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Non-Coeliac Gluten Sensitivity and Bloating
Posted 6 months ago by Katie
If you suffer from long term digestive problems such as bloating, flatulence, and stomach cramps, and have been tested by your doctor for coeliac disease but given the all clear, you may be one of many who are now suffering from a condition known as non-coeliac gluten sensitivity (NCGS), and so could benefit from reducing or eradicating gluten from your diet.
Gluten-related disorders include coeliac disease, wheat allergy, IBS, and non-coeliac gluten sensitivity.
Coeliac disease is an autoimmune condition where gluten must be avoided because it causes inflammation and damages the lining of the small intestine. You can harbour a genetic predisposition to coeliac disease, and up to 40% of the general population carry the HLA-DQ2 or HLA-DQ8 genes, which has been associated with the condition, but does not guarantee that you will go on to develop coeliacs. Coeliac disease is characterised by an immune response to dietary gluten, a protein found in wheat, rye, barley, and other grains, leading to inflammation and damage to the intestinal lining of the G.I. tract. This leads to many symptoms including malabsorption, fatigue, bloating, diarrhoea, skin rashes, anaemia and weight loss.
Gluten is comprised of two proteins, gliadin and glutenin. Wheat allergy is an IgE-mediated reaction to the gliadin found in wheat products. The onset of symptoms can range from minutes to hours after ingestion, so sometimes it can be difficult to pinpoint whether it was the gluten you were reacting to. Common symptoms include itching in the ears, nose, and throat, skin rashes, and wheezing.
Irritable Bowel Syndrome (IBS) is a common disorder characterised by GI symptoms such as bloating, abdominal pain, changeable bowel movements, and gas. Symptoms can be managed with diet, lifestyle, and a reduction of stress. There are many causes attributed to IBS, including chronic stress, food allergy/intollerance, leaky gut, bacterial infection, and changes in the gut bacteria (microbiome).
What is non-coeliac gluten sensitivity?
Non-coeliac gluten sensitivity (NCGS), or non-coeliac wheat sensitivity (NCWS), is an emerging clinical condition causing IBS related symptoms similar to those in coeliac disease, in response to ingestion of gluten-containing cereals. These symptoms resolve when gluten is removed from the diet, however sufferers will not test positive for coeliac disease or IgE-mediated wheat allergy. The condition is associated with G.I. symptoms, most commonly including bloating, abdominal pain, diarrhoea, alongside other symptoms such as muscle pain, brain fog, fatigue, and anxiety. People with a gluten sensitivity will develop symptoms after the ingestion of gluten, but not as adverse or acute as those with coeliac disease.
A person with a gluten intolerance can’t digest the protein portion of many commonly eaten grains. When this protein is ingested, it combines with the enzyme transglutaminase to form an immune complex, which deposits on the lining of the intestines. The body recognizes this as a foreign substance, and begins an immune reaction to the complex. Immune cells enter into the area and release a series of toxins to try to “kill” this unidentified immune complex. These toxins from the immune system cause inflammation in the digestive system and damage the tissues that line the gastrointestinal tract. This is what causes unexplained digestive symptoms like bloating, diarrhoea, constipation, gas, and cramping, and is also responsible for feelings of fatigue and malaise after a meal containing these foods.
The prevalence of this condition is estimated to be greater than that of coeliac disease (which is 1%) but often goes undiagnosed. Gluten sensitivity may affect 6-10% of the general population.
Research into non-coeliac gluten sensitivity
Non-coeliac gluten sensitivity is something that is being recognised as a problem in many countries across the world, but more research is needed to understand the condition and who is at risk. Current evidence for this condition suggests that gluten is a causative factor, however there is still speculation as to whether it is the gluten or other components in the wheat such as the FODMAPS. FODMAPS are a group of carbohydrates that are poorly absorbed in certain people, causing IBS-like symptoms. For more on this please read 'Recent research blames FODMAPs for bloating.' Some researchers have noted an improvement in symptoms when following a gluten-free diet. A study by Biesiekierski et al. was the first randomised, controlled trial to suggest that non-coeliac IBS patients might benefit from a gluten-free diet. Pain and bloating were significantly worse in subjects after ingestion of gluten.
A randomised, double-blind, placebo-controlled trial, published in The American Journal of Gastroenterology, demonstrated that gluten worsened the functional symptoms in non-coeliac gluten-sensitive (NCGS) patients, from whom coeliac sufferers were excluded.1 Other studies have reported intestinal cell damage and immune activation after ingestion of gluten-containing cereals, and in the absence of a coeliac diagnosis.
Should I avoid gluten altogether if I suspect I have NCGS?
There is a lot of confusion around NCGS because gluten sensitivity, like IBS, is a symptom-based condition of diverse pathogenesis. If you are experiencing symptoms when eating foods that contain wheat, barley, rye or oats and suspect you have a sensitivity to gluten, it’s important to first rule out coeliac disease by getting tested by your doctor. For coeliacs, the only known treatment is a lifelong, strict gluten-free diet. Coeliac disease, non-coeliac gluten sensitivity, and wheat allergy are medical conditions and types of food hypersensitivities that can be treated using the appropriate diet, with elimination of either gluten or wheat.
