Gluten Sensitivity: Understanding the Condition, Symptoms, Causes, and Treatment

Gluten sensitivity is a common issue affecting millions worldwide. As a gluten-sensitive and vegan person, it’s essential to understand how gluten affects your body and how you can manage your condition effectively. This blog post aims to provide a comprehensive overview of gluten sensitivity, its comparison to celiac disease, symptoms, causes, and potential treatment segments. We’ll also delve deeper into more possible treatment segments and lifestyle changes.

What is Gluten Sensitivity?

Gluten sensitivity is when the body reacts negatively to gluten, wheat, rye, and barley protein. It is often confused with celiac disease, an autoimmune disorder in which the body attacks itself when gluten is consumed. However, gluten sensitivity does not cause the same intestinal damage as celiac disease but can still cause digestive issues and other symptoms.

Comparison between Celiac Disease and Gluten Sensitivity

Celiac disease and gluten sensitivity share common symptoms such as bloating, abdominal pain, and diarrhea. However, there are significant differences between the two conditions. The primary difference is the level of damage caused to the small intestine. In celiac disease, gluten consumption triggers an immune response that damages the small intestine lining, leading to various health problems.

In gluten sensitivity, gluten consumption triggers symptoms, but the small intestine’s lining is not damaged. Celiac disease can also be diagnosed through blood tests and biopsies, while gluten sensitivity does not have a specific diagnostic test.

Another critical difference between the two conditions is the severity of the health implications. While gluten sensitivity can cause discomfort and affect the quality of life, celiac disease can be life-threatening if left untreated. Celiac disease can lead to malabsorption of nutrients, anemia, osteoporosis, infertility, and an increased risk of certain cancers if left untreated.

It is essential to note that gluten sensitivity differs from a wheat allergy, a severe and potentially life-threatening allergic reaction to wheat proteins. In contrast, gluten sensitivity is not an allergic reaction but an immune response to gluten proteins.

Symptoms of Gluten Sensitivity

Gluten sensitivity is a condition that can manifest itself in various ways, with symptoms ranging from mild to severe. Here’s a closer look at the most common symptoms:

• Bloating, gas, and abdominal pain – Gluten sensitivity can cause inflammation in the gut, leading to digestive issues such as bloating, gas, and abdominal pain.
• Diarrhea or constipation – Gluten sensitivity can cause changes in bowel movements, leading to diarrhea or constipation. The changes may be sudden, and they may be accompanied by discomfort and pain.
• Nausea or vomiting – Some individuals with gluten sensitivity may experience nausea or vomiting after consuming gluten-containing foods.
• Headaches and migraines – Gluten sensitivity has been associated with headaches and migraines. While the exact mechanisms behind this link are not yet fully understood, it’s believed that inflammation in the gut can trigger headaches and migraines.
• Joint pain and muscle stiffness – In some cases, gluten sensitivity can cause joint pain and muscle stiffness, debilitating and affecting an individual’s quality of life.
• Fatigue and brain fog – Gluten sensitivity can also cause fatigue and brain fog, making it challenging to concentrate and perform daily tasks.
• Skin rashes and itching – Gluten sensitivity can cause skin rashes and itching, such as dermatitis herpetiformis, a skin condition characterized by itchy, blistering rashes.

It’s worth noting that not everyone with gluten sensitivity experiences all of these symptoms. Some individuals experience only a few, while others experience more severe symptoms.

If you suspect you have gluten sensitivity, speaking with a healthcare provider to get a proper diagnosis and treatment plan is essential.

Causes of Gluten Sensitivity

The cause of gluten sensitivity is unknown, but research suggests that it may be related to the gut microbiome and intestinal permeability. In people with gluten sensitivity, the gut lining may be more permeable than usual, allowing the gluten to pass through and trigger an immune response. Additionally, some research suggests that gluten sensitivity may be related to other food sensitivities and allergies.

One of the leading theories about the cause of gluten sensitivity is related to the gut microbiome and intestinal permeability. The gut microbiome is a complex ecosystem of microorganisms that live in the gut and play a critical role in digestion and immune function. Studies have shown that individuals with gluten sensitivity have altered gut microbiota compared to healthy individuals, which may contribute to the development of gluten sensitivity.

