Treatment of non-celiac gluten sensitivity

In the context of diagnosis a gluten-free diet represents an important criterion for confirming NCGS. If neither celiac disease nor wheat allergy are present, a trial gluten-free diet may be introduced. If the symptoms improve within a two week period, and then occur again after a gluten challenge, NCGS is likely to be confirmed. The patient should only switch to a gluten-free diet once the diagnosis is confirmed.

Low-gluten rather than gluten-free

It has been demonstrated that patients with NCGS may be able to tolerate a small amount of gluten without developing symptoms [1]. After one or two years of a gluten-free diet, patients with NCGS can attempt to reintroduce small amounts of gluten. In contrast to celiac disease, a strict gluten-free diet is therefore not mandatory in cases of NCGS; a low-gluten diet may be sufficient to avoid symptoms. How much gluten can be eaten without any problems must be tested individually. The fact that it is not necessary to maintain a permanent gluten-free diet is a crucial difference to celiac disease, which requires strict lifelong maintenance of a gluten-free diet.
 

Amylase-trypsin inhibitors as a possible trigger

There is currently a lack of research to confirm whether gluten is the trigger of symptoms amongst patients with NCGS, or whether other fractions within gluten-containing cereal grains e.g. amylase-trypsin inhibitors (ATIs) – primarily found in wheat , are to blame [2]. Because gluten-free foods are naturally wheat-free and thus contain no ATIs, a gluten-free or low-gluten diet is generally the recommended therapy option for patients with NCGS.

FODMAPs as a possible trigger

There are suspected NCGS patients who do not respond to a gluten-free diet. Studies have indicated that a low-FODMAP diet improves symptoms in some patients with irritable bowel syndrome (IBS) [3], therefore an alternative diagnosis of IBS, treated by a low-FODMAP diet may yield results for such patients.