Gluten Intolerance May Not Exist

[garbon]

http://www.forbes.com/sites/rosspomeroy/2014/05/15/non-celiac-gluten-sensitivity-may-not-exist/

In 2011, Peter Gibson, a professor of gastroenterology at Monash University and director of the GI Unit at The Alfred Hospital in Melbourne, Australia, published a study that found gluten, a protein found in grains like wheat, rye, and barley, to cause gastrointestinal distress in patients without celiac disease, an autoimmune disorder unequivocally triggered by gluten. Double-blinded, randomized, and placebo-controlled, the experiment was one of the strongest pieces of evidence to date that non-celiac gluten sensitivity (NCGS), more commonly known as gluten intolerance, is a genuine condition.

By extension, the study also lent credibility to the meteoric rise of the gluten-free diet. Surveys now show that 30% of Americans would like to eat less gluten, and sales of gluten-free products are estimated to hit $15 billion by 2016 — that's a 50% jump over 2013′s numbers!

But like any meticulous scientist, Gibson wasn't satisfied with his first study. His research turned up no clues to what actually might be causing subjects' adverse reactions to gluten. Moreover, there were many more variables to control! What if some hidden confounder was mucking up the results? He resolved to repeat the trial with a level of rigor lacking in most nutritional research. Subjects would be provided with every single meal for the duration of the trial. Any and all potential dietary triggers for gastrointestinal symptoms would be removed, including lactose (from milk products), certain preservatives like benzoates, propionate, sulfites, and nitrites, and fermentable, poorly absorbed short-chain carbohydrates, also known as FODMAPs. And last, but not least, nine days worth of urine and fecal matter would be collected. With this new study, Gibson wasn't messing around.

37 subjects took part, all with self-reported gluten sensitivity who were confirmed to not have celiac's disease. They were first fed a diet low in FODMAPs for two weeks, then were given one of three diets for a week with either 16 grams per day of added gluten (high-gluten), 2 grams of gluten and 14 grams of whey protein isolate (low-gluten), or 16 grams of whey protein isolate (placebo). Each subject shuffled through every single diet so that they could serve as their own controls, and none ever knew what specific diet he or she was eating. After the main experiment, a second was conducted to ensure that the whey protein placebo was suitable. In this one, 22 of the original subjects shuffled through three different diets — 16 grams of added gluten, 16 grams of added whey protein isolate, or the baseline diet — for three days each.

Analyzing the data, Gibson found that each treatment diet, whether it included gluten or not, prompted subjects to report a worsening of gastrointestinal symptoms to similar degrees. Reported pain, bloating, nausea, and gas all increased over the baseline low-FODMAP diet. Even in the second experiment, when the placebo diet was identical to the baseline diet, subjects reported a worsening of symptoms! The data clearly indicated that a nocebo effect, the same reaction that prompts some people to get sick from wind turbines and wireless signals, was at work here. Patients reported gastrointestinal distress without any apparent physical cause. Gluten wasn't the culprit; the cause was likely psychological. Participants expected the diets to make them sick, and so they did. The finding led Gibson to the opposite conclusion of his 2011 research:


"In contrast to our first study... we could find absolutely no specific response to gluten."

Instead, as RCS reported last week, FODMAPS are a far more likely cause of the gastrointestinal problems attributed to gluten intolerance. Jessica Biesiekierski, a gastroenterologist formerly at Monash University and now based out of the Translational Research Center for Gastrointestinal Disorders at the University of Leuven in Belgium,* and lead author of the study alongside Gibson, noted that when participants consumed the baseline low-FODMAP diet, almost all reported that their symptoms improved!

"Reduction of FODMAPs in their diets uniformly reduced gastrointestinal symptoms and fatigue in the run-in period, after which they were minimally symptomatic."

Coincidentally, some of the largest dietary sources of FODMAPs — specifically bread products — are removed when adopting a gluten-free diet, which could explain why the millions of people worldwide who swear by gluten-free diets feel better after going gluten-free.

Indeed, the rise in non-celiac gluten sensitivity seems predominantly driven by consumers and commercial interests, not quality scientific research.

"On current evidence the existence of the entity of NCGS remains unsubstantiated," Biesiekierski noted in a review published in December to the journal Current Allergy and Asthma Reports.

Consider this: no underlying cause for gluten sensitivity has yet been discovered. Moreover, there are a host of triggers for gastrointestinal distress, many of which were not controlled for in previous studies. Generally, non-celiac  gluten sensitivity is assumed to be the culprit when celiac's is ruled out. But that is a "trap," Biesiekierski says, one which could potentially lead to confirmation bias, thus blinding researchers, doctors, and patients to other possibilities.

Biesiekierski recognizes that gluten may very well be the stomach irritant we've been looking for. "There is definitely something going on," she told RCS, "but true NCGS may only affect a very small number of people and may affect more extraintestinal symptoms than first thought. This will only be confirmed with an understanding of its mechanism."


Currently, Biesiekierski is focused on maintaining an open mind and refining her experimental methods to determine whether or not non-celiac gluten sensitivity truly exists.

"We need to make sure that this research is as well controlled as possible and is reproducible," Biesiekierski told RCS, subsequently adding the quintessential adage of proper science.

"Much, much more research is needed."

[Ideologue]

Lot of exclamation points for a piece of journalism.

[garbon]

They are very excited!

[Sheilbh]

Wouldn't surprise me at all. A couple of people who I know who've developed, out of nowhere, gluten intolerance have also suddenly developed a host of other food intolerances that roughly trend with them appearing in the newspaper.

Within a year they've gone from eating what everyone else does to hassling poor waiters in an Indian restaurant about ghee

[The Brain]

They think they are dogs.

[derspiess]

Lord, I hope this turns out to be true. Would be hilarious.

[Ideologue]

Well, celiac disease would still exist.

[MadImmortalMan]

Well, celiac disease would still exist.

Yeah, that's definitely real. The rest could well be just a fad.

[LaCroix]

may?? the research clearly shows it does not exist. it's a huge scam, like many health fads

[Darth Wagtaros]

Don't get the Gluten Free movement. SOmeone on facebook was crowing about getting gluten free creme brule for godsakes.

[Scipio]

Are you telling me that Jenny McCarthy's son's autism wasn't caused by gluten intolerance? That's unpossible!

[crazy canuck]

Well, celiac disease would still exist.

Yeah, that's definitely real. The rest could well be just a fad.

Well the fad part is that people buy a bunch of "gluten free" products but essentially eat the same things.  So instread of eating cereal, crackers, bread etc etc with gluten they buy gluten free alternatives.  But that isnt really a change in diet. They are still eating a lot of carbs.

We tend to eat a low gluten diet but mainly because we eat a lot of meat, fruit and veggies.  But I have to say I do love bread and pasta.  The real stuff.  Not the gluten free alternative.

[Caliga]

Not surprising.  Right after the obsession with peanut allergies seemed to die down, suddenly we were hearing all this gluten shit.  I wonder what the next food mass hysteria will be?

[sbr]

I have a friend/coworker that I have known for ~15 years or something who definitely has some sort of gluten allergy/intolerance.  Among some other things she had very bad sleeping problems, if she had to drive for more than 40 minutes she would often have to pull over and take a nap mid-trip, one time she got home from work and fell asleep in her car in the driveway and slept there for 3 hours.  She finally narrowed the problem down to gluten, and since she removed it from her diet completely a few years ago all of her problems have disappeared.

[Jaron]

If this is true, we can all eat bread again! rejoice!