An Unexpected Twist for “Gluten Sensitivity”

While the concept of gluten sensitivity without celiac disease has been recognized since 1980 (Gastroenterol 1980; 79: 801-06), a recent study indicates that gluten may not be the main culprit in inducing these symptoms (Gastroenterol 2013; 145: 320-28; editorial 276-79).

The authors of this double-blind crossover study were the same investigators who popularized the concept of nonceliac gluten sensitivity (NCGS) two years ago (Am J Gastroenterol 2011; 106: 508-14).  In this current study, they demonstrate that in NCGS patients consuming a low FODMAPs diet (see previous post links below) gluten reintroduction did not cause specific or reproducible symptoms.

Methods: In this study, they enrolled 37 subjects with NCGS who fulfilled Rome III criteria for IBS and improved on a gluten-free diet (GFD).  All participants continued their GFD and after a 1-week baseline, started on a low FODMAP diet for a 2-week run in period.  Subsequently, patients were randomly assigned to 3 study arms: high gluten (16 g gluten/day), low gluten (2 g gluten & 14 g whey per day) or control (16 g whey/day).  Each participant took this diet for 1 week, had a 2-week washout, then crossed over to each arm.  In addition, at least 8 months, 22 subjects underwent another brief crossover study (high-gluten, whey only, or control with no additional protein).  As part of the study, clinical, serological, and immunologic parameters were monitored during all aspects of the rechallenges.

Results: “Gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein.” There were no changes in any serological or immunologic parameters between the dietary challenges.

There were several limitations to this study of this highly-selected cohort which are well-described in their discussion.

Bottom-line: Gluten might not be a specific trigger once dietary FODMAPs are reduced.

Related blog posts:

17 thoughts on “An Unexpected Twist for “Gluten Sensitivity”

  1. Pingback: “Gluten-Related Disorders” (Part 2) | gutsandgrowth

  2. Pingback: Most Popular Posts | gutsandgrowth

  3. Pingback: Newest FODMAPs Study for IBS | gutsandgrowth

  4. Pingback: Gluten-free diet “has legs” | gutsandgrowth

  5. Pingback: Use of Gluten-Free Diet with Inflammatory Bowel Diseases | gutsandgrowth

  6. Pingback: Low-FODMAPs with or without Gluten-Free Diet in IBS | gutsandgrowth

  7. Pingback: Mechanism for FODMAPs diet | gutsandgrowth

  8. Pingback: Ondansetron for Irritable Bowel with Diarrhea? | gutsandgrowth

  9. Pingback: NASPGHAN Postgraduate Course 2014 -Nutriton Module | gutsandgrowth

  10. Pingback: Wheat Intolerance Syndrome? | gutsandgrowth

  11. Pingback: Low FODMAPs Diet in Pediatric Irritable Bowel | gutsandgrowth

  12. Pingback: FODMAPS Advice From Harvard | gutsandgrowth

  13. Pingback: “Men Sometimes See Exactly What They Wish To See” and Gluten Sensitivity | gutsandgrowth

  14. Pingback: Is Autoimmunity Associated with Nonceliac Wheat Sensitivity? | gutsandgrowth

  15. Pingback: Zonulin –Possible Biomarker for Gluten Sensitivity? | gutsandgrowth

  16. Pingback: Is a Gluten-Free Diet a Healthy Diet for Those without Celiac Disease? | gutsandgrowth

  17. Pingback: What Happens When Patients With ‘Gluten Sensitivity’ Are Challenged with Gluten? | gutsandgrowth

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.