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A Lesser-Known Gluten Sensitivity

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There’s no question that “going gluten-free” is the dietary trend of the day, with sales of gluten-free products estimated to be about $2.6 billion in the United States. Gluten is the main protein in wheat, barley and rye. It is ubiquitous in our food supply, found in such fare as bread, cereal, pasta, pizza, couscous, bulgur and beer.

However, banning gluten—in effect, an entire food group—is at odds with the advice from nutrition and medical experts to increase the consumption of whole grains in the diet as a means of improving health and fighting chronic diseases. A gluten-free diet can also be lacking in key nutrients, such as thiamine, riboflavin, niacin, folate and iron.

Given these concerns, who really needs to go gluten-free? Until recently, that question was fairly easy to answer: people with celiac disease and people with a wheat allergy who were also allergic to other gluten-containing grains. Over the past decade, however, a new classification has emerged—non-celiac gluten sensitivity (NCGS)—an intolerance to gluten. A growing body of research suggests that this problem is real and that people with NCGS might benefit from reducing their gluten consumption.

What is non-celiac gluten sensitivity?

According to a 2015 report in Gastroenterology, there is “increasing and undisputable evidence” for NCGS’ existence. Typical symptoms of NCGS include bloating, stomach pain, diarrhea or constipation and nausea. Symptoms appear within hours or days of ingesting gluten-containing foods and disappear quickly when these foods are eliminated from the diet. Nongastrointestinal symptoms, including headache, lack of energy, joint and muscle pain and “foggy” brain, have also been noted.

Diagnosis is difficult, as there are no blood tests or other ways to identify the condition. However, in addition to the symptoms previously discussed, the presence of other clues may suggest NCGS; for example, many people with gluten intolerance are intolerant to other foods, such as cow’s milk or eggs. They also tend to have a history of allergy dating back to childhood. Also, while some of the gastrointestinal symptoms are similar to those experienced by people with irritable bowel syndrome (IBS), the presence of nongastrointestinal symptoms (not experienced by everyone with NCGS) makes it easier to rule out IBS as a cause.

In spite of doctors’ improved understanding of NCGS, questions remain, including why it occurs and how many people it truly affects. Current estimates suggest that 0.6 to 6 percent of the population may have NCGS. The condition occurs most commonly among women in their 20s and 30s, but it can arise at any age.

Why does it occur?

At this point, researchers aren’t really sure. Early evidence suggests that NCGS is the result of an aberrant immune system response to gluten, although not the same type of response seen in celiac disease or other autoimmune disorders in which the body turns on itself, or an allergic reaction, which occurs when the immune system overreacts to a harmless substance. In addition, some researchers believe there may be a genetic component to the problem.

Clearly, more research is needed to help doctors better understand why some people develop NCGS and what the long-term implications of having the condition are. For now, the good news is that it does not appear to be associated with serious adverse effects, such as poor absorption of nutrients from foods or intestinal damage, and it is not life-threatening.

Getting a diagnosis

NCGS is diagnosed by excluding both celiac disease and wheat allergy. Many individuals self-diagnose and treat the condition by reducing gluten-containing foods in their diets. However, before you eliminate gluten from your diet, it’s important to get tested for celiac disease and wheat allergy to rule those conditions out; otherwise those test results may be inaccurate.

If you don’t have celiac disease or a wheat allergy but you are experiencing symptoms suggestive of NCGS, experts advise keeping a food diary. Record your symptoms in response to your regular diet, including gluten-containing foods for 10 to 14 days. Then continue the food diary while you eliminate all gluten- and wheat-containing foods for another 21 days. Finally, do a food challenge: Start reintroducing suspect foods into your diet one at a time to see if they trigger symptoms.

If you are gluten intolerant, you’ll want to focus your diet on naturally gluten-free foods such as fruits, vegetables, beef, poultry, fish, nuts and eggs. You can still consume grains that don’t contain gluten, such as amaranth, buckwheat, corn, millet, quinoa, rice, sorghum and teff, as well as flax, lentils, potatoes and soy. Many experts also believe oats (if they are from a source that has not been contaminated by wheat, rye or barley) are not harmful to people with NCGS and even most individuals with celiac disease, and they are a source of significant, much-needed nutrients in the diet. A host of commercially prepared gluten-free products are also now available, and they are far more palatable than they were in the past. It’s important, however, to check the labels of these products to see what they contain. To replace gluten, many products are higher in sugar, calories and fat than their regular counterparts, which may actually cause weight gain.

Finally, if you’re following a gluten- or wheat-free diet, it’s a good idea to talk to your health care provider or a nutritionist to see if you should be taking a multivitamin to ensure you’re getting all of the nutrients your body needs. And since it’s unclear if gluten sensitivity is a permanent condition, think about reintroducing gluten and wheat products back into your diet periodically—say, annually—to determine if you’re still sensitive to them. 

Posted in Digestive Health on January 22, 2016

Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Health After 50 Disclaimer

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Health After 50 Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the editors cannot be answered in this space.

The views expressed here do not constitute medical advice, and do not represent the position of Scientific American Health After 50 or Remedy Health Media, LLC, which has no responsibility for any comments posted on this site.

I've been NCGS for over 20 years and I find corn/maize is just as bad as wheat. They symptom you don't mention is atrial fibrillation, which wheat etc cause in me- and it's the only thing that starts it off for me.

Also, you don't mention the root flours that people can eat eg potato starch, tapioca, cassava etc. They're invaluable in an NCGS life.

What upsets me is that now wheat isn't in everything, corn/maize is. There is an increasing incidence of corn/maize intolerance.

I wish someone would cure the condition. It sets you apart in many ways and some people won't socialise with you because of your limitations. They think you're being fussy about food.

I think it's the new forms of wheat, maize etc which are not good for humans. They're pest and human resistant!

Posted by: Shannah | January 22, 2016 7:11 PM

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