointestinal symptoms are relatively rare. Although it is undisputed that in some cases the positive effect of eliminating gluten can be explained by the placebo effect, this is not true for NCGS. A double-blind, randomized, placebo-controlled trial found that gastrointestinal symptoms of NCGS were more common in the gluten-treated group than in the placebo group. Several studies have concluded that some of the patients with irritable bowel syndrome (IBS) can be associated with NCGS, meaning that eliminating gluten can also reduce the symptoms of IBS.
Despite the name and definition, it has been shown that gluten is responsible for the onset of gastrointestinal and extraintestinal symptoms in only 16-30% of non-celiac gluten-sensitive patients. In addition to gluten, other components of wheat also play a role in the development of NCGS-related complaints. These components include fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (collectively known as FODMAPs) found in gluten-containing grains, legumes, dairy products, sweeteners, and many vegetables and fruits. FODMAPs can be insufficiently absorbed in the small intestine for those who are sensitive to them, and these poorly digested carbohydrates are fermented by intestinal bacteria, which is accompanied by gas formation and can cause bloating, abdominal pain and cramps or diarrhea.
The researchers came to the conclusion that a low FODMAP diet can also help alleviate the symptoms experienced in NCGS. Furthermore, the results also suggest that the simultaneous use of a gluten-free and low-FODMAP diet has an additional beneficial effect.
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