How Non-Celiac Gluten Sensitivity Is Treated

You can't cure or reverse gluten intolerance, but that doesn't mean you can't treat it. Gluten intolerance, or gluten sensitivity, is a common problem involving an adverse reaction to gluten—a protein found in wheat, barley, and rye. Several dietary recommendations have been used for gluten sensitivity treatment, including the gluten-free diet, FODMAPs, or a restricted α-amylase/trypsin inhibitors diet (ATI diet).

Gluten intolerance is different from celiac disease. Celiac disease is an autoimmune condition, whereas gluten sensitivity is a negative reaction to gluten. Non-celiac gluten sensitivity (NCGS) is the most prevalent cause of gluten sensitivity, but the treatment may be similar for both conditions.

This article covers three diets to help reduce gluten sensitivity symptoms and highlights places where gluten may be hiding. It also discusses over-the-counter and prescription treatments for gluten intolerance.

Diet and Lifestyle Changes for 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.

The following diets are recommended for people with NCGS and are discussed in detail below:

• Gluten-free diet
• Low-FODMAP diet
• Low-ATI diet

There isn't a test specifically for diagnosing NCGS. NCGS may be suspected after your healthcare provider conducts tests that rule out celiac disease and wheat allergies. Your provider may ask you to record your symptoms after you eliminate gluten for a week. If symptoms improve, it could indicate NCGS.

The Gluten-Free Diet

The gluten-free diet (GFD) is the most popular gluten-sensitivity treatment. According to a 2018 study there is convincing evidence that a GFD can benefit people with NCGS, but the data is not definitive and there is conflicting data. The study also revealed that most people who are eating gluten-free foods do NOT have a definitive physical condition that requires treatment.

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

• Quinoa
• Rice
• Buckwheat
• Sorghum
• Tapioca
• Millet
• Amaranth
• Oats (when labeled gluten-free)

Foods to avoid on the gluten-free diet include:

• Wheat
• Whole wheat
• Barley
• Rye
• Durum wheat
• Wheat berries
• Graham
• Bulgur
• Farro
• Farina
• Kamut
• Spelt
• Malt
• Triticale (a grain made of a mixture of rye and wheat)

In addition, a study linked low-gluten diets to a high risk for type 2 diabetes. One reason a gluten-free diet may not provide beneficial nutrients found in cereal fiber. 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.

FODMAPs are difficult to digest and are thought to be one culprit responsible for symptoms of NCGS and IBS.

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:

• Cauliflower
• Onions
• Leeks
• Garlic
• Asparagus
• Artichokes
• Snow peas
• Mushrooms

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

• Fruits (peaches, plums, pears, apples, figs, mangoes, watermelon, cherries, blackberries, dried fruit)
• Breads, cereals, and pasta, and other products based on wheat, rye, or barley
• Dairy products (unless they are lactose-free)
• Pistachios, cashews
• Most legumes, including kidney beans, split peas, baked beans, chickpeas
• Sweeteners (including artificial sweeteners, honey, sorbitol, mannitol, xylitol, and high-fructose corn syrup)

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. ATIs may promote the symptoms of gut inflammation seen in NCGS, which differs from celiac disease.

As a result of this research, an 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.

Gluten-free is a voluntary label that must meet the Food and Drug Administration's standards.

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 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 you've been prescribed gluten-free medications.

Over-the-Counter Treatment for Gluten Sensitivity

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

Note: There is insufficient clinical research data to definitively show that these natural remedies 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 break down nutrients (including gluten), but is not proven in the treatment of gluten sensitivity.
• Drinking herbal infusions (peppermint, chamomile, or ginger tea) helps reduce nausea and maintains hydration.
• Taking probiotics is thought by some to improve gut health. A mouse model experiment showed some promise in reducing inflammation due to gluten.

Prescriptions for Gluten Sensitivity

An exciting new investigative drug is on the horizon for the treatment of gluten sensitivity. A randomized, double-blind, placebo-controlled 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 regularly but, rather, as an emergency treatment for times when accidental ingestion occurs. More studies are needed before the new drug will be considered safe, effective, and available to the public.

Summary

Unfortunately, gluten sensitivity, aka gluten intolerance, can't be cured or reversed. However, you can modify your diet and lifestyle to prevent gluten-related symptoms.

Diets that may help with non-celiac gluten sensitivity include the gluten-free diet, low-FODMAP diet, and low-ATI diet. Over-the-counter treatments are available if you accidentally consume gluten in food or medications. Prescription medication for treating gluten intolerance is not available yet.

Talk to a healthcare provider if you think you have gluten sensitivity. They will be able to rule out celiac disease and other allergies that could be causing similar symptoms and can advise you on how to change your diet to fit your specific needs.