Gluten-free diet participants, which could have masked the true effect of gluten reintroduction. In a review of May 2015 published in Gastroenterology, Fasano "et al." conclude that besides gluten, ATIs and FODMAPs present in gluten, wheat, barley, rye, and their derivatives play a role in the development of NCGS symptoms. ATIs, which resist proteolytic digestion, may be the inducers of innate immunity in people with coeliac disease or NCGS. FODMAPs cause mild wheat intolerance at most, which is mainly limited to gastrointestinal symptoms. After exclusion of coeliac disease and wheat allergy, the subsequent step for diagnosis and treatment of NCGS is to
Gluten diet and a self-diagnosis of gluten sensitivity. People with NCGS may develop gastrointestinal symptoms, which resemble those of irritable bowel syndrome or wheat allergy, or a wide variety of non-gastrointestinal symptoms, such as headache, chronic fatigue, fibromyalgia, atopic diseases, allergies, neurological diseases, or psychiatric disorders, among others. Besides gluten, additional components present in wheat, rye, barley, oats, and their derivatives, including other proteins called ATIs and short-chain carbohydrates known as FODMAPs, may cause NCGS symptoms. The effects of FODMAPs are only limited to gastrointestinal mild discomfort. ATIs may cause toll-like receptor 4 (TLR4)-mediated intestinal inflammation in humans. People can also