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Non-Celiac Gluten Sensitivity: It’s a Thing?

Heidi James, MD, Robert Berger, MD, and Vanessa Cardy, MD
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15:16

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Non-celiac gluten sensitivity (NCGS) is a controversial  emerging clinical entity.  Individuals without celiac disease or wheat allergy can describe  IBS-like gastrointestinal symptoms as well as other manifestations like brain fog when they consume gluten containing foods. While the pathophysiology is not well understood, many, including Dr. Berger, are recognizing this as a legitimite disorder.

 

Pearls:

  • Non-celiac gluten sensitivity is likely a real thing and not just in our patients’ heads. If they have eliminated things in their diet and it has made them better without being too restrictive, go with it.

  • Diagnosis is based on history of no major red flags (rectal bleeding, weight loss, significant family history) or lab abnormalities (anemia, negative Celiac screen).

  • Treatment is elimination of the offending food. FODMAPS (fermentible oligo-, di-, monosaccharide polyol) diet may also help. See the summary below for a link to a helpful resource and more information about this diet.

 

  • Is non-celiac gluten sensitivity a thing? Yes. More research and evidence is emerging! It may fall on the spectrum of IBS.

    • There are many potential reasons for it. The idea that genetic modification of wheat or the type of gluten has not been well shown. However, it appears gluten may alter  our gut microbiome.

  • What are the symptoms? Almost every symptom has been reported.

    • Most common symptom is bloating.

    • Others: abdominal cramping, urgency and anything on the spectrum of IBS as well as mental fogginess and fatigue.

  • So what about diet? It really can make a difference. However, just because a patient is eating gluten-free doesn’t mean it is healthy. Remember to pay attention to other things such as sugar, salt and food additives.

    • FODMAPS (fermentible, oligo-, di-, monosaccharides and polyols): highly fermentable by our gut bacteria leading to gassy byproducts → bloating, cramps, distension, loose stools.

      • Recent study has shown this diet resulted in decrease of IBS symptoms in 50% of those patients who adhered to it.

      • Unfortunately following a FODMAP diet is not intuitive or easily memorized. Check out this link for helpful resources to refer patients to.

What do you need for diagnosis? No red flag symptoms (weight loss, rectal bleeding), no significant family history and no worrisome lab abnormalities (anemia, Celiac screen negative). Further work-up is probably overkill.

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My Gut Biome Told Me So Full episode audio for MD edition 174:19 min - 82 MB - M4AHippo Primary Care RAP May 2017 Summary 301 KB - PDF

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