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No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates

Celiac.com 09/23/2013 - Patients with non-celiac gluten sensitivity (NCGS) do not have celiac disease, but see an improvement in symptoms when they adopt gluten-free diets.

Photo: CC--Pierre MetivierA team of researchers recently investigated the specific effects of gluten after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates (fermentable, oligo-, di-, monosaccharides, and polyols [FODMAPs]) in patients with suspected NCGS.

The research team included Jessica R. Biesiekierski, Simone L. Peters, Evan D. Newnham, Ourania Rosella, Jane G. Muir, and Peter R. Gibson.

The team performed a double-blind cross-over trial of 37 subjects (aged 24−61 y, 6 men) with NCGS and irritable bowel syndrome (based on Rome III criteria), but not celiac disease.

They assigned study participants randomly to groups given a 2-week diet of reduced FODMAPs, and were then placed on high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week, followed by a washout period of at least 2 weeks.

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The researchers then evaluated serum and fecal markers of intestinal inflammation/injury and immune activation, and indices of fatigue.

The team then crossed twenty-two participants over to groups receiving gluten (16 g/d), whey (16 g/d), or control (no additional protein) diets for 3 days, using visual analogue scales to evaluate symptoms.

They found that gastrointestinal symptoms consistently and significantly improved for all patients during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein.

The team saw gluten-specific effects in just 8% of study subjects. They saw no diet-specific changes in any biomarker. During the 3-day re-challenge, participants’ symptoms increased by similar levels among groups. Gluten-specific gastrointestinal effects were not reproduced. An order effect was observed.

A placebo-controlled, cross-over re-challenge study showed no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in FODMAPs.

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4 Responses:

 
Robena
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said this on
30 Sep 2013 10:16:10 AM PDT
Great study, but I do wish when giving the reports they would break it down into terms that ordinary people can understand. Not everyone has a medical degree.

 
celiacMom
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said this on
01 Oct 2013 5:17:48 AM PDT
yep, FODMAP diet made big difference to me (for good) but I'm still afraid to try gluten again.

 
Megan Rieff
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said this on
04 Oct 2014 7:44:36 AM PDT
I think it is incredibly important to note that the study suggest it is "fructan" in the wheat as opposed to "gluten." This study has been so misrepresented by the media, I wish that you guys would address this a little more thoroughly. The misrepresentation of this study by the media does a huge disservice to people a lot of people. Not to mention the fact that this was a very specific study of 37 people with IBS and self-diagnosed gluten sensitivity. It is basically a preliminary study that calls for more study and is not prescriptive across the board. I actually emailed Dr. Gibson the other day, because I am trying to get PBS to correct their inflammatory headline and misleading article. I would be happy to share that email with you. I would really appreciate it if you guys would write up a more thorough article. We need better education about this in the public.
Furthermore for people like me (who didn't have doctors who knew about celiac disease to test for it), people who have been put on a gluten free diet for other reasons, or people who legitimately have NCGS this has been really bad publicity. "This in no way means that gluten does not cause gut symptoms in people without coeliac disease – but just not in this 37. The implication is that gluten is not a common cause of gut symptoms as some people believe" (P. Gibson, personal communication, October 2, 2014).
The only reason celiac disease is now acknowledged by the community at large is because of all the people who fought for their rights and education of the public. I hope that celiac.com can support that effort among the NCGS, wheat free community. Whether it is the fructan or the gluten we deserve for people to take us seriously as well. Please support us, we always speak out for you!

 
Megan Rieff
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said this on
04 Oct 2014 7:47:10 AM PDT
Oh, I also forgot to mention. Had the media reported on this in an educational rather than inflammatory manner, it could have helped a lot of people who have experienced significant but not complete recovery on a gluten-free diet. This study suggests that these people could benefit from a low FODMAP diet, which you guys did write about here. I am just speaking to how unfortunate it was that this study was so misrepresented by the media, when it could have been really beneficial.




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Hi Allie and welcome First off, I know 3 years was a long wait, but at 17 you've figured out celiac way before many people do. That should make a big impact on minimising its effects and helping you with the diet, so, bizarrely enough, congratulations! A lot of good advice has been brought together in this thread: Don't worry that your symptoms are bad now. As you follow the diet your body will begin healing itself and you're still very young so hopefully this will go really smoothly. Think in terms of the next 6 months rather than weeks however, recovery will likely take a little time. Eat as healthily as you can, lots of whole foods and try to avoid the gluten free processed substitutes as your digestive system needs all the help it can get at this moment. You may want to avoid dairy as well for now and think about reintroducing it later. This site has been really helpful to me and others. I hope you find it just as useful. Best of luck! ps, your increased reaction to gluten during the challenge phase was perfectly normal. Many find that reintroducing it much worse than the initial affects and take some time to get over the challenge. That's why you'll see lots of posts here urging folks to 'stay on gluten' till their testing is complete!

Hi! My daughter is 19 was diagnosed at age 16. It took about 12-18 month s for her to fully heal from the damage and feel "normal" again. Also because of the damage done she had reactions to dairy, so you may want to try no or minimum dairy until youre fully healed. Just a suggestion. Hope you start feeling well soon!

Hi yall! New to this blog, but really glad it exists because I have lots of questions. First off, I'm Allie! I'm 17 and newly diagnosed Celiac after about 3 years of searching for answers. I initially went gluten-free on the recommendation of a friend, I felt better in about a month and then my pediatric gastroenterologist had me do the gluten challenge, and my symptoms were the worst they have ever been, and ones I barely noticed before became very present. I did the biopsy and was diagnosed, it's been about 2 weeks and my symptoms are still pretty bad, although my diet has no known sources of gluten or cross contamination. Wondering if anyone has any input on healing post gluten challenge, any tips or how long it took for you would be quite helpful! Thanks

Might want to look into a keto diet, I have UC on top of celiacs and keto is working great Yeah I have major nerve and brain issues with gluten, gluten ataxia with nerve issues and brain issues. Seems to cause my body to attack my brain and nerve system. My brain stumbles fogs, and starts looping, the confusion causes me to become really irritable, I call it going Mr Hyde. Like my mind will start looping constantly on thoughts and not move driving me literally mad, or it used to. Now days it is primary the numbness anger but the gut issues and sometimes random motor loss limit me motionless to the floor now days for the duration of the major anger effects. Used to be a lot more mental then painful gut. I did a mental trauma post on it on while back where I came out about all my mental issues with gluten.

^^^^^^ good info, tips and tricks^^^^^^^^^ yes, crumbs will make you sick. also, breathing flour/pancake mix, etc that is in the air because eventually, you're going to swallow some.