Furthermore, gluten has been shown to increase gut permeability, which can lead to the release of inflammatory substances into the bloodstream. This inflammatory response can trigger symptoms associated with gluten sensitivity.

Another theory behind the development of gluten sensitivity relates to other food sensitivities and allergies. Individuals with gluten sensitivity may also be sensitive to other foods, such as dairy or soy. In one study, researchers found that individuals with gluten sensitivity were more likely to have antibodies against multiple food antigens, suggesting that the condition may be related to a broader immune response to food.

It’s essential to note that while these theories provide some insight into the potential causes of gluten sensitivity, further research is needed to fully understand the condition’s underlying mechanisms.

Possible Treatments for Gluten Sensitivity

To diagnose gluten sensitivity, doctors start by ruling out Celiac disease and wheat allergy. If those tests come back negative, they may recommend an elimination diet. An elimination diet involves removing all sources of gluten from the diet for several weeks and then reintroducing them one at a time to see if symptoms return. If symptoms return with the reintroduction of gluten, it is likely that the person has gluten sensitivity.

The treatment for gluten sensitivity is to follow a gluten-free diet. This involves avoiding all foods that contain gluten, such as wheat, barley, rye, and some oats. Following a gluten-free diet can be challenging, as gluten is found in many processed and packaged foods. It is essential to read labels carefully and be aware of hidden sources of gluten, such as sauces, dressings, and soups.

Following a gluten-free diet can be more complicated for vegans with gluten sensitivity, as many vegan foods contain gluten. However, following a vegan and gluten-free diet is possible with careful planning and attention to food choices. Some vegan, gluten-free foods include fruits, vegetables, beans, lentils, nuts, seeds, quinoa, and gluten-free grains like rice, corn, and millet.

In conclusion, gluten sensitivity is a common condition that affects many people, especially those with autoimmune disorders. The symptoms of gluten sensitivity can vary, but they typically include gastrointestinal discomfort, headaches, joint pain, and fatigue. While the exact cause of gluten sensitivity is unknown, research suggests that it may be related to the gut microbiome and intestinal permeability.

The treatment for gluten sensitivity is to follow a gluten-free diet, which can be challenging but is essential for managing symptoms and maintaining overall health. For those following a vegan diet, it is important to be mindful of hidden sources of gluten and to focus on whole foods and gluten-free grains. 

However, many gluten-free alternatives, such as quinoa, buckwheat, and amaranth, are available. Additionally, it’s important to address any underlying gut health issues contributing to gluten sensitivity.

If you suspect you have gluten sensitivity, it is essential to speak with a healthcare provider to rule out other conditions and get a proper diagnosis.

Dietary Changes

A gluten-free and plant-based diet can help manage gluten sensitivity symptoms and improve overall health. These foods contain nutrients, vitamins, and minerals that help support the immune system, reduce inflammation, and improve gut health.

Fruits and vegetables are rich in fiber, antioxidants, and phytonutrients that help maintain a healthy gut microbiome and prevent inflammation. Legumes and beans are also excellent sources of fiber and protein and contain essential vitamins and minerals like iron and zinc. Nuts and seeds provide healthy fats, protein, and fiber, which help reduce inflammation and maintain healthy cholesterol levels.

Gluten-free grains like quinoa, buckwheat, and amaranth are excellent sources of fiber, protein, and essential vitamins and minerals like magnesium and iron. These grains are also easy to digest and have a low glycemic index, making them ideal for people with gluten sensitivity.

Gluten-free flours like almond, coconut, and rice flour can be used instead of wheat flour in baking and cooking. These flours are naturally gluten-free and provide healthy fats, fiber, and essential vitamins and minerals.

Adapting to a gluten-free and plant-based diet can be challenging, but many resources are available to help people make the transition. Some helpful tips include:

Reading labels carefully – it’s essential to read labels carefully and avoid gluten-containing foods.

Experimenting with new recipes – many gluten-free and plant-based recipes are available online, in cookbooks, and on social media.

Stocking up on gluten-free pantry staples – keeping a well-stocked pantry with gluten-free grains, flours, and other ingredients can make it easier to cook and bake gluten-free.

Consulting with a registered dietitian – a registered dietitian can provide personalized advice and support for people with gluten sensitivity.

By making these dietary changes, people with gluten sensitivity can manage their symptoms, improve gut health, and support overall health and well-being.

