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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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2 Responses:

 
F. Sawyer
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said this on
26 May 2017 10:18:18 AM PDT
First off to test positive for Gluten you must be on a full regiment of gluten foods when tested. And yes, there is such a thing as having the same symptoms when you do not test positive. In fact, these individuals are more sensitive that the ones who test positive. Because most of these people cannot even eat gluten free food.

 
Jeff Adams
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated ( Author)
said this on
27 May 2017 1:36:26 PM PDT
This study does not take a position on whether or not there might be a condition called non-celiac gluten sensitivity. Nor does the study negate the possibility that some people with celiac-like symptoms fail to test positive for anti-gliadin antibodies. The study merely describes the lack of evidence to support NCGS in double-blind studies. Could it still be a thing? Sure. Does the clinical evidence support it? Not in this study. Another serious problem, as pointed out by the study is the fact that 40% of patients routinely report celiac-like symptoms after receiving a placebo. This indicates either a psycho-somatic aspect to these symptoms, or possibly an unknown sensitivity. Either way, many questions need to be answered before we will have a solid scientific answer.




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