Non-Celiac Gluten Sensitivity (NCGS)

Non-celiac gluten sensitivity (NCGS) is a medical condition characterized by symptoms similar to celiac disease, but without the same level of immune system activation and intestinal damage. People with NCGS experience adverse reactions to gluten, a protein found in wheat, barley, and rye, but do not test positive for celiac disease or wheat allergy.

Definition and Diagnosis

NCGS is defined as a condition in which individuals experience symptoms that improve when gluten is removed from the diet, but do not have celiac disease or a wheat allergy. The diagnosis of NCGS is made by excluding other conditions, such as celiac disease, irritable bowel syndrome (IBS), and small intestine bacterial overgrowth (SIBO), and by observing an improvement in symptoms when gluten is removed from the diet.

Symptoms

The symptoms of NCGS can vary widely, but common complaints include:

• Bloating and abdominal pain
• Diarrhea or constipation
• Fatigue
• Headaches
• Joint pain
• Nausea and vomiting
• Skin rashes

Pathophysiology

The exact mechanisms underlying NCGS are not fully understood, but several theories have been proposed. These include:

• Increased gut permeability, allowing toxins to pass through the intestinal lining and trigger an immune response
• Activation of the innate immune system, leading to inflammation and tissue damage
• Alterations in the gut microbiome, which can contribute to symptoms such as bloating and abdominal pain

Treatment and Management

The primary treatment for NCGS is a gluten-free diet. This involves avoiding foods that contain wheat, barley, and rye, and seeking out gluten-free alternatives. In some cases, additional therapies may be recommended, such as:

• Probiotics to support gut health
• Pain management medications for symptoms such as abdominal pain and headaches
• Nutritional supplements to address any underlying deficiencies

Prevalence and Demographics

NCGS is estimated to affect approximately 0.5-6% of the general population, although the exact prevalence is difficult to determine due to variations in diagnostic criteria and study methodologies. NCGS can affect individuals of any age, sex, or ethnicity, but is more commonly reported in females and individuals with a family history of autoimmune disorders.