Science is beginning to validate the notion that even those who do not have coeliac disease may benefit from a gluten-free diet. In a study2 looking at the incidence of autoimmune thyroid issues in patients with coeliac disease, NCGS, IBS, and a healthy control, they found that the incidence of autoimmune thyroid disease was increased equally in coeliacs and in those with non-coeliac gluten sensitivity. The healthy controls, and those with IBS, did not have an increased incidence of autoimmunity. They also found that antinuclear antibodies (ANA), a marker for autoimmunity, were in fact higher in the NCGS group, thus showing the damaging long-term effects of gluten intake compared with the coeliacs, who adhere to strict gluten-free diets. What’s worrying about these findings is that the damaging effects of gluten intolerance could be occurring inside your gut for your entire life, without you even knowing about it.
Due to lack of diagnostic testing for for NCGS, it is advisable to reduce your consumption of gluten-containing foods or eliminate completely for a given period and see if your symptoms improve. I see many clients displaying symptoms of gluten intolerance in my clinical practice, and so I often advise clients to avoid gluten for 4-6 weeks to see if symptoms improve.
How can I support my gut if I suspect I have a gluten intolerance?
If you identify yourself as gluten intolerant and have decided to embark on a gluten-free diet there are some things you can do to help reset your gut and speed up the process of 'healing and sealing'. A damaged, inflamed gut lining caused by the ingestion of gluten can be supported by eating certain foods that nourish the digestive system, as well as taking supplements that speed up the process of healing.
Getting gut health in order is the real key to solving any food digestion or sensitivity problems over the long-term! A big part of the problem facing westerners today is an imbalanced gut environment caused by the increasing processed foods, pesticides, sugars, vegetable oils, antibiotics and other pharmaceuticals we are exposed to. Another contributing factor that I consider a problem is the mechanised and hybridised bread production that renders the wheat indigestible, all for the sake of quick baking times. All of these factors upset the balance of good bacteria (probiotics) in the digestive system. When the gut is in a dysbiotic (bacteria is not balanced) state, gluten proteins can harm the intestinal tract, causing irritation and inflammation, and can eventually lead to leaky gut. Gut bacteria such as Bifidobacteria and Lactobacillus are often referred to as “good bacteria” as they exert health-promoting properties. For more information on leaky gut and how to modulate intestinal permeability please read 'Functional Foods for Leaky Gut and Bloating.'
One of my favourite gut allies in healing our guts is is a friendly probiotic yeast called Saccharomyces Boulardii. Saccharomyces boulardii reduces inflammation in the gastrointestinal tract and increases the number of brush border enzymes along the intestinal wall which are responsible for the absorption of nutrients from the diet. This friendly yeast, which derives from the skin of the lychee fruit, also supports the secretion of IgA, a vital part of our immune defence which is often inhibited by gluten intake in individuals who are intolerant.
Saccharomyces Boulardii was one of 8 probiotic organisms used in a longitudinal study looking at the therapeutic effects of oral administration of probiotics on the overall symptoms of NCGS patients. The study published in The Journal of Human Nutrition and Food Science found improvements in symptoms and, in some cases, complete remission of symptoms, suggesting promising support for their role in gut health.
Sourdough bread is often tolerated well by people with a gluten intolerance, as the dough contains a starter culture of live microorganisms whereby the gluten is broken down and fermented during the resting period before baking. The traditional sourdough process neutralizes the anti-nutrients in the wheat grains as the flour is kept moist and acidic for many hours (or days). Some preliminary evidence has shown that the traditional sourdough method may actually sever the bonds of the “toxic” peptides in wheat gluten responsible for the coeliac reaction, and neutralize them as well. Increased intestinal permeability was found in coeliac patients who consumed regular commercial bread, compared with no markers after consuming sourdough over the same period.
Prebiotics are a food source for your body's probiotics (good bacteria) and can be found in foods such as garlic, onion, artichokes, sweet potato, asparagus, and leeks. These foods contain special types of indigestible fibre such as inulin, resistant starch and fructooligosaccharides, which suppress the growth of pathogenic bacteria and may help to modulate intestinal permeability. If you think of your gut as a garden of probiotics, the probiotics fertilise your friendly bacteria and help to keep them flourishing for the benefit and health of your body. They share a symbiotic relationship and a delicate balance is required for optimal gut health.
"We need [prebiotics] in our diet as they ‘feed’ our good bacteria [probiotics], so they can continue to flourish within our digestive system and ward off bad bacteria as well as support our immune system, mental health, skin, energy levels and everything else in between."
You may also be interested in reading the following articles:
1 Carrocio, A et al. (2012) Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity. 'The American Journal of Gastronenterology' [online] Vol 107 pp. 1898-1906 Available at:https://www.nature.com/articles/ajg2012236 [Accessed: 3/11/2018]
2 Carrochio, A et al. (2015) High Proportions of People With Non coeliac Wheat Sensitivity Have Autoimmune Disease or Antinuclear Antibodies. 'Gastroenterology'. Vol. 149(3) pp. 596-603. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26026392 [Accessed: 3/11/2018)
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