Non-coeliac gluten sensitivity (NCGS)
A condition in which a person has symptoms after eating gluten and improves by removing it, without having coeliac disease or a wheat allergy.
NCGS is a diagnosis of exclusion: it is defined by what it is NOT, neither coeliac disease (no gut damage or autoantibodies) nor wheat allergy (no IgE). Yet the people affected feel real symptoms after gluten: bloating, pain, fatigue, headaches, “brain fog”. Estimated prevalence: 1 to 6% of the population.
An original angle (the real culprit may be elsewhere): NCGS is controversial because there is no biomarker. Research is exploring several fascinating leads:
- It may not be gluten but FODMAPs: wheat contains fructans (a type of FODMAP). Studies show that some “gluten-sensitive” people actually react to fructans, not gluten. They feel better gluten-free… because they are also cutting out fructans.
- ATIs (amylase/trypsin inhibitors): other wheat proteins that could activate innate immunity.
- An increase in intestinal permeability (leaky gut) has been observed.
A major practical implication: before banning gluten for life, you should first rule out coeliac disease (tests BEFORE stopping gluten), then possibly try a supervised low-FODMAP diet. Many people needlessly give up gluten when the problem lies elsewhere (FODMAPs, dysbiosis).
A gluten-free diet is restrictive and costly, and can create deficiencies (fibre, B vitamins) if poorly managed. It should not be adopted lightly on the basis of self-diagnosis.