Non-Coeliac Gluten Sensitivity

There are many cases of coeliac disease which have not been diagnosed, but what about those who experience symptoms similar to coeliac disease but do not have the autoimmune disease? One potential diagnosis is non-coeliac gluten sensitivity or gluten sensitivity, which some individuals may be diagnosed with. Even though there are similar symptoms to coeliac disease, it has not been identified how potentially or if the immune system is involved in gluten sensitivity, as no antibodies are produced, and there is no damage to the intestinal lining.  

Is gluten sensitivity the same as an allergy to wheat?  

No, it is not. A wheat allergy is caused by a reaction triggered by the immune system to proteins which are found in wheat and occurs very soon after the consumption of wheat (usually within seconds or minutes).  

Symptoms of gluten sensitivity 

As mentioned, the symptoms are similar to that of coeliac disease including:  

• Bloating 
• Abdominal pain 
• Diarrhoea 
• Constipation 
• Nausea 
• Fatigue 

So, if non-coeliac gluten sensitivity isn’t coeliac disease and it isn’t a wheat allergy, what is it? 

Gluten sensitivity is a fairly new area, so more research is needed to identify and truly understand what gluten sensitivity is and its clinical features, and how to diagnose and treat it. There are currently no specific diagnostic tests that can be used to diagnose non-coeliac gluten sensitivity, as there are no antibodies which have been identified as being specific or sensitive to gluten sensitivity in either saliva, stool or blood testing. 

As it is not known what actually causes non-coeliac gluten sensitivity, there is some question that it may not actually be gluten which is causing the symptoms for those with gluten sensitivity, but instead something else within wheat. Below are some of the other triggers which may be the cause of non-coeliac gluten sensitivity.  

Usually when we hear about FODMAP (fermentable oligo-, di-, and mono-saccharides, & polyols) we think about IBS and the Low FODMAP Diet. There is some research which indicates that perhaps FODMAPs may be causing the symptoms instead of gluten. FODMAPs are poorly digestible carbohydrates, and wheat, barley and rye (which all contain gluten) are high in FODMAPs. Should you follow a low FODMAP diet? A low FODMAP diet should be assisted by a dietitian or your GP who can guide you through, as low FODMAP isn’t meant to be ongoing. There is also evidence that FODMAPs would not cause the inflammatory response in those with non-coeliac gluten sensitivity but could worsen the symptoms.  

α-amylase trypsin inhibitors are a family of albumins, which make up a part of wheat protein. They help to defend the plant against parasites and insects by inhibiting their digestive enzymes. These have been shown to contribute to the symptoms of non-coeliac gluten sensitivity. 

Microbial lipopolysaccharide is another theory with, lipopolysaccharide the majority of the cell wall in Gram-negative bacteria and can stimulate inflammation. In the intestine the consumption of foods which contain α-amylase trypsin inhibitors, activates a protein in the cell membrane in our body (known as TLR4), which stimulates inflammation that resembles that from lipopolysaccharides. In healthy individuals it is made inactive in the body, however in the cases of where there is gut barrier dysfunction, this is not that case, and lipopolysaccharide are found to be higher in those with gastrointestinal disorders.  

As you can see from the above the true cause of non-coeliac gluten sensitivity hasn’t been identified, and it appears that it may not even be gluten itself. More research is being conducted around the area.  

If you are experiencing symptoms on coeliac disease when you eat wheat, barley or rye, and you think you may be reacting to gluten, it is important to get tested for coeliac disease. Do not just cut out gluten without speaking to your GP, as when testing for coeliac disease you need to be eating gluten for the tests to actually work. If the results come back as negative for coeliac disease, your GP will be able to work out what else may be causing your symptoms, including non-coeliac gluten sensitivity. Seeing a doctor is so important when you are experiencing gastrointestinal symptoms, or any symptoms, as they can make the correct diagnosis, and can treat you accordingly.  

Please note that coeliac disease, and non-coeliac gluten sensitivity are not the only conditions that are related to gastrointestinal issues, this tip is just discussing non-coeliac gluten sensitivity. Please speak to your GP before cutting out gluten.  

To read more about coeliac disease, please click here for our blog.

Daisy, MSc PGDip ANutr, is a Registered Associate Nutritionist with a Master's Degree in Public Health Nutrition, and a Post Graduate Diploma in Eating Disorders and Clinical Nutrition, both of which are Association for Nutrition (AFN) accredited. She, also, has a BSc degree in Psychology and Cognitive Neuroscience; and has completed an AFN accredited Diet Specialist Nutrition course.

Daisy has worked for an NHS funded project, the Diabetes Prevention Programme; and shadowed a nutritionist in Harley Street. 

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