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How Solid is the Evidence for Non-celiac Gluten Sensitivity?


Photo: CC--Owwe

Celiac.com 05/15/2017 - For all the talk of studies touting evidence for non-celiac gluten sensitivity, the actual data don't stack up very well, according to an recent assessment by two researchers, whose results appear in Clinical Gastroenterology and Hepatology.

In an effort to determine the accuracy of using a double-blind, placebo-controlled study to confirm diagnosis of non-celiac gluten sensitivity in patients who respond to a gluten-free diet, researchers Javier Molina-Infante, and Antonio Carroccio recently set out to assess data on a series of such studies. Both researchers are affiliated with the Department of Gastroenterology, Hospital Universitario San Pedro de Alcantara in Caceres, Spain.

For their study, the pair analyzed data from 10 separate double-blind, placebo-controlled, gluten-challenge trials on a total of 1312 adults. The available studies varied significantly in many ways. The duration of the gluten challenge, for example, varied from 1 day to 6 weeks. The daily doses for those gluten challenges varied from 2 grams to 52 grams, with 3 studies administering 8 grams or less each day. The composition of the gluten-free placebo also varied considerably between tests; including variation by gluten-free product type, and levels of xylose, whey protein, rice, or corn starch containing fermentable carbohydrates.

Most of the studies did find gluten challenge to significantly increase symptom scores compared with placebo. However, out of 231 NCGS patients, only 38 patients (16%) showed gluten-specific symptoms. Moreover, nearly half (40%) of these patients showed similar or increased symptoms in response to placebo; something researchers term a 'nocebo' effect. That leaves just 6 or 7 patients out of 231 showing gluten-specific symptoms.

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The researchers also point to heterogeneity and to potential methodology flaws in gluten challenge studies. They also present powerful questions about gluten as the trigger for symptoms in most patients with presumptive NCGS. Lastly, they highlight the importance of the nocebo effect in these types of studies.

These results certainly invite more careful, rigorous studies on the matter, and challenge researchers to provide solid data from well-crafted double-blind placebo controlled studies.

Basically, what little evidence we thought we had to support the existence of non-celiac gluten sensitivity has been shown to be thin at best. Until solid evidence arrives, the status of non-celiac gluten sensitivity will remain open to question and doubt by both researchers and potential sufferers.

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Welcome to the forum. Be sure to browse through the DH section for advice and tips. Glad your wife is gluten free. My hubby was gluten free some 12 years before my diagnosis. Sure makes it a bit easier!

As I am sitting here, I am wearing a retainer. Yep, had a tooth extracted a few months ago. To keep the space open for a future transplant, my dentist ordered a retainer. I read that PUB MED study. One kid. Not very scientific at all! Gluten Free Watchdog agrees that the odds of this kid being glutened by her retainer is slim and none. Like my PCV sprinklers lines, retainers probably do not last a lifetime. Ask your dentist how long they should last. No one wants to eat plastic!

I've had them about six or seven times at several different Starbucks locations. My sister has, also. Neither one of us have had any signs of getting glutened. They are served in a parchment paper bag that should be handed to you straight from the oven sealed. I've heard many internet complaints about the bags being dusty, too many ingredients, unhealthy, etc., but honestly, they are pretty darned tasty! And, when you are traveling and hungry, they are even tastier. They sell out quickly at most Starbucks, but I've been able to purchase one as late at 6 p.m.

I wish they didn't use " gluten" as a headline. People abuse and starve children for a variety of " reasons". gluten-free was just one they picked, it could have been paleo or kosher or whatever...

Ugh! This again..... first ...it was one person...not a study... just someone's speculation. if I am remembering correctly - no one actually tested the retainer. The kid was a 12-16 yr old an drew could have gotten caught eating gluten, etc, etc, etc. And then those internet folks who love to spread " bad news" or use that stuff to further their purpose, jumped on it. And then let's talk to a chemist or plastic scientist - if the plastic leaches our actual proteins, like gluten, wouldn't the plastic piece break down after a while? welcome to the world of Celiac internet myths. adding - none of the Celiac Centers, Associations, etc have warned people not to use a retainers.