The Lowdown on Non Coeliac Gluten Sensitivity
Non coeliac gluten sensitivity (NCGS) is neither an autoimmune or allergic reaction, but causes similar symptoms to those seen in coeliac disease when gluten is consumed. Symptoms are wide and varied and include diarrhoea, fatigue, “foggy mind”, joint pains and unexplained rashes. Researchers are yet to discover why non coeliac individuals experience marked symptoms upon ingestion of gluten, while others remain unaffected.
The immune system is suspected to play a key role, those suffering from gluten sensitivity have lower T regulatory cells leading to inflammatory effects.
Evidence suggests that NCGS and coeliac disease may be related disorders of reactivity and inflammation, with coeliac disease at the upper end of the spectrum and NCGS at the lower end. Other triggers that cause a loss of gluten tolerance are dysbiosis and gut barrier dysfunction, often after antibiotic use and the use of NSAIDS (non-steroidal anti-inflammatory drugs).
Naturopaths are very used to hearing the phrase, “never been the same since”, which often ties in with an infection such as food poisoning, parasitic infection or a bout of gastroenteritis. Merely avoiding gluten in coeliac disease or NCGS is not addressing the whole issue; Naturopaths have realised for years that it is more complicated than this.
Addressing dysbiosis and “leaky gut” is essential in patients with gluten sensitivity and coeliac disease. Research shows that the structure and function of the intestinal epithelium remains compromised in coeliac patients well after gluten has been removed from the diet. Studies of gut mucosa have not normalised in a large proportion of patients even 5 years after gluten withdrawal.
Emerging research suggests even in NCGS underlying immune mechanisms may promote food sensitivities to additional foods such as dairy, yeast and other grains.
Iron deficiency is one of the most common nutritional deficits in patients with coeliac disease and NCGS. Malabsorption of iron is often due to the consequence of villous atrophy (finger like projections in the gut which increase the surface area for nutrient absorption). Unfortunately gluten also damages the acid producing cells in the stomach, which are necessary for iron absorption. Iron is also essential in the formation of lactoferrin, a protein necessary for fighting GI (gastrointestinal) infections, whether it be viral, bacterial, fungal, or parasitic. This means that chronic gluten exposure weakens the immune system’s ability to fight infection.
An article I came across told an interesting story (published in The British Medical Journal in 2012), by a biochemist who reflected on 20 years of unexplained health. After an overseas trip, in 1991, he suffered from a severe bout of vomiting and diarrhoea, he seemingly recovered on his return home. During the next six to twelve months his general health deteriorated. The next two decades consisted of multiple symptoms including exhaustion, severe bloating, nausea, indigestion, fluctuating bowel habits, rashes, joint and muscle pain, mood swings, mild depression, poor sleep patterns, and interstitial cystitis. Four years later he had his gallbladder removed after a bout of biliary colic, which failed to give him relief and his health continued to deteriorate.
By 2008 he was unable to walk uphill and became gradually house bound:
“ I began a desperate search for some clue as to what was wrong with me, a chance conversation in a chat room forum with someone who had exactly my symptoms suggested I try to exclude gluten and lactose from my diet. This is how I finally reached my own self-diagnosis.”
Within a week of implementing the exclusion diet his symptoms had dramatically reduced. Even small traces of gluten or lactose brought all the symptoms back within hours. As he didn’t exhibit classic coeliac disease the doctors were dismissive of his revelation.
A gut infection often triggers the gut to become more permeable to gluten and lactose, which often starts in childhood, and with subsequent infections the condition is exacerbated. It is now estimated that for every person diagnosed with coeliac disease there are at least 6-7 people with NCGS, which translates as 6-10% of the population.
Our gut is “the seat of all health”, and the focal point of human energy. The state of the gut has a profound influence upon our health. A healthy gut is intrinsically linked to neurological, physiological and immunological health.