Non Coeliac Gluten SensitivtiyThere has been a notable surge in interest, as well as a fair share of controversy, surrounding gluten-free diets in recent years. Although it is well known that going gluten-free is vital in the treatment of coeliac disease or wheat allergy, more and more people are electing to become gluten-free without these diagnoses. If you suspect gluten sensitivity, what might be the benefits of eliminating it from your diet? Does it work? And are there any downsides or risks?

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The Low Down: key messages

  • Gluten is a type of protein found in wheat, barley and rye grains.
  • If you are experiencing symptoms from eating gluten, it is important to get checked for underlying coeliac disease or other serious problems first, before embarking on a gluten-free diet. The only way to diagnose Coeliac Disease (CD) is by endoscopic biopsy, although a blood test can be carried out first to see if antibodies are present. You need to still be eating gluten for these tests to be accurate.
  • There is currently limited understanding and information available regarding Non-Coeliac Gluten Sensitivity. Although it has been recognized and named as a specific condition by governing bodies, there is still no validated test for it yet: Cyrex Laboratories offers the most comprehensive test that I am aware of. It is thought that it may have some similarities with irritable bowel syndrome (IBS).
  • Although it can be beneficial for some, going gluten-free does not necessarily mean you will have a better or healthier diet. Often ‘gluten-free’ processed foods (such as biscuits or bread) can be less nutritionally balanced than gluten-containing foods.
  • Although gluten itself is not an essential nutrient, if you do elect to go gluten-free, or reduce gluten containing foods, be mindful about finding alternative ways to maintain a balanced diet. It’s always best to seek the advice of a nutrition professional or dietician if you have any concerns. Take a look at my article ‘Eating well gluten-free’ for suggestions to help you maintain a well-balanced and healthy diet whilst swerving gluten. 

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The Nitty-Gritty 

 

Definitions

Gluten is a protein found in wheat, as well as other grains, such as barley and rye.

Coeliac disease is a debilitating condition where the body’s immune system attacks itself when gluten is eaten (a so called autoimmune reaction). This damages the lining of the gut, so that nutrients fail to absorb properly. It can develop at any age and early diagnosis is important as, if left untreated, it can cause serious damage and problems that can go beyond the digestive system.

Coeliac

’Non-Coeliac Gluten Sensitivity’ (NCGS for short) is a phrase that is used to describe people who feel better when gluten is eliminated from their diet, but where coeliac disease or wheat allergy has been ruled out. We are not entirely sure yet what causes the symptoms of NCGS: it may be an increased permeability of the intestine (often referred to as ‘leaky gut’); it may be increased inflammation in the lining of the gut; it may be related to the immune system; or a number of other possibilities. Unfortunately, none of these theories are proven yet and a great deal more research is needed.

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Background

Only 1% of the population is diagnosed with coeliac disease (although the true figure is thought to be higher 1,2). In a survey of over 1000 people from the UK, however, 13% reported symptoms thought to be related to gluten sensitivity, with 3.7% following a gluten-free diet. Although NCGS is increasingly recognised as a distinct condition, we don’t yet have a reliable diagnostic test for it (please be wary of those who are supposedly offering such testing), so the exact number of people suffering from the condition is vague. We know that some are self-diagnosing NCGS but it is vital to get yourself checked for coeliac disease or other underlying problems before embarking on a gluten-free diet, as the presence of gluten in your body is needed for accurate testing. Early diagnosis of coeliac is vital to ensure that you receive appropriate long-term support & monitoring.

Symptoms of NCGS may include any of the following (after exclusion of coeliac disease or other causes) 3,4

Importantly, they occur after eating gluten, and rapidly improve when gluten is withdrawn.

  • Diarrhoea
  • Abdominal discomfort or pain
  • Bloating
  • Flatulence
  • Fatigue
  • Headache
  • Lethargy
  • Joint aches and pains
  • Dermatitis or skin rash
  • Low mood or anxiety

What about IBS (irritable bowel syndrome)?

You might have noticed that the NCGS symptoms listed above are very similar to those often experienced by people with IBS. There is a clear crossover of symptoms. So much so, in fact, that some researchers now consider NCGS to be a possible sub-type of IBS (although this is still controversial). This is because in certain scientific studies, some people with IBS (but not NCGS) felt better when they actively restricted gluten from their diets. Likewise, some people with NCGS (but not IBS) felt better when they followed a low FODMAP* diet which is often recommended for the management of IBS1.

* FODMAP stands for ‘Fermentable Oligo- Di- Mono-saccharides and Polyols’ – quite a mouthful to say – but essentially it just means avoiding specific types of carbohydrates which are poorly absorbed by the intestine. These undigested carbohydrates can lead to bloating and other gastrointestinal symptoms that are common in IBS.

Is it really the gluten that is to blame here?

This is an interesting question, as perhaps it is not just the gluten which is causing symptoms in many people with NCGS. Perhaps it is also the fact that gluten-containing grains (wheat, barley, rye) happen to be higher in FODMAPs than naturally gluten-free grains. It may therefore be the high FODMAPS in gluten grains which may lead to NGCS symptoms, at least in some people.3 More research is still needed.

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Potential benefits of going gluten-free

It is a bit beyond the scope of this article to discuss specific disease conditions where a trial of being gluten-free may be beneficial. If you feel that this is something you’d like more information on, I would suggest you seek the personalised advice of a nutrition professional to help guide you (see my FAQs page for info on finding a nutritionist).

While the nutrition jury may still be out on whether there are any conclusive benefits on a biological level in the elimination of gluten from diets, there may still be a few potential benefits on a more practical level for some.

