Letzte Aktualisierung am 4. September 2024 von Dr. Michael Zechmann-Khreis
Non-celiac gluten sensitivity (NCGS) has been discussed since the early 200s. Originally, it was thought to be a condition in which those affected experience symptoms from eating gluten without suffering from coeliac disease or a wheat allergy1. It is also sometimes referred to as non-celiac disease non-wheat allergy sensitivity. Other triggers have also been considered, not just gluten. FODMAPs, ATI or various protein components have been and are being discussed 2-4. Another hypothesis is that a weakened intestinal barrier could play a role5.
The current guideline on celiac disease therefore recommends using the term non-celiac wheat sensitivity (NZWS) instead of non-celiac gluten sensitivity (NZGS) 6.
So what triggers the complaints?
This remains the subject of scientific debate. So far, we only know that the symptoms are not triggered by a single substance such as gluten, FODMAPs, ATI or fructans. However, we also know that the one-sided avoidance of these substances is more bad than good for those affected. For example, those on a low FODMAP diet may experience short-term improvement, but their quality of life is severely (and unnecessarily) restricted and the gut microbiome is impoverished7. In the long term, this does more harm than good.
It has often been recommended to use old wheat varieties such as spelt, einkorn or emmer instead of highly cultivated wheat. However, there is no scientific evidence to support this recommendation8.
Diagnosis and therapy
The diagnosis of NCGS is difficult as there is no specific test for it. It is a diagnosis of exclusion, in which coeliac disease6 and wheat allergy must first be ruled out. The diagnosis is often made when symptoms improve on a gluten-free diet and reappear after the reintroduction of gluten-containing foods. In addition, a food and symptom diary should be kept to “identify reproducible correlations […]”6.
The recommendation for therapy is currently an individualized nutritional therapy. This involves developing a symptom-oriented diet “with avoidance or reduction of individually relevant trigger factors “6 that is individually tailored to the person affected. However, this therapy only works in cooperation with a state-recognized and well-trained nutritionist and is associated with costs. A strict avoidance diet of certain ingredients is not recommended by the specialist associations.
Sources
1 Reese, I. et al. Non-celiac gluten/wheat sensitivity (NCGS)-a currently undefined disorder without validated diagnostic criteria and of unknown prevalence: Position statement of the task force on food allergy of the German Society of Allergology and Clinical Immunology (DGAKI).
Allergo J. Int. 27, 147-151 (2018).
2 Biesiekierski, J. R. et al. No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates.
Gastroenterology 145, 320-328.e3 (2013).
3 Dale, H. F., Hatlebakk, J. G., Hovdenak, N., Ystad, S. O. & Lied, G. A. The effect of a controlled gluten challenge in a group of patients with suspected non-coeliac gluten sensitivity: A randomized, double-blind placebo-controlled challenge. Neurogastroenterol.
Motil. 30, e13332 (2018).
4. Nordin, E., Brunius, C., Landberg, R. & Hellström, P. M. Fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs), but not gluten, elicit modest symptoms of irritable bowel syndrome: a double-blind, placebo-controlled, randomized three-way crossover trial. Am. J. Clin.
Nutr. 115, 344-352 (2022).
5 Uhde, M. et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease.
Gut 65, 1930-1937 (2016).
6 Felber, J. et al. Updated S2k guideline coeliac disease of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS): December 2021 – AWMF register number: 021-021.
Z. For Gastroenterol. 60, 790-856 (2022).
7 Schumann, D. et al. Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis.
Nutrition 45, 24-31 (2018).
8 Zimmermann, J., Longin, F. H., Schweinlin, A., Basrai, M. & Bischoff, S. C. No Difference in Tolerance between Wheat and Spelt Bread in Patients with Suspected Non-Celiac Wheat Sensitivity.
Nutrients 14, 2800 (2022).
