By Amy Ratner, Beyond Celiac Medical and Science News Analyst

Part Two

Those who have non-celiac gluten sensitivity may not always have to follow the gluten-free diet for life, a review of five years of research suggests.

While non-celiac gluten sensitivity has not been studied as extensively as celiac disease, it was included in an evidence-based update on the pathophysiology, diagnosis, treatment and implications of the conditions done by the Center for Celiac Research and Treatment at Mass General Hospital for Children.

In an article published in the Journal of the American Medical Association (JAMA) researchers noted that it’s important to determine whether a patient has celiac disease or gluten sensitivity because the diagnosis impacts long-term treatment.

In fact, researchers found that gluten sensitivity may be a transient condition, unlike celiac disease, which requires life-long commitment to the gluten-free diet.

“We are still not sure about many things with non-celiac sensitivity, including whether it is a transient or permanent condition,” said Alessio Fasano, M.D., director of the celiac center and an author of the JAMA article. “Expert recommendation for non-celiac gluten sensitivity treatment is that the gluten-free diet should be followed for 1 to 2 years before retesting gluten tolerance.”

Here are some other points the researchers noted about gluten sensitivity:

• The frequency of gluten sensitivity is unknown because there are no validated biomarkers, but it is thought to be more common than celiac disease.

Biomarker: a measurable substance in an organism whose presence is indicative of some phenomenon such as disease.

• No specific tests for gluten sensitivity have been developed, but it should be suspected when patients have improvement of gastrointestinal and other symptoms on a gluten-free diet, after celiac disease and a wheat allergy have been ruled out. Expert recommendations for healthcare providers to diagnose gluten sensitivity is to evaluate a patient’s symptoms while eating gluten for one week compared to one week on the gluten-free diet.
• Innate immunity plays a critical role in initiating celiac disease and possibly gluten sensitivity.

More: What researchers found about celiac disease

• Gluten sensitivity is not as well understood as celiac disease. But one study suggests that adaptive immunity, which is triggered in celiac disease, is not involved, a hypothesis supported by the absence of damage to the villi.

Antigen: Any substance that causes your immune system to produce antibodies against it.

Innate immunity: Nonspecific defense mechanisms that come into play immediately or within hours of an antigen’s appearance in the body. These mechanisms include physical barriers such as skin, chemicals in the blood, and immune system cells that attack foreign cells in the body. The innate immune response is activated by chemical properties of the antigen.

Adaptive immunity: An antigen-specific immune response. The adaptive immune response is more complex than the innate. The antigen first must be processed and recognized. Once an antigen has been recognized, the adaptive immune system creates an army of immune cells specifically designed to attack that antigen. Adaptive immunity also includes a “memory” that makes future responses against a specific antigen more efficient

• Gluten sensitivity is characterized by intestinal symptoms like those found in celiac disease. Additionally, foggy brain is often reported. Overall, gluten sensitivity triggers fewer types of non-intestinal symptoms than celiac disease, with 13 noted in the article.
• The gluten-free diet is the only treatment for both celiac disease and gluten sensitivity. But gluten sensitivity may be a transient condition. Consequently, the diet should be followed by gluten-sensitive patients for one to two years, followed by testing for gluten tolerance. It is noted that some gluten-sensitive patients have severe enough symptoms that they may choose to follow the gluten-free diet indefinitely.
• Both celiac disease and gluten-sensitivity patients need to be monitored by a gastroenterologist and dietitian knowledgeable about the gluten-free diet because of the challenges the diet presents and the harm that even trace amounts of gluten presents. Trace amounts of gluten can be as harmful as lack of adherence to the gluten-free diet.

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