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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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