If you’ve ever heard someone say they have a gluten sensitivity or know someone who avoids gluten, you might wonder what it’s all about. There is a lesser known concept called Non-Celiac Gluten Sensitivity (NCGS). Think of this as Celiac Disease’s less familiar, ugly cousin. Up until recently, most doctors and the medical community didn’t give it much attention, but last year, a groundbreaking study was released, catching the attention of researchers worldwide. So what exactly is NCGS and why should you care?
Unraveling the Mystery: A Comprehensive Study
Back in June of 2022, a major study was published on the existence and impact of NCGS. This study was groundbreaking not only because of its’ findings, but the sheer number of Gastroenterologists, Celiac disease experts, and other researchers participating, across the globe. The study delved into the mucosal changes associated with this condition, which were only previously associated with Celiac disease. The research involved 175 NCGS patients, 261 individuals with Celiac Disease (CeD), and 262 control subjects. So, what did they find? Let’s take a walk through the garden to learn more.
Villi and crypt – Sounds like a late night 80’s TV show
Imagine the small intestine as a garden. The finger-like structures known as villi are similar to flowers, leaves, and the aerial parts of a plant, above the soil. This is where photosynthesis occurs and the plants draws in nutrients from Co2, the sun, and so forth. Similar to plants, our villi catch and absorb all the nutrients coming through the small intestine. The crypt represents the hidden roots beneath the soil and even the soil layer. Together, they both play a crucial role in nutrient absorption and maintaining a healthy digestive system. When both are healthy, the garden inside our digestive system thrives.
Honey, I shrunk the villi
Previously, researchers had not given much thought to people with NCGS. It was a theory or nuisance at best. More importantly, research has only evaluated the health of the villi, as opposed to the crypt and the villi, for NCGS patients, until now. This study was different because with NCGS study participants, the villi showed signs of distress. Researchers observed that NCGS patients had significantly shorter villus height compared to the control subjects, but longer than those with CeD. In other words, prior to this study, doctors practiced that only Celiac disease patients encountered issues with the villi, as evidenced by the changing length.
Even in the early stages (Marsh 0) of glutenous damage, these changes challenged the conventional definition of what’s “normal.” The flowers in the garden were getting shorter, but because they were still blooming, we overlooked them. For folks unfamiliar with Celiac terminology, the Marsh system is an indicator of the length of the villi, where Marsh 0 is normal and Marsh 3c is late stage Celiac, beyond repair. Marsh 0 would be the grass of a wild prairie while Marsh 3 is the flat and shaved grass of a putting green.
Digging a deeper Crypt
It’s not just about the villi, though. Researchers looked a bit deeper at the crypts of study patients. The crypts, like roots, reached deeper into the soil of the NCGS garden, than previously thought. You could also imagine it as the soil layer creeping up the plant, burying it further. NCGS patient crypts measured significantly deeper compared to controls, and more closely resembled CeD patients. This is helpful for people suffering from NCGS though, because it confirms there is something happening and you can still be sick from gluten, even if you don’t have Celiac disease. These changes further emphasized the presence of a mucosal immune response in the garden, hinting at a reaction to something disturbing the roots.
Why the bigger security team
The other interesting finding in the study was the increase of intraepithelial lymphocytes (IELs). Think of these as a bunch of security guards hanging around your garden. Flower bouncers, if you will. These are the immune cells in your body that show up when there is a problem. It’s normal to have a few here and there, but when you get a group of them, something is wrong. Prior to this study, when labs look at a biopsy under a microscope, they count the IELs on a slide. If there are more than 25, there is disease and less than 25, no disease. In this case, Celiac disease.
Using this metric leaves no room for highly reactive people falling on the spectrum between not having celiac and celiac. Some gastroenterologists acknowledge NCGS, but it’s still not widely accepted, nor an official diagnosis. “Leaky gut,” follows a similar pattern, for those of you familiar the term. NCGS is popular among functional practitioners, but standard Western medicine has largely rejected the idea of NCGS. However, this study demonstrated that NCGS patients has a villous IEL density higher than control patients, but lower than in CeD patients. In other words, this showed a new and consistent “middle ground” for NCGS patients.
Another way of thinking about the IELs is like the amount of security showing up an event. Imagine the IELs as security when a performer comes to down. Think of Beyonce as Celiac disease with all the security teams fully staffed, and NCGS as Megan the Stallion with ample security, but less than Beyonce. Since security (IEL count) was still high for NCGS patients in the study, it validated a new threshold between normal and pathological (Celiac Disease), further highlighting the unique garden landscape of NCGS. This finding also lights the path for more diagnostic options, for folks suffering from gluten sensitivity, which is exciting news.
NCGS and why you should care
NCGS is not just a trend. It’s a real condition affecting people worldwide, with sneaky and damaging impacts. Perhaps your doctor tested for Celiac and said you were fine, but in your heart, you know you something is wrong. NCGS could be a missing piece. Understanding the garden-like complexity of the small intestine helps shed light on the intricacies of NCGS. These findings could pave the way for improved diagnostic methods and personalized treatments for individuals with NCGS in the future. This study validates what many of us may be thinking but can’t prove, about how we feel.
With ongoing research, and similar studies, the future is bright for better understanding NCGS and potentially helping millions of people silently suffering from mystery illness. I’m optimistic and hopeful about future research, shedding more light on the complexities of gastrointestinal disorders, specifically related to the foods we eat.
So, the next time you encounter someone with NCGS or hear about gluten sensitivity, remember it’s not just in our heads, or the latest trend. Do you want to learn more about navigating chronic illness and how gluten may be impacting your health? Book a complimentary breakthrough session with us. It could be the transformational conversation you didn’t know you needed. We love talking about gluten at Pomona Wellness, so check out some additional Wellspiration here and here.
Medical Disclaimer:
These statements have not been evaluated by the Food and Drug Administration (FDA). The information provided in this blog post is for educational and informational purposes only and should not be considered as medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, treatment, cure or prevention of any disease. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.