Supplements

Supplements can help manage gluten sensitivity by supporting the gut and immune system. Some supplements that may be beneficial include:

Probiotics: Probiotics can help support the gut microbiome, which is essential for maintaining a healthy digestive system. Look for a probiotic supplement with multiple strains of beneficial bacteria.

Digestive Enzymes: Digestive enzymes can help break down food more effectively, which may reduce digestive issues caused by gluten sensitivity.

Omega-3 Fatty Acids: Omega-3 fatty acids have anti-inflammatory properties and may help reduce inflammation in the gut caused by gluten sensitivity.

Probiotics, digestive enzymes, and omega-3 fatty acids have all been shown to help reduce inflammation in the gut and support overall digestive health. However, consulting with a healthcare provider before starting any supplements is essential.

Lifestyle Changes

Lifestyle changes can also help manage gluten sensitivity symptoms. Some changes to consider include

Stress Reduction: Stress can exacerbate digestive issues, so finding ways to reduce stress levels can be helpful. Activities like yoga, meditation, and deep breathing can help reduce stress.

Exercise: Exercise can help improve digestion and reduce inflammation in the body. Aim for at least 30 minutes of moderate activity most days of the week.

Sleep: Getting enough sleep is essential for overall digestive health. Aim for 7-9 hours of sleep each night.

Gluten sensitivity can be challenging, particularly for those who follow a vegan diet. However, understanding the condition, symptoms, causes, and treatment options makes it possible to manage gluten sensitivity effectively. Avoiding gluten-containing foods, making dietary changes, taking supplements, and making lifestyle changes can help manage gluten sensitivity symptoms. If you suspect you may have gluten sensitivity, it’s essential to work with a functional medicine doctor with expertise in nutrition to develop an individualized treatment plan that addresses your unique needs.

If you’re struggling with gluten sensitivity, contact us to schedule a complimentary consultation. We can help you develop an individualized treatment plan that addresses your unique needs and helps you manage your gluten sensitivity effectively. Don’t let gluten sensitivity control your life – take the first step towards optimal health today.

References:

1. De Palma G, Nadal I, Medina M, Donat E, Ribes-Koninckx C, Calabuig M, Sanz Y. Intestinal dysbiosis and reduced immunoglobulin-coated bacteria associated with coeliac disease in children. BMC Microbiol. 2010 Oct 26;10:63. doi: 10.1186/1471-2180-10-63. PMID: 20977738; PMCID: PMC2988723.
2. Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev. 2011 Jan;91(1):151-75. doi: 10.1152/physrev.00003.2008. PMID: 21248165; PMCID: PMC3277000.

Gluten Sensitivity

By Dr. Justin Marchegiani

Gluten sensitivity is a state of genetics, just like your genes cannot be changed. Therefore, what we have control over is the expression of our genes. Gluten is one of those food products which our genetics have not adapted to well. I suggest that if you are a person who have genetics that predispose you to gluten sensitivity, avoid gluten. Since this is the way in which you can control  how your genes are being expressed.

Terminologies related to gluten or grain

Gluten Sensitivity

Many people with gluten sensitivity can be gluten intolerant or have a gluten allergy as well. The terms allergy and intolerant have come to mean different things in conventional medicine. “Sensitivity” is the more excepted terminology in gluten circles. Sensitivity is referring to the fact that your immune system is hyper responsive to the gluten proteins. The byproduct of these hyper-immune responses is inflammation. And if prolonged, autoimmune conditions are a strong possibility.

Gluten Allergy

The term “gluten allergy” typical refers to your immune system creating an IgE immune response (anaphylactic in nature) to the gluten protein. These allergies are inborn and are usually known at birth.  We know allergies can also be delayed in nature via an IgG or IgA response with new cutting testing. And this is closer to what we see in gluten sensitivity.

Gluten Intolerance

Gluten Intolerance typically refers to the inability to break down the gluten proteins in the digestive tract. Just like with lactose intolerance, some individuals have a difficult time breaking down lactose. Lactose is milke sugar. But with specific enzymes (like lactaid), this is possible. Most people who are gluten sensitive have a difficult time breaking gluten down, too. But taking enzymes alone will not be enough to avoid the inflammation and autoimmune destruction from consuming it.

