What is Gluten Sensitivity?
Gluten sensitivity, also referred to as Non-Celiac Gluten Sensitivity (NCGS), Wheat Sensitivity, or Non-Celiac Wheat Sensitivity (NCWS), has been a subject of substantial interest and controversy within the health and medical community.
The complexities of gluten sensitivity diagnosis, treatment, and overall understanding can be overwhelming to patients and practitioners alike. The term "non-celiac gluten sensitivity" first surfaced in the 1970s. It was used to describe patients suffering from a form of chronic diarrhea that improved upon adopting a gluten-free diet, despite the absence of celiac disease.
In 2010, the term was reintroduced to describe individuals who experienced a variety of gastrointestinal and extra-intestinal symptoms after consuming gluten, and in whom celiac disease, wheat allergy, and other major organic intestinal and extra-intestinal disorders have been excluded.
The clinical presentation of NCGS can be multi-systemic, with a wide range of signs and symptoms, including bloating, abdominal pain, irregular bowel movements, headaches, brain fog, and fatigue. Interestingly, the latency between gluten ingestion and the appearance of symptoms is usually quite short, typically within hours or days.
Gluten Sensitivity Vs. Wheat Sensitivity
While symptoms in NCGS are triggered by consumption of gluten-containing cereals, the offending dietary proteins have not yet been definitively identified. They could include components different from gluten itself, such as amylase-trypsin inhibitors (ATIs), wheat germ agglutinin, or even FODMAPs.
Celiac Disease Vs. Gluten Sensitivity
Celiac disease is an autoimmune disorder triggered by gluten consumption in genetically predisposed individuals. The immune response results in inflammation and damage to the small intestine, leading to malabsorption of nutrients.
On the other hand, gluten sensitivity is a less severe condition where the immune system reacts to the ingestion of gluten, but the intestinal lining doesn't suffer damage. Although the symptoms of both conditions can overlap, the potential for long-term damage to the body differs significantly.
While celiac disease can be diagnosed through blood tests and a biopsy of the small intestine, gluten sensitivity does not have a definitive diagnostic test and is often diagnosed by exclusion — ruling out celiac disease, wheat allergy, and other gastrointestinal disorders.
There are a couple of functional medicine tests that can diagnose celiac disease and gluten sensitivity, they are the Cyrex Array 3x and the Vibrant Wellness Wheat Zoomer.
These tests give a detailed analysis of wheat and gluten intolerance and the Wheat Zoomer also has leaky gut markers so you can assess the damage that gluten may have caused.
Not everyone has to avoid gluten, this is where testing can be valuable to avoid unnecessary gluten restriction.
Diagnosis of Gluten Sensitivity
When suspecting a gluten-related disorder, it's crucial to conduct a full work-up to exclude celiac disease and wheat allergy. This should occur while patients continue to consume gluten. Other organic gastrointestinal conditions, like inflammatory bowel disease and lactose intolerance, should arguably also be ruled out.
A specific biomarker for NCGS is currently lacking, complicating diagnosis. As such, patients are asked to identify and track 1-3 main symptoms over a six-week gluten-free period and during a gluten-challenge phase. A significant reduction in the baseline score for these symptoms indicates a positive response.
Advanced gluten testing - if your not sure if you are gluten sensitive, have a wheat allergy, or celiac disease, then the most comprehensive tests that you can do are the Cyrex Array 3 OR the Wheat Zoomer
If you combine the Cyrex Array 3 with the Array 4 you can also test for gluten cross-reactive foods to get a complete picture of whether there are certain foods to eliminate, reduce or you are fine to eat.
To test if you have the genes for gluten sensitivity or celiac disease I recommend doing the SelfDecode genetic testing. SelfDecode has over 200 reports on many different health conditions, including evidence based recommendations to help improve your health.
Prevalence of Gluten Sensitivity
Due to the lack of a disease-specific biomarker, the overall prevalence of NCGS is unclear. Estimates suggest that it occurs in about 2% of the population, although self-reported gluten sensitivity can be up to 13%. It predominantly affects females in their late 30s and 40s, with a female to male ratio of more than 5:1.
The transglutaminase markers are indicative of celiac disease
Treatment of Gluten Sensitivity
A strict gluten-free diet is typically the first line of treatment. However, it's unclear if long-term, strict avoidance of all gluten-related products is necessary, as NCGS may be transient. Gluten tolerance should be reassessed, often suggested after several months to a year on a gluten-free diet.
Patients with gluten sensitivity may also require gut-healing, anti-inflammatory interventions. Dysbiosis, or microbial imbalance, is another potential cause of gluten sensitivity. Treating this can lead to better gluten tolerance in some individuals.
A low FODMAP diet has also been suggested, with preliminary studies indicating decreased gastrointestinal symptoms in patients undergoing such a diet. However, gluten-free diets remain the mainstay of treatment.
Is Gluten Inappropriately Demonized?
The assertion that gluten damages the gut of healthy individuals is largely based on a handful of in vitro studies, causing some to question whether we should base dietary recommendations for the entire human population off of these findings.
Renowned gluten researcher Dr. Alessio Fasano suggests that while some people clearly need to avoid gluten, for most, it's not necessary. Fasano emphasizes that the human body, for the most part, copes with gluten just fine, engaging in a constant, controlled reaction with it.
In conclusion, gluten sensitivity is a real condition.
While the short-term solution may be to avoid gluten, it's important to rule out other contributing factors and treat the underlying cause. A one-size-fits-all approach is not appropriate for this complex and multi-faceted health issue.
Testing with the Cyrex Array 3 test or the combination of Array 2, 3 and 4 is the best option to assess what is exactly happening, you need to be eating gluten before doing these tests.
However if you eliminate gluten and find that you feel 100 % better then you may not need to do further testing, especially if you are happy to continue to avoid gluten.
Other tests to consider would be the GI Map stool test or the Vibrant Wellness Gut Zoomer to assess for gut pathogens, dysbiosis and other intestinal health markers.
The Vibrant Wellness Gut Zoomer can be combined with the Wheat Zoomer for a discounted price, you can find out more here