How Non-Celiac Gluten Sensitivity Is Treated

Gluten sensitivity is a common problem involving an adverse reaction to gluten—a protein found in wheat, barley, and rye. The primary treatment for gluten sensitivity from any cause is a change in diet. Several dietary recommendations have been used for gluten sensitivity treatment, including the gluten-free diet, FODMAPs, or a restricted α-amylase/trypsin inhibitors (ATI diet).

Gluten sensitivity can be severe (as in celiac disease) or mild, as in non-celiac gluten sensitivity (NCGS). The latter is the most prevalent cause of gluten sensitivity, but the treatment may be similar for both conditions depending on an individual’s specific symptoms.

Home Remedies and Lifestyle

Because NCGS is considered a different condition than celiac disease, for the purposes of this article the focus will be on the treatment of non-celiac gluten sensitivity.

The primary treatment is aimed at changing the diet and observing whether the dietary changes alleviate gastrointestinal symptoms (such as gas, abdominal pain, diarrhea, and nausea). Other treatment modalities include addressing the non-gastrointestinal symptoms of NCGS, such as nutritional deficiencies that may occur due to damage to the small intestine.

Because there is no definitive test to diagnose NCGS, the condition involves self-reports from patients. This subjective diagnosis limits the ability to accurately evaluate how effective the treatment of NCGS is.

Gluten and ATIs

Diet change, specifically eliminating gluten (wheat, barley, and rye) from the diet, is the primary treatment modality for gluten sensitivity, but many experts feel that gluten may not be the only culprit. In fact, according to a 2018 study, other mechanisms that trigger symptoms may be in play.

These include:

• Amylase-trypsin inhibitors (ATIs): Molecules found in wheat, barley, and rye that may fuel the immune reaction that occurs in those with gluten sensitivity
• Fermentable oligo-di-monosaccharides and polyols (FODMAPs): A type of carbohydrate found in wheat and in many other foods, FODMAPs are difficult to digest and are thought to be one culprit responsible for symptoms of NCGS and irritable bowel syndrome (IBS).

The Gluten-Free Diet

The gluten-free diet (GFD) is the most popular gluten sensitivity treatment. According to a 2018 study, “Although convincing evidence is available to support the benefits of a GFD for certain patient populations without a gluten-related disease (especially patients with IBS and NCGS), the data are conflicting and not definitive.” The study also revealed that most people who are eating gluten-free foods do NOT have a definitive physical condition that requires treatment.

The primary foods that are eliminated with a gluten-free diet are grains such as wheat, barley, and rye. Grains to avoid on a gluten-free diet include all varieties of wheat, including whole wheat, durum wheat, wheat berries, graham, bulgur, farro, farina, kamut, spelt, and bromated flour.

Another type of grain that should be avoided on a gluten-free diet is triticale (a grain made of a mixture of rye and wheat).

Grains that are allowed on the gluten-free diet include:

• Quinoa
• Brown rice
• Wild rice
• Sorghum
• Tapioca
• Millet
• Amaranth
• Oats

In addition, a study linked low-gluten diets to a high risk for Type 2 diabetes. One reason a gluten-free diet may be unhealthy is because many commercial gluten-free products are much higher in sugar content than whole wheat and whole-grain products. Therefore, it’s important to consult with your healthcare provider to be sure of a diagnosis of NCGS before changing your diet.

The Low FODMAP Diet

FODMAP is an acronym for "fermentable oligosaccharides, disaccharides, monosaccharides, and polyols," which are short-chain carbohydrates and sugar alcohols, that are part of wheat, wheat products, and many other foods. FODMAPs are not absorbed very well by the digestive tract, which can then cause abdominal pain and bloating. They may occur naturally in some foods, or they can be an additive.  

A 2018 study examined the part that FODMAPs play in the role of NCGS symptoms. What the study revealed was that gastrointestinal (stomach and intestines) symptoms were improved when study participants with gluten sensitivity ate a low FODMAP diet. 

This study disclosed that various components of wheat may be responsible for symptoms of NCGS, and that a low FODMAP diet may be a good treatment option.    