Celiac Disease

In science today, gluten sensitivity has been primarily connected  with celiac disease. Thus, the misconception is if you don’t have celiac disease, you don’t have gluten sensitivity. This couldn’t be further from the truth! The testing used to diagnose and assess celiac disease can miss many people. Essentially, you can have all of the telltale signs and symptoms of gluten sensitivity or celiac disease, yet still be misdiagnosed. The typical mainstream diagnosis for celiac disease is a sample of your micro-villi from your small intestine. This can be seen via endoscopy. The micro-villi have to be worn down 80% for you to be considered celiac.

There are a couple problems with this diagnosis criteria:

1. What if we do not collect a sample that was affected by gluten?

2. What if the  micro-villi have not been worn down 80%?

This method is analogous to pulling a bucket of water out of the ocean. It is like examining that there is no fish in the bucket. And then concluding the ocean must have no fish. This may not be a perfect analogy, but I think you know what I’m getting at.

Blood Test

There are other blood tests that can be used to confirm celiac disease. These blood test includes transglutaminase antibodies, endomyseal antibodies. Other blood tests are deamidated gliadin and gliadin antibodies. If you come back positive with one of these test markers, you can be confident that you have celiac disease. But the problem is many individuals come back negative with these markers may still have gluten sensitivity.

So this is where genetic testing comes into play. If you have a gene that predisposes you to gluten sensitivity, it’s just a matter of time till those gene expresses itself. The more physical, chemical and emotional stress you  are under, the more increased chance that your gluten sensitive genes will react. Then it will start creating symptoms. The symptoms for gluten sensitivity are all over the map!

Genetic Test

I think genetic testing is a good tool to assess if you have the genes for gluten sensitivity.  The problem with other testing is it’s very easy to have false negative result. This means the test comes back negative. But in reality, you may still have gluten sensitivity. If you come back with a gluten sensitive gene, you can be confident that it’s just a matter of time before that gene expresses itself. This will be the case if you keep eating gluten.

The primary genes that are involved in celiac disease are HLA-DQ2 and HLA-DQ8.  There are other HLA-DQ genes involved as well. HLA-DQ 1, HLA-DQ 3 and HLA-DQ 7 are also genes that predispose you to gluten sensitivity. When you’re looking at genetics such as HLA-DQ testing, you get one HLA-DQ gene from each parent.   If you receive two HLA-DQ 2’s or two HLA-DQ 8’s, this increases the risk of celiac disease. The same goes for gluten sensitivity.

According to the genetics, the only people that are immune to gluten sensitivity are people with the genetic sub-types HLA-DQ 4. This is actually less than 1% of the population. There needs to be more research done validating gluten sensitivity and its connection with the genetics (1).

Population Affected

The percentage estimates surrounding gluten sensitivity regarding the population are a point of contention among experts. Dr. Alessio Fasano at the University of Maryland medical school is a pioneer in gluten research. He feels that only 6 to 7% of the population are gluten sensitive. On the other hand, Dr. Ford a pediatrician in New Zealand and the author of the book “The Gluten Syndrome,” believes  30% to 50% of the population are gluten sensitive.  And according to Dr. Kenneth Fine, over 50% of the population is gluten sensitive. Either way you look at it, the new estimates that are coming out surrounding gluten sensitivity are showing a significant increase than the original 1% estimates of celiac disease.

The information that we have now shows the majority of the population are gluten sensitive. Majority of symptoms that come from gluten are not necessarily correlated with digestive issues.  And this is the problem with gluten sensitivity. Gluten sensitivity includes symptoms that are gastrointestinal in nature like bloating, gas, diarrhea and IBS. With gluten sensitivity, you are actually 8x more likely to have extra intestinal symptoms. And these are symptoms not related to the gastrointestinal tract, like headaches, depression, lupus and thyroid disease.  This is the main reason why gluten sensitivity is so easily glossed over today.

Most patients with gluten sensitivity complained of 2 or more symptoms (2).

The symptoms of gluten sensitivity

Celiac disease is a form of gluten sensitivity. So essentially, if you have celiac disease, you are gluten sensitive. And if you are gluten sensitive, you don’t have to necessarily have celiac disease.

