Are You Really Gluten Sensitive? (Part 1): Three Thoughts on Gluten Sensitivity
People with Celiac Disease need to avoid gluten, but more and more people are choosing to avoid gluten. Some claim they have Non-Celiac Gluten Sensitivity (NCGS), while others claim that gluten is bad for everyone. In this post, I’ll explore Non-Celiac Gluten Sensitivity (NCGS). I’m also planning a post on avoiding gluten by choice, so keep an eye out.
Three Thoughts About on Gluten Sensitivity
In the medical field, there are several theories regarding gluten sensitivity. There is no consensus yet as to whether or not it is a real condition separate from celiac disease.
After reviewing studies, I’ve identified three main ideas:
1. NCGS patients have Celiac Disease but were not tested for it or were not tested properly.
2. NCGS patients are not actually sensitive to gluten. Their symptoms are caused by other compounds in the food.
3. NCGS is a separate condition from Celiac Disease.
1: NCGS patients have Celiac Disease but were not tested for it or were not tested properly.
62% of people who believed they had gluten sensitivity had not been tested for Celiac Disease prior to starting a gluten-free diet. Patients are supposed to eat gluten for four weeks prior to an intestinal biopsy test for Celiac Disease. If they don’t, their intestines may start to heal. While we certainly want your intestines to heal, this makes it harder to get an accurate diagnosis.
2: NCGS patients are not actually sensitive to gluten. Their symptoms are caused by other compounds in the food.
65% report of NCGS patients reported symptoms continued after completely removing gluten-containing foods from their diets. In these cases, symptoms are likely caused by something other than gluten. These patients may experience symptoms related to lactose intolerance, fructose intolerance, or other Fermentable Oligo-, Di-, and Mono-saccharides And Polyols (FODMAPs).
If symptoms are reduced by avoiding gluten-containing foods, though, this does not mean gluten itself is necessarily the cause of symptoms. For example, the patient may be intolerant to wheat only (not wheat, barley, and rye which all contain gluten).
3: NCGS is a separate condition from Celiac Disease.
Some studies support that NCGS is a real condition, separate from Celiac Disease. Researchers believe patients with Celiac Disease and NCGS produce different antibodies and inflammatory markers in response to gluten. Additionally, patients with NCGS may not have as much “intestinal permeability” (meaning the ability for compounds, such as gluten, to go through the intestinal walls).
I tried to simplify the results of scientific studies. If you want to read more, here are the studies I reviewed:
Aziz, I., Lewis, N.R., Hadjivassiliou, M., Winfield, S.N., Rugg, N., Kelsall, A., … Sanders, D.S. (2013). A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. European Journal of Gastroenterology & Hepatology; 26: 33-39.
Biesiekierski, J.R., Newnham, E.D., Shepherd, S.J., Muir, J.G., Gibson, P.R. (2014). Characteristics of adults with a self-diagnosis of nonceliac gluten sensitivity. Nutrition in Clinical Practice; 29(4):504-509.
Biesiekierski, J.R., Peters, S.L., Newnham, E.D., Rosella, O., Muir, J.G., Gibson, P.R. (2013). No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology; 145: 320-328.
Bucci, C., Zingone, F., Russo, I., Morra, I., Tortora, R., Pogna, N., … Ciacci, C., (2013). Gliadin does not
induce mucosal inflammation or basophil activation in patients with nonceliac gluten
sensitivity. Clinical Gastroenterology and Hepatology; 11: 1294-1299.
Gibson, P.R., Shepherd, S.J. (2010). Evidence-based dietary management of functional Gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology; 25: 252-258.
Husby, S., Koletzko, S., Korponay-Szabo, I.R., Mearin, M.L., Phillips, A., Shamir, R., … Zimmer, K.P. (2012). European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease. Journal of Pediatric Gastroenterology and Nutrition; 54(1): 136-160.
Lionetti, E., Castellanata, S., Francavilla, R., Pulvirenti, A., Tonutii, E., Amarri, S., … Catassi, C. (2014). Introduction of gluten, HLA status and the risk of celiac disease in children. New England Journal of Medicine, 371: 1295-1303. doi: 10.1056/NEJMoa1400697
Massari, S., Liso, M. De Santis, L., Mazzei, F., Carlone, A., Mauro, S., … Minelli, M. (2011). Occurrence of nonceliac gluten sensitivity in patients with allergic disease. Int Arch Allergy Immunol; 155: 389-394. doi: 10.1159/000321196
Pallav, K., Leffler, D.A., Tariq, S., Kabbani, T., Hansen, J., Peer, A., … Kelly, C.P. (2011). Noncoeliac
enteropathy: the differential diagnosis of villous atrophy in contemporary clinical practice.
Alimentary Pharmacology and Therapeutics, 35: 380-390. doi: 10.1111/j.1365-2036.2011.04938.x
Sapone, A., Lammers, K.M., Casolaro, V., Cammarta, M., Giuliano, M.T., De Rosa, M., … Fasano, A. (2011). Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: Celiac disease and gluten sensitivity. BMC Medicine; 9. Retrieved from http://www.biomedcentral.com/1741-7015/9/23
Volta, U., Tovoli, F., Cicola, R., Parisi, C., Fabbri, A., Piscaglia, M., … Caio, G. (2012). Serological tests in gluten sensitivity (nonceliac gluten intolerance). J Clin Gastroenterol; 46 (8): 680-685.