Crohn's Disease Forum » Books, Multimedia, Research & News » Does Non-Celiac Gluten Intolerance Actually Exist?

05-17-2014, 04:38 PM   #1
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Does Non-Celiac Gluten Intolerance Actually Exist?

Individuals with Celiac disease are intolerant to gluten. However, cutting out dietary gluten is also suggested to many suffering from inflammatory bowel disease (IBD), which is often associated with Ulcerative Colitis and Crohn’s disease. On top of that, many self diagnose themselves with gluten intolerance and claim a wide range of health benefits to a gluten-free diet. A recent study has shown that for those with non-Celiac gluten sensitivity (NCGS), the gluten itself might not be to blame for GI troubles. The study comes Peter Gibson of Monash University and the results were published in the journal Gastroenterology.

The study was a follow-up to one Gibson performed in 2011. That study used 34 subjects in a double-blind randomized placebo-controlled trial. The results showed that those who had undergone a gluten free diet for 6 weeks experienced more relief from symptoms including pain, bloating, and fatigue than those who ingested controlled amounts of gluten during that same period. His conclusion at the time stated that NCGS likely existed, but there wasn’t an obvious underlying mechanism.

In this new study, Gibson utilized 37 subjects who had self-reported NCGS and IBD. Rather than just relying on subjective reports of pain, the researchers carefully monitored urine, stool, and serum samples. The diet was strictly controlled in order to rule out other nutritional variables that were not accounted for in the original study. These potential triggers included lactose, certain preservatives, and FODMAPs, which are short-chain carbohydrates which the body cannot always readily absorb.

For the first two weeks of the study, participants held a diet low in FODMAPs. Next, they cycled through diets with high-gluten, low-gluten, and a whey isolate placebo for a week each. After that, a secondary experiment was conducted with 22 of the original subjects to confirm the efficacy of the placebo. The low-FODMAP diet, high gluten diet, and the placebo diet were all consumed for three days at a time.

Ultimately, Gibson’s team discovered that following the low-FODMAP baseline diet, every other diet, including the gluten free, resulted in an increased reporting of symptoms of gas, bloating, and pain. During the second part of the experiment, the participants reported increased symptoms even while on the baseline diet. The researchers attributed this to a “nocebo” effect. This is the opposite of the placebo effect, where people take a medication with no active ingredients, but they believe they are and show signs of improvement. For a nocebo, anyone taking a substance that they perceive to be potentially harmful can actually exacerbate symptoms. The results showed that only 8% of the participants had gluten-specific effects from the diet, leading the researchers to reverse their opinion from the 2011 study and say that NCGS doesn’t really seem to be a factor in diets low in FODMAPs.

Some examples of FODMAP-containing foods include artificial sweeteners, beans, high-fructose corn syrup, and gluten-containing grains like wheat, rye, and barley. There is a great deal of overlap, thus giving up gluten invariably means cutting out a great deal of FODMAP sources as well. As the gluten sensitivity was compared against a low-FODMAP diet, future studies should seek to resolve the role FODMAPs play in intestinal irritation. This will help define the results of other studies that have found a connection between gluten and gastrointestinal distress in non-Celiac patients with IDB.
05-21-2014, 10:48 PM   #2
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"Alternatively, gluten might induce symptoms only in the presence of a moderate content of FODMAPs. Many gluten-containing cereals are high in fructans, which are a problem in patients with IBS15 and their concomitant reduction with the introduction of the GFD might lead to improved gut symptoms, wrongly perceived to be due to a reduction in gluten intake. "

“In all participants, gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein,” Gibson and his research team write in their study."

Is it the gluten or the fodmaps? -ALL patients “significantly worsened to a similar degree when their diets included gluten or whey protein,” - but they were not “gluten-specific gastrointestinal effects” – large amounts of nutritionally empty carbs- usually containing wheat – removal leads to improvement, reintroduction leads to worsening.

Hmmmm, I ate gluten and felt worse but not in a gluten-specific way??

".....the study found that gluten is likely not alone responsible for all of the adverse health effects many without celiac disease experience as a result of gluten consumption, indicating that other factors beyond gluten in wheat, including fructans (which are reduced in the FODMAPs) diet, enzyme inhibitors (e.g. α-amylase/trypsin inhibitors), and lectins..., likely play role in explaining why so many who employ a wheat free diet experience self-reported improvements in their health."
.....although it is correct to state that 'Non-Celiac Gluten Sensitivity' may not be as large a problem as initially anticipated, 'Non-Celiac Wheat Sensitivity' very well is.
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05-21-2014, 11:03 PM   #3
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I have Celiac Sprue in my family (not immediate family, but family nonetheless) and I was diagnosed with a mild gluten intolerance while investigating horrendous pain. However, I went gluten free for about 8 months and initially things seemed better, but all my symptoms returned so I didn't see the point in being on a gluten-free diet anymore. The upside is, I discovered Spaghetti Squash and different diets open you up to new foods and ways of cooking and baking.

The initial sample for this study were 'self-diagnosed' subjects and there weren't many of them. I'm a bit dubious of the results, except to say that the mind is a powerful thing.

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