There are many common manifestations of gluten sensitivity, I call this the web of gluten sensitivity:

This includes:

• Various anemia’s
• Type I diabetes
• Hashimotos and other thyroid diseases
• Fibromyalgia
• Chronic fatigue syndrome
• Lupus
• Gut infections
• Skin issues (psoriasis, eczema, dermatitis herpetiformis)
• Psychological and mood disorders (schizophrenia, depression).

I challenge you to Google scholar or Pubmed. Search for gluten or celiac disease with any disease of your choice. You will see many results come up in your search, proving the connection cannot be ignored.

My favorite method to assess for gluten sensitivity!

The problem with many of the tests that are out there, is that similar information can be received through a simple elimination provocation diet. And this is where inflammatory foods are cut out for a period of time and then added back in. The only time I conduct testing on patients, is if patients are resistant to changing their diet. Then the lab test can be very useful. It’s because they can quantify to the patient in an objective manner that these issues are real. Some people  need to see that type of evidence before they cut out some of their most favorite and addicting foods!

I find almost all individuals who are suffering from some type of chronic illness benefit when they cut gluten out of their diet. The foods that contain gluten, which are all grains, tend to be very low in nutrition. In addition, they have a high glycemic index and create inflammation. Hence, it is always better to eat foods that are nutrient dense, anti-inflammatory and low in toxins.

My recommendations are for all of my patients to start off with some type of anti-inflammatory, autoimmune paleo or bulletproof style of eating. The focus with this type  of eating is to be consuming foods that are anti-inflammatory, low in toxins and nutrient dense. This allows us to put our body into a state of healing.  We can start recovering from all of the damage created by the gluten exposure by following this guideline. Macro-nutrient will be important. This includes ratios involving carbohydrate, protein and fat. It can always be adjusted to meet the needs of the patient. I deal with these macro-nutrient ratios on individual basis per patient.

What Do You Do If you Aren’t Feeling Better After Going Gluten Free?

When dealing with patients that are chronically ill,  making the above dietary recommendations may not be enough. The inflammation created from years of stress and gluten consumption may have caused damage to your bodies. This includes your adrenals, thyroid and gastrointestinal system. You may have weakened your immune system because of all these. Also, chronic infections like parasite, bacterial, fungal and viral infections have already gained a foothold. So, I find removing these infection can be the missing barriers that are preventing people from getting better.

If you’re not getting better  from going gluten-free,  feel free and schedule a complimentary consultation. Click here to review what your options are.

References:

1.A. Fasano et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: Celiac disease and Gluten sensitivity. BMC Medicine 2011, 9:23. doi:10.1186/1741-7015-9-23.

2. New understanding of gluten sensitivity. Umberto Volta & Roberto De Giorgio: Nature Reviews Gastroenterology & Hepatology 9, 295-299 (May 2012).

Gluten Sensitivity and Brain Health

By Dr. Justin Marchegiani

What is Non-Celiac Gluten Sensitivity (NCGS)?

Non-celiac gluten sensitivity (NCGS) is a functional condition, not a disease. NCGS could, however, progress into a pathogenic disease.

Imagine a scale with 0 being optimal health and 10 being disease. NCGS may fall in the range of 5 to 8 as it progressively climbs down the scale toward disease.

Researchers have finally started to accept NCGS as a real condition, and they are talking about some of the scientific mechanisms that are driving this functional condition toward a pathogenic disease.

NCGS vs. Celiac Disease

Celiac disease is gluten sensitivity and it is a pathogenic condition. Gluten sensitivity is your immune system reacting to gluten. In testing for celiac disease, we’ll find  elevated levels of antibodies such as endomysial and transglutaminase. In NCGS, we may not see those immunological markers.

We may take the NCGS patient off of gluten entirely, and the patient may get better. Even though the patient isn’t showing the celiac markers, he or she is improving when gluten is removed. The article findings, referenced at the end of this post, concluded that if the NCGS patient doesn’t address the gluten issues, the patient will continue to progress into a disease state.

We can prevent this type of disease from occurring by recognizing that the patient potentially has  NCGS and providing strategies, such as avoiding gluten. This is to fix the gut and reverse the process.

Brain Inflammation and Gluten

Gluten has been shown in multiple studies to decrease blood flow to the brain. Our carotid arteries carry oxygenated blood and nutrients to the brain. So when blood flow decreases (the  main issue we see in a person consuming gluten that’s sensitive to it), we’re going to see results such as brain fog and maybe even migraines. So there is a connection between brain inflammation and gluten—the literature already supports this.

