Why Grains and Not Just Gluten in Non-Coeliac Gluten Sensitivity?

I was just reading the paper I referred to yesterday and picked up an interesting little sentence which helps us a bit with why we seem to need to knock out all grains rather than classical gluten/gliadin wheat, rye and barley.

Recently, in a double-blind randomised trial, Biesiekierski et al
showed that patients with NCGS truly develop symptoms
when eating gluten. It is unclear at this time what components
of grains trigger symptoms in people with NCGS…

In other words, there is a suggestion that it may be other than the classic gluten/gliadin proteins that we are reacting to. My view is that it is not just about the protein fractions at all. Our bodies react even when proteins have been denatured and when starches are still present, for example, despite what the science suggests and manufacturers love to tell us about their products being ‘gluten-free’. It may be short-sighted to believe it is just certain fractions of grain just because we have studied those most, but the jury is out. Nice to see it referred to here, though.

In fact, the whole paragraph about NCGS is interesting:

Non-coeliac gluten sensitivity

The term NCGS relates to one or more of a variety of immunological, morphological or symptomatic manifestations that are precipitated by the ingestion of gluten in people in whom CD has been excluded. (Ed’s note: in other words, NCGS can involve immune reaction, tissue changes (eg the leaky gut/villi atrophy) and/or symptoms.)

NCGS is a condition in which gluten ingestion leads to
morphological or symptomatic manifestations despite the
absence of CD. (Ed’s note: or in the absence of how we currently diagnose CD anyway which is not 100% reliable as we know.)

As opposed to CD, NCGS may show signs
of an activated innate immune response but without the
enteropathy, elevations in tTG, EMA or DGP antibodies, and
increased mucosal permeability characteristic of CD. (Ed’s note: note the broken mucosal barrier problem there which is what causes the malabsorption and ever-growing list of food/substance reactions we are trying to work on in treatment.)

Recently, in a double-blind randomised trial, Biesiekierski et al
showed that patients with NCGS truly develop symptoms
when eating gluten. It is unclear at this time what components
of grains trigger symptoms in people with NCGS and
whether some populations of patients with NCGS have subtle
small intestinal morphological changes.

While there is currently no standard diagnostic approach to NCGS, systematic evaluation
should be conducted, including exclusion of CD and other inflammatory disorders. (Ed’s note. Good point. I look forward to the day when we have a standard way of diagnosing NCGS. For now, my advice is an amalgamation of tests including antibodies, genes and symptom change on traditional and grain free diet.)

Excellent paper, well done to the team of 16 doctors experienced in gluten-related disorders from 7 countries who researched this area well and came up with the new naming suggestions. Fab.

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