  • Many refined snack foods (chocolate bars, cakes and biscuits) contain gluten, so eliminating such foods will help to reduce the amount of processed foods you may consume. Some people find that being gluten-free also helps them to avoid the usual temptation of such foods, too.
  • Although there is nothing inherently ‘wrong’ with wheat products, filling up on lots of simple, processed carbs (bread, toast, muffins, pasta etc.) means that we may have less appetite for more nourishing whole foods instead, such as piles of green leafy vegetables, lean proteins and healthy fats. Over-reliance on convenient gluten-containing foods is certainly a common habit I see in my nutrition practice.
  • No longer being able to rely on an over-priced sandwich or pasta salad for lunch everyday means that lots of my gluten-free clients elect to make their own packed lunches (often using last night’s leftovers, with extra greens thrown in). Cheaper, most often healthier and certainly more varied.

Please note – many people I speak to choose to go gluten-free in the hope that they will lose weight by doing so. Unfortunately, this is not necessarily an effective strategy. You can still eat an excessive amount of energy and plenty of unhealthy foods, even if it is all ‘gluten-free’! However, I do often see substantial weight loss when a client removes all grains (not just those containing gluten) from their diet- as I have written about previously. This is not right for everyone, and should only be done with an appropriate increase in plant foods (legumes, fruits and vegetables). Remember, there is no ‘one size fits all diet’, so what works for one person may not work for you!

Potential risks of going gluten-free

  • Unless it is necessary for your health, it is best not to make overly restrictive rules that completely exclude certain foods. This not only helps us to avoid excessive anxiety or worry when it comes to eating, but it also helps us to reduce the risk of developing dietary deficiencies accidentally.
  • Gluten-containing grains are not necessarily ‘bad’ or ‘unhealthy’. As well as being a source of carbohydrates, they can also provide some important plant-based protein, iron, folate and B vitamins. 5 If you do choose to go gluten-free, it is therefore important to be mindful in your approach 4 and ensure that you are eating a healthy, balanced diet.
  • There is a big difference between the array of naturally gluten-free foods (such as rice, corn, potatoes, quinoa etc.), and those that are made gluten-free by processing (such as ‘gluten-free’ bread, cereals, biscuits and cakes).
  • Gluten-free processed foods may have a higher carbohydrate (including sugar) and fat content, and less folate, iron and B vitamins than their gluten-containing equivalents – so are not always necessarily a ‘healthier’ alternative. 5
  • Gluten-free diets may also be slightly lower in fibre than a standard diet, so be careful to ensure you are getting plenty of fibre from elsewhere (which generally means lots of fresh fruits and veggies).

Naturally healthy & gluten-free foods

Corn, Rice, Sorghum, Teff, Millet, Amaranth, Quinoa, Buckwheat and Oats*

*Although oats do not contain gluten themselves, they are often contaminated with gluten in the fields or during processing – hence why you will find ‘gluten-free oats’ for sale.

Head over to my three naturally gluten grain recipes for inspiration.

Brown Rice Donburi Bowl

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Why I choose to eat gluten-free: My personal story

I first gave up gluten after attending a lecture by Dr Tom O’Bryan, who has dedicated many years to investigating gluten’s potential impact on health and autoimmune disease. I had been wheat free for a number of years – which had helped relieve my IBS symptoms – but I hadn’t gone so far as to consider gluten.

I gave it up, firstly, as an experiment in order to be able to give better guidance and advice to my clients. By day three, a huge fog had cleared from my mind that I hadn’t realised was there; I had so much more energy, too. I haven’t looked back since and I can honestly say I haven’t missed it.

I quickly learnt that the gluten-free isle was not an option, so I became familiar with alternative foods, such as gluten-free grains, as a way to enjoy all my usual meals without gluten. It isn’t so hard once you get your head around it. There is now much wider availability of gluten-free options available when I am eating out.

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Want to find out more?

Here are some great resources for further information:

References

  1. Lebwohl, B., Ludvigsson, J.F. and Green, P.H.R. (2015) ‘Celiac disease and non-celiac gluten sensitivity’, BMJ, , p. h4347. doi: 10.1136/bmj.h4347.
  2. Lis, D.M., Stellingwerff, T., Shing, C.M., Ahuja, K.D. and Fell, J.W. (2015) ‘Exploring the popularity, experiences, and beliefs surrounding gluten-free diets in Nonceliac athletes’, International Journal of Sport Nutrition and Exercise Metabolism, 25(1), pp. 37–45. doi: 10.1123/ijsnem.2013-0247.
  3. Nijeboer, P., Bontkes, H., Mulder, C. and Bouma, G. (2013) ‘Non-celiac gluten sensitivity. Is it in the gluten or the grain?’, Journal of gastrointestinal and liver diseases : JGLD., 22(4), pp. 435–40.
  4. Biesiekierski, J.R. and Iven, J. (2015) ‘Non-coeliac gluten sensitivity: Piecing the puzzle together’, United European Gastroenterology Journal, 3(2), pp. 160–165. doi: 10.1177/2050640615578388.
  5. Penagini, F., Dilillo, D., Meneghin, F., Mameli, C., Fabiano, V. and Zuccotti, G. (2013) ‘Gluten-free diet in children: An approach to a Nutritionally adequate and balanced diet’, Nutrients, 5(11), pp. 4553–4565. doi: 10.3390/nu5114553.

Bibliography

Beyond Celiac (2016) Non-celiac gluten sensitivity. Available at: www.beyondceliac.org/celiac-disease/non-celiac-gluten-sensitivity (Accessed: 11 November 2016).