How Does Gluten Get to the Brain?

The brain talks to the gut and the gut talks to the brain through what’s known as the gut-brain axis (GBA). This happens via the sympathetic nervous system’s fight-or-flight mechanisms and the parasympathetic nervous system’s vagus nerve stimulation.

In the parasympathetic nervous system, when the brain is talking to the gut and sending good vagal stimulation, it’s telling the gut to rest, relax, repair, absorb, digest, and assimilate nutrition.

In the sympathetic nervous system, the brain is telling the body to send blood to the extremities (the hands, the feet, etc.) or to fight or flee. If you get scared enough, you may even have enough stimulation to wet yourself. So different scenarios could result based on how much stimulation you have.

We want more of our parasympathetic nervous system working during the day because we want to be able to utilize all of the nutrients in our diet.

The gut-brain axis is bidirectional—it goes both ways—so if we have dysbiotic materials (bad bacteria, infections, etc.) in our gut, that can affect the signals going back to the brain and create inflammation. Garbage in, garbage out.

The gut has its own nervous system called the enteric nervous system. So stress in the gut can affect stress in the body because the body’s going to release cytokines and inflammatory compounds, and even toxins, from the various pathogenic bacteria in the gut. This could affect the overall nervous system function. So inflammation in the gut causes inflammation in the brain and, because it’s bidirectional, potentially vice versa.

Click here if you feel like you are having brain fog, losing your memory, and you want it fixed.

Bacterial Balance in the Gut

Bacterial balance in the gut is important. We have commensal bacteria in our gut, which can potentially be beneficial bacteria or pathogenic bacteria. What instigates that switch from beneficial to pathogenic will be things like sugar consumption, stress, insulin resistance, and previous or current infections.

If the bacterial balance is heavier on the pathogenic side, it may result in the following:

• Dysbiosis
• Vasovagal dysfunction
• Insulin resistance
• Lipopolysaccharide (LPS)
• Diarrhea

NCGS Treatments

The article addressed medical treatments for NCGS, and I’ve included natural treatments here as well.

Vagus Stimulation

Dr. Kharrazian’s book, “Why Isn’t My Brain Working?” states you can do the following to stimulate your vagus nerve: gargle hard for a couple of minutes each morning, stimulate your gag reflex by touching the back of your tongue, and sing really loud.

In my clinical opinion, this is palliative, or supportive, and is not going to be enough to address the underlying issue. As much as I wish we could sing away our disease or our NCGS, there are things higher up on the hierarchy that are driving these issues.

A7NRA (Alpha-7 Nicotinic Receptor Agonist)

The article addresses these as medications that act on the acetylcholine receptors. Some natural ways we can activate, or stimulate, the A7NRA would be to take compounds such as alpha-GPC or L-carnitine.

CRFR1AA (Corticotropic-Releasing Factor Receptor 1 Antagonist)

This compound is stimulated in the hypothalamus to make adrenocorticotropic hormone (ACTH). The pituitary makes ACTH, which then goes to the adrenals to make cortisol. So this antagonist (medication) is trying to block that receptor and dampen the cortisol response. In the natural-medicine world, we would use things like phosphorylated serine or adaptogenic herbs to get the hypothalamus and pituitary to cool down.

Probiotics

We may use soil-based probiotics or probiotics with specific strains, such as saccharomyces boulardii to increase your IgA. Some people may have SIBO (small intestinal bacterial overgrowth) and may not tolerate some probiotics as well, so they may have to use specific strands that are less sensitive.

Antioxidants

Antioxidants that have been beneficial in the literature include turmeric, curcumin, and resveratrol. These are beneficial at dampening brain inflammation.

Click here if you want to heal from the damage non-celiac gluten sensitivity (NCGS) has caused!

Reference:

Daulatzai, M. A. February 2, 2015. “Non-Celiac Gluten Sensitivity Triggers Gut Dysbiosis, Neuroinflammation, Gut-Brain Axis Dysfunction, and Vulnerability for Dementia.” CNS & Neurological Disorders—Drug Targets. (https://www.readbyqxmd.com/read/25642988/non-celiac-gluten-sensitivity-triggers-gut-dysbiosis-neuroinflammation-gut-brain-axis-dysfunction-and-vulnerability-for-dementia)