Researchers have discovered why gluten may not always be responsible for symptoms in the case of non-coeliac gluten sensitivity.
Many people avoid gluten – a protein found in wheat, rye and barley – for various reasons. Coeliac disease – which affects approximately 1% of the population – is when the body’s immune system attacks itself when someone eats gluten. This leads to inflammation and damage to the gut. For people with coeliac disease, avoiding gluten for life is essential. In fact, researchers have discovered why gluten may not always be responsible for symptoms. In the case of non-coeliac gluten sensitivity, this highlights the complexities involved.
What is Non-Coeliac Gluten Sensitivity?
But people with gut or other symptoms after eating foods containing gluten can test negative for coeliac disease or wheat allergy. They are said to have non-coeliac gluten sensitivity, and make up about 10% of the population. Unlike coeliac disease or a wheat allergy, non-coeliac gluten sensitivity has no biomarker. There’s no blood test or tissue marker that can confirm it. Diagnosis instead relies on excluding other conditions. Through structured dietary testing, the diagnosis is achieved. Additionally, researchers have discovered why gluten may not always be responsible for symptoms in the case of non-coeliac gluten sensitivity.
Is Gluten To Blame?
In the case of non-coeliac gluten sensitivity, a group of researchers at the University of Melbourne wanted to understand whether gluten itself, or other factors, cause their symptoms. The groundbreaking research published in The Lancet suggests that most people who believe they’re sensitive to gluten are actually reacting to other factors. These include fermentable carbohydrates [known as FODMAPs] or brain-gut dynamics. For this group, the researchers found that gluten-specific reactions were uncommon. When they occurred, changes in symptoms were usually small. Many participants who believed they were “gluten sensitive” reacted equally – or more strongly – to a placebo. Interestingly, researchers have discovered why gluten may not always be responsible for symptoms in the case of non-coeliac gluten sensitivity during these studies.
Gluten Sensitivity
The study challenges the idea that gluten itself is the culprit behind symptoms in non-coeliac gluten sensitivity. The experts are calling for better diagnostic tools and more personalised treatment. They also want an end to unnecessary gluten avoidance. The major scientific review has found that what many people call “gluten sensitivity” may actually be linked to the way the gut and brain communicate, not to gluten itself. The comprehensive review analysed existing studies on non-coeliac gluten sensitivity (NCGS). Researchers aimed to clarify why people experience symptoms after eating foods that contain gluten. This is despite the fact they do not have coeliac disease. Symptoms such as bloating, abdominal pain, and fatigue are common among those who report gluten sensitivity. Associate Professor Jessica Biesiekierski from the University of Melbourne led the study. She explained that the results challenge long-held assumptions about the condition. “Contrary to popular belief, most people with NCGS aren’t reacting to gluten,” she said.
FODMAP
“Our findings show that symptoms are more often triggered by fermentable carbohydrates, commonly known as FODMAPs, by other wheat components or by people’s expectations and prior experiences with food.” They found that when people ate a low-FODMAP diet – avoiding foods such as certain fruits, vegetables, legumes and cereals – their symptoms improved. This improvement continued even when gluten was reintroduced. “Millions of people around the world avoid gluten believing it harms their gut, often after experiencing real symptoms that range from mild discomfort to severe distress,” Biesiekierski said. Notably, researchers have discovered why gluten may not always be responsible for symptoms in the case of non-coeliac gluten sensitivity. This is shifting the direction of future research. “Improving our scientific and clinical understanding of a condition affecting up to 15 per cent of the global population is incredibly important.”
Based on their review the researchers recommend ruling out coeliac disease and wheat allergy first; optimise the quality of someone’s overall diet; trial a low-FODMAP diet if symptoms persist and only then, consider a four to six-week dietitian-supervised gluten-free trial, followed by a structured re-introduction of gluten-containing foods to see whether gluten truly causes symptoms.
