During the past decade there has been an impressive increase in popularity of the
gluten-free diet (GFD)—now the most trendy alimentary habit in the United States and
other countries. According to recent surveys, as many as 100 million Americans will
consume gluten-free products within a year. Operating under the concept that the GFD
benefits only individuals with celiac disease, health care professionals have struggled
to separate the wheat from the chaff; there are claims that eliminating gluten from
the diet increases health and helps with weight loss, or even that gluten can be harmful
to every human being. However, apart from unfounded trends, a disorder related to
ingestion of gluten or gluten-containing cereals, namely nonceliac gluten sensitivity
(NCGS), has resurfaced in the literature, fueling a debate on the appropriateness
of the GFD for people without celiac disease. Although there is clearly a fad component
to the popularity of the GFD, there is also undisputable and increasing evidence for
NCGS. However, we require a better understanding of the clinical presentation of NCGS,
as well as its pathogenesis, epidemiology, management, and role in conditions such
as irritable bowel syndrome, chronic fatigue, and autoimmunity. Before we can begin
to identify and manage NCGS, there must be agreement on the nomenclature and definition
of the disorder based on proper peer-reviewed scientific information. We review the
most recent findings on NCGS and outline directions to dissipate some of the confusion
related to this disorder.
Keywords
Abbreviations used in this paper:
ATI (amylase trypsin inhibitor), FODMAPs (fermentable oligo- and disacchararides), GFD (gluten-free diet), GI (gastrointestinal), IBS (irritable bowel syndrome), IL (interleukin), NCGS (nonceliac (nonallergy) wheat sensitivity), NHANES (National Health and Nutrition Examination Survey), TG (tissue transglutaminase), TLR (Toll-like receptor)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: March 14, 2015
Accepted:
December 23,
2014
Received:
October 30,
2014
Footnotes
Conflicts of interest AF is Co-Founder and a stock holder of Alba Therapeutics and receives research fund support from INOVAS Diagnostics. DS holds a patent on the tissue transglutaminase assay. The remaining authors disclose no conflicts.
Identification
Copyright
© 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
