Exposure to Different Amounts of Dietary Gluten in Patients with Non-Celiac Gluten Sensitivity (NCGS): An Exploratory Study

Abstract

It is unclear whether patients with non-celiac gluten sensitivity (NCGS) can tolerate gluten. We have evaluated the changes of both gastrointestinal symptoms and quality of life for NCGS patients after the re-introduction of dietary gluten. Twenty-two NCGS patients reporting functional gastroenterological symptoms and on gluten-free diet (GFD) for the previous three weeks were exposed to incremental gluten-containing diets. Three groups were compared at baseline (immediately after 3-weeks on GFD) and immediately after the return of symptomatology: (i) a group tolerating a low-gluten diet (3.5 g gluten/day, week 1, n = 8), (ii) a group tolerating a mid-gluten diet (8 g gluten/day, week 2, n = 6), and (iii) a group tolerating a high-gluten diet (13 g gluten/day, week 3, n = 8). Their gastrointestinal symptoms and quality of life were assessed at baseline and post-intervention. The most common symptoms were: constipation (46%), abdominal pain (50%) and dyspepsia (38%). A decrease in several short form health survey (SF-36) sub-scores (all p < 0.03) after gluten re-introduction was only observed in the group tolerating the low-gluten diet; the same group showed a lower post-intervention role-emotional SF-36 score (p = 0.01). Most gastrointestinal symptoms remained similar after gluten re-introduction. However, a decrease in the general perception of well-being was only found after gluten re-introduction in the group tolerating a low-gluten diet (p = 0.01); the same was true when comparing the post-intervention general well-being perception among the three groups (p = 0.050). In conclusion, dissimilar responses from patients with NCGS were observed after the re-introduction of gluten, with gluten at a low dosage affecting the quality of life and general well-being of a group of patients, whereas others tolerate even higher doses of dietary gluten.

Self-Reported Non-Celiac Gluten Sensitivity in Brazil: Translation, Cultural Adaptation, and Validation of Italian Questionnaire

“…In people who suffer from gluten-related disorders, these symptoms are frequently associated as a consequence of food restriction, and not as a symptom caused by gluten ingestion [10]. It is noteworthy that our results are similar to the literature in which the NCGS symptoms commonly found include bloating, abdominal pain, diarrhea, epigastric pain, nausea, aerophagia, lack of well-being, tiredness, headache, foggy mind, and anxiety [5,8,10,14,37].…”

“…Currently, due to the lack of specific biomarkers to diagnose NCGS, its diagnosis involves the elimination of CD and WA, followed by a gluten-free diet (GFD), and then a challenge with gluten-containing food. The exclusion is followed by assessing the reduction/remission of symptoms after a strict adherence to a GFD, and observing if symptoms return or worsen with gluten consumption [2,4,5]. Therefore, the diagnostic criteria for NCGS should include self-reported gluten intolerance, negative CD serology and no WA [1,2,6].…”

Non-Celiac Gluten Sensitivity: A Review

“…Roncoroni et al conducted a study on dietary exposure to different amounts of gluten in patients meeting the criteria of the NCGS [53]. Researchers observed different reactions of patients after the introduction of gluten.…”

Comparative quantitative LC–MS/MS analysis of 13 amylase/trypsin inhibitors in ancient and modern Triticum species

“…This activation of innate immunity is dose-dependent and may result in NCGS symptoms in susceptible individuals as well as worsening of other pre-existing inflammatory reactions 2 , 4 . The symptoms of NCGS can be both gastrointestinal (e.g., abdominal pain, diarrhea, bloating) and extra-intestinal (e.g., headache, chronic fatigue, depression) and disappear or improve on a gluten-free diet 5 – 8 . Apart from ATIs, other components have been discussed to cause NCGS, such as gluten peptides and proteins as well as fermentable oligo-, di- and monosaccharides and polyols (FODMAPs) 9 – 13 .…”