As with coeliac disease, the therapy for non-coeliac gluten sensitivity (NCGS) is to avoid gluten. However, it is not generally necessary to maintain a gluten-free diet as strictly or for as long as in the case of coeliac disease. It is important that the patient only begins a gluten-free diet after the diagnosis.
In the context of diagnosis a gluten-free diet represents an important criterion for confirming NCGS. If neither coeliac disease nor wheat allergy are present, a trial gluten-free diet may be introduced. If the symptoms improve within a two week period, and then occur again after a gluten challenge, NCGS is likely to be confirmed. The patient should only switch to a gluten-free diet once the diagnosis is confirmed.
Low-gluten rather than gluten-free
It has been demonstrated that patients with NCGS may be able to tolerate a small amount of gluten without developing symptoms . After one or two years of a gluten-free diet, patients with NCGS can attempt to reintroduce small amounts of gluten. In contrast to coeliac disease, a strict gluten-free diet is therefore not mandatory in cases of NCGS; a low-gluten diet may be sufficient to avoid symptoms. How much gluten can be eaten without any problems must be tested individually. The fact that it is not necessary to maintain a permanent gluten-free diet is a crucial difference to coeliac disease, which requires strict lifelong maintenance of a gluten-free diet.
Amylase-trypsin inhibitors as a possible trigger
There is currently a lack of research to confirm whether gluten is the trigger of symptoms amongst patients with NCGS, or whether other fractions within gluten-containing cereal grains e.g. amylase-trypsin inhibitors (ATIs) – primarily found in wheat , are to blame . Because gluten-free foods are naturally wheat-free and thus contain no ATIs, a gluten-free or low-gluten diet is generally the recommended therapy option for patients with NCGS.
FODMAPs as a possible trigger
There are suspected NCGS patients who do not respond to a gluten-free diet. Studies have indicated that a low-FODMAP improves symptoms in some patients with irritable bowel syndrome (IBS) , therefore an alternative diagnosis of IBS, treated by a low FODMAP diet may yield results for such patients.
- Catassi C, Elli L et al. Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts' Criteria. Nutrients. 2015 Jun 18;7(6):4966-77.
- Junker, Y. et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J. Exp. Med. 209, 2395–2408 (2012).
- Biesiekierski, J. R. et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 145, 320–328 (2013).