Foods to Avoid on the Low FODMAP Diet

There are many foods that are considered high in FODMAPs. Foods that are restricted on the low FODMAP diet include vegetables such as:

• Cabbage
• Cauliflower
• Broccoli
• Onions
• Asparagus
• Artichokes
• Leeks
• Snow peas
• Beets
• Sweet corn
• Brussels sprouts
• Celery

Other foods that are restricted on the low FODMAP diet include:

• Garlic
• Mushrooms
• Fruits (peaches, apricots, nectarines, plums, prunes, mangoes, apples, pears, watermelon, cherries, blackberries, and dried fruits)
• Breads, cereals, and pasta
• All products made of wheat and rye
• Dairy products (unless they are lactose-free)
• Nuts
• Sweeteners (including artificial sweeteners, honey, agave nectar, sorbitol, mannitol, xylitol, and high-fructose corn syrup)
• Isomalt (an additive found in sugar-free gum, mints, and cough syrups)
• Alcohol
• Processed beverages (such as sports drinks and coconut water)

The Low ATI Diet

Amylase/trypsin inhibitors, otherwise known as ATIs, are plant-derived proteins that cause wheat to be pest-resistant (able to resist damage from mealworms and bugs). 

It’s been theorized by some researchers that gluten is NOT the primary culprit when it comes to NCGS symptoms. In fact, according to Professor Detlef Schuppan, ATIs may promote the symptoms of gut inflammation seen in NCGS, which he says differs from celiac disease. “We do not believe that this [inflammation in NCGS] is triggered by gluten proteins," explains Professor Schuppan. 

As a result of this new research, a new option for gluten sensitivity treatment is the low ATI diet.

Foods to avoid that are high in ATI's include rye, barley, wheat (and all variations of wheat products) as well as gluten-containing:

• Cereals
• Bread
• Pasta
• Other foods

Gluten In Pre-Packaged Foods and Medications

On occasion, people with gluten sensitivity may accidentally ingest foods or medications with gluten. There is no mandatory labeling of products that contain gluten, rather, a person with gluten sensitivity must read labels and be able to decipher which food ingredients contain gluten.

Eating out at restaurants, misreading labels or ingesting foods or medicines that are not labeled properly, can result in accidental ingestion of gluten. 

For example, gluten can be used to make binders in specific types of over-the-counter and prescription drugs, to bind the medicine together. There are no federal regulations mandating that the drug companies disclose on the labels whether gluten is used in prescription, over-the-counter drugs, herbal products or natural supplements.

Before taking any medications, ask your healthcare provider or pharmacist to contact the drug manufacturer to find out if the medications are gluten-free.

Over-the-Counter Remedies

If a person with gluten sensitivity does accidentally take a medication that has gluten or unknowingly eats food with gluten, a few natural remedies have been suggested by experts.

Note: There are insufficient clinical research data to definitively show that these natural products are effective in alleviating symptoms, after accidental ingestion of gluten, but they are considered relatively safe and low risk.

• Drinking plenty of fluids improves digestion, helps flush the system and improves hydration (particularly for vomiting and diarrhea).
• Taking digestive enzymes helps the body to efficiently breakdown nutrients (including gluten), but not proven in the treatment of gluten sensitivity. Dr. Amy Meyers suggests, “Be sure to take an enzyme that includes dipeptidyl peptidase (DPP-IV), which helps break down gluten specifically.”
• Taking activated charcoal binds toxins, reduces gas and bloating.
• Drinking herbal Infusions (peppermint, chamomile or ginger tea) helps reduce nausea and maintains hydration.
• Taking omega-3 fatty acid supplements such as cold-water fish oil, flax, and chia, to help decrease inflammation.
• Taking extra probiotics to repair the gut. Dr. Meyers suggests doubling up on probiotics for two weeks after ingesting gluten.
• L-glutamine supplements are amino acids that repair and protect the lining of the stomach after damage is done by gluten.
• Collagen supplements are rich in anti-inflammatory amino acids that protect and repair the lining of the stomach and digestive tract.

Prescriptions

An exciting new investigative drug is on the horizon for the treatment of gluten sensitivity. A randomized, double placebo study found that a new medication may block the unwanted symptoms of gluten sensitivity, such as diarrhea.

The drug is not designed to be used for eating gluten on a regular basis but, rather, as an emergency treatment for times when accidental ingestion occurs. More studies are needed before the new drug will be considered safe and effective and available to the public.