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Review
. 2020 Dec 10;12(12):3785.
doi: 10.3390/nu12123785.

Is Gluten the Only Culprit for Non-Celiac Gluten/Wheat Sensitivity?

Maria Gloria Mumolo  1 , Francesco Rettura  1 , Sara Melissari  1 , Francesco Costa  1 , Angelo Ricchiuti  1 , Linda Ceccarelli  1 , Nicola de Bortoli  1 , Santino Marchi  1 , Massimo Bellini  1
Affiliations
Review

Is Gluten the Only Culprit for Non-Celiac Gluten/Wheat Sensitivity?

Maria Gloria Mumolo et al. Nutrients. .

Abstract

The gluten-free diet (GFD) has gained increasing popularity in recent years, supported by marketing campaigns, media messages and social networks. Nevertheless, real knowledge of gluten and GF-related implications for health is still poor among the general population. The GFD has also been suggested for non-celiac gluten/wheat sensitivity (NCG/WS), a clinical entity characterized by intestinal and extraintestinal symptoms induced by gluten ingestion in the absence of celiac disease (CD) or wheat allergy (WA). NCG/WS should be regarded as an "umbrella term" including a variety of different conditions where gluten is likely not the only factor responsible for triggering symptoms. Other compounds aside from gluten may be involved in the pathogenesis of NCG/WS. These include fructans, which are part of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), amylase trypsin inhibitors (ATIs), wheat germ agglutinin (WGA) and glyphosate. The GFD might be an appropriate dietary approach for patients with self-reported gluten/wheat-dependent symptoms. A low-FODMAP diet (LFD) should be the first dietary option for patients referring symptoms more related to FODMAPs than gluten/wheat and the second-line treatment for those with self-reported gluten/wheat-related symptoms not responding to the GFD. A personalized approach, regular follow-up and the help of a skilled dietician are mandatory.

Keywords: celiac disease; gluten; gluten-free diet; irritable bowel syndrome; low FODMAP diet; non-celiac gluten/wheat sensitivity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
GF product market, by region, during the forecast period of 2016 to 2023, modified from Research and Markets, Report May 2019 [2]. Abbreviations: GF: gluten-free; APAC: Asia-Pacific countries; RoW: rest of the world.
Figure 2
Figure 2
(a) The structure of the gluten protein gluten network. (b) The classification of wheat gluten proteins. (c) Gliadin and glutenin loci in Triticum aestivum (AABBDD), modified from Sharma, 2020 [26]. HMW: high molecular weight, LMW: low molecular weight.
Figure 3
Figure 3
Classification of wheat allergy depending on the route of exposure and the underlying immunologic mechanism. Abbreviations: WDEIA: wheat-dependent, exercise-induced anaphylaxis.
Figure 4
Figure 4
Diagnosis of non-celiac gluten/wheat sensitivity (NCG/WS), modified from Catassi, 2015 [147]. GFD: gluten-free diet.
See this image and copyright information in PMC

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