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.
Subject(s)
Celiac Disease/diet therapy , Diet, Carbohydrate-Restricted/methods , Diet, Gluten-Free/methods , Diet/adverse effects , Malabsorption Syndromes/diet therapy , Amylases/antagonists & inhibitors , Celiac Disease/etiology , Disaccharides , Fermentation , Fructans/adverse effects , Glutens/adverse effects , Glycine/adverse effects , Glycine/analogs & derivatives , Humans , Malabsorption Syndromes/etiology , Oligosaccharides , Polymers , Trypsin Inhibitors/adverse effects , Wheat Germ Agglutinins/adverse effects , GlyphosateABSTRACT
Wheat is a common cereal in the Western diet and an important source of protein as well as fiber. However, some individuals develop adverse reactions to a wheat-containing diet. The best characterized is celiac disease which develops after intake of gluten in individuals with genetic predisposition. Other wheat-related conditions are less well defined in terms of diagnosis, specific trigger and underlying pathways. Despite this, the overall prevalence of wheat-related disorders has increased in the last decades and the role of microbial factors has been suggested. Several studies have described an altered intestinal microbiota in celiac patients compared to healthy subjects, but less information is available regarding other wheat-related disorders. Here, we discuss the importance of the intestinal microbiota in the metabolism of wheat proteins and the development of inflammatory or functional conditions. Understanding these interactions will open new directions for therapeutic development using bacteria with optimal wheat protein degrading capacity.
Subject(s)
Gastrointestinal Microbiome , Plant Proteins/metabolism , Triticum , Adaptive Immunity , Bacteria/metabolism , Celiac Disease/diet therapy , Celiac Disease/metabolism , Celiac Disease/microbiology , Diet, Gluten-Free , Food Hypersensitivity/diet therapy , Food Hypersensitivity/microbiology , Food Hypersensitivity/prevention & control , Glutens/adverse effects , Humans , Immunity, Innate , Plant Proteins/immunology , T-Lymphocytes/immunology , Triticum/adverse effects , Triticum/immunology , Trypsin Inhibitors/adverse effects , Trypsin Inhibitors/metabolism , Wheat Germ Agglutinins/adverse effects , Wheat Germ Agglutinins/metabolismABSTRACT
PURPOSE OF REVIEW: There has been significant interest in gluten over the last decade, with an increase in interest of gluten-related disorders outside coeliac disease. Particularly, there has been a focus on the role of gluten in noncoeliac gluten sensitivity (NCGS) and irritable bowel syndrome (IBS). There is significant overlap between both of these conditions, with the aim of this review to explore their complex relationship. RECENT FINDINGS: Gluten has been demonstrated to generate symptoms in individuals with NCGS. However, there appears to be an increasing role for gluten in symptom generation in patients with IBS also. Other components of wheat, other than gluten, are now also thought to be contributing factors in symptom generation. SUMMARY: There appears to be significant overlap between IBS and NCGS. It is likely that a subset of patients presenting with IBS actually have NCGS. In addition, it is likely that individuals with IBS may also have symptoms triggered by gluten. With the pathophysiology of both conditions not fully understood, as well as increasing knowledge of wheat components in symptom generation, further research is required to help distinguish between both.
