Recently, headlines like Gluten Sensitivity is BullSh*t, Gluten ‘Sensitivity’ Probably Not a Real Condition and Gluten Intolerance May Be Completely Fake are cropping up all over the internet.
I’m receiving hundreds of emails wondering why I am not outraged, why I haven’t addressed the issue.
Honestly, after seeing the headlines, reading the articles, and tracking down the empirical research upon which those weak statements are based, I really didn’t feel all that ruffled.
But, you do, so let’s talk it out.
Let’s Start with the Study
The study cited in these attention-grabbing headlines is one published in the journal Gastroenterology, in August 2013. That’s right… last August. I read it then, unmoved.
That study was conducted by Peter Gibson and colleagues. Gibson is a respected gastroenterology professor at Monash University in Australia. You can read more about him and his various positions here.
The study is titled No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.
Have you heard of FODMAPs?
This is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Say that 9 times really fast.
FODMAPs are short-chain carbohydrates that aren’t completely absorbed in the gastrointestinal tract and can be fermented by gut bacteria. Research indicates these fermentable carbohydrates may be a significant factor in conditions like Irritable Bowel Syndrome (IBS). This article will provide more insight if you’d like to learn more about FODMAPs.
Back to the Study
Now the study title makes a bit more sense, right?
It indicates individuals who report having gluten sensitivity had no negative issues eating gluten when FODMAP foods were reduced in their diet. Said another way, Gibson’s research claim is that it may be the FODMAPs in foods, not the gluten, making those self-proclaimed gluten sensitive folks sick.
Before we drink the punch, I need to share 2 tidbits of info with you.
Two Red Flags
1. Peter Gibson reveals a conflict of interest in this research, as he is one of the authors of the book, The Low FODMAP Diet: A Revolutionary Plan for Managing IBS and Other Digestive Disorders (the authors include celiac disease as one of those “other” digestive disorders). Just Google the title if you’re interested in seeing it. It is on Amazon.
2. Funding for this study was supported by George Weston Foods, one of the largest producers of bread and bakery products and ingredients in Australia and New Zealand.
Although it is clear promoting a FODMAP diet is in Gibson’s best financial interest, and it is more than a touch interesting that gluten is suddenly not an issue (like it was in 2011 when Gibson’s research at that time found gluten-containing diets caused gastrointestinal distress, even in people without celiac disease) when a bread producing company is footing the research bill, let’s do a quick review of how the study was conducted and give Gibson and his group a fair shake.
The study consisted of 37 individuals who tested negative for CD, but who reported to have gluten sensitivity and irritable bowel syndrome (IBS).
First, all participants were placed on a 2-week diet of reduced FODMAP foods. (You can read about specific foods eaten on a low FODMAP diet here.)
After 2 weeks on the low FODMAP diet, study participants entered their randomly assigned group for 1 week:
- High gluten diet (16 grams gluten per day)
- Low gluten diet (2 grams gluten + 14 grams whey protein per day)
- Control diet (16 grams whey protein per day)
After completing the week of their assigned special diet, the following assessments were made:
- Blood and fecal markers of intestinal inflammation and/or injury
- Immune activation
- Indicators of fatigue
Next, there was a 2-week “washout” period off the specialized diets, then 22 of those original 37 participants crossed over to one of 3 randomly assigned groups for 3 days:
- Gluten (16 grams per day)
- Whey (16 grams per day)
- Control (no additional protein)
After 3 days, participants’ symptoms were evaluated by visual analogue scales (a commonly used subjective measurement tool, such as a “strongly agree”, “strongly disagree” type questionnaire).
Note: a handful of original participants left the study after a few days due to lack of tolerance for the diet.
- All participants reported improved gastrointestinal symptoms on the initial low FODMAP diet.
- Participants reported negative symptoms when their diets included gluten or whey.
- 8% of participants showed gluten-specific effects in the initial challenge.
- Biomarkers did not reveal changes related to diet.
- Gluten-specific effects were not reproduced in the 3-day re-challenge.
Direct from the published research, “These data suggest that NCGS, as currently defined, might not be a discrete entity or that this entity might be confounded by FODMAP restriction, and that, at least in this highly selected cohort, gluten might be not be a specific trigger of functional gut symptoms once dietary FODMAPs are reduced.”
So, to be clear, this conclusion states, based on this single, small study that:
- Non-celiac gluten sensitivity (NCGS) may not be a standalone condition.
- NCGS may be difficult to distinguish when FODMAP foods are restricted in the diet.
- Gluten may not have the same effect on the gastrointestinal tract when FODMAP foods are reduced.
Gibson reports a “nocebo” effect where the self-reported gluten sensitive participants expected to feel worse on the study diets, so they did.
Have you ever been told your negative symptoms of gluten sensitivity or CD are “all in your head”? It’s frustrating, isn’t it?
Gluten Sensitivity is Real ~ Here’s What We Know
I don’t want to bog you down with research, but I do think it is important to highlight the following so that readers are able to make an informed decision based on more than those outrageous headline and a single study.
- In 2010, the year before Peter Gibson’s initial research revealing gluten sensitivity as a stand alone condition, research conducted by Dr. Anna Sapone and colleagues (including Dr. Alessio Fasano) was published in the journal, International Archives of Allergy and Immunology, that stated gluten sensitivity was a clinical condition distinct from celiac disease.
- More confirming research followed, leading Dr. Fasano to call a consensus conference in February 2011 on gluten-related disorders where naming these disorders was discussed and a definition of gluten sensitivity was established.
- There are no biomarkers for gluten sensitivity, thus diagnosis is based on exclusionary criteria.
- According to Dr. Fasano in his book, Gluten Freedom, until biomarkers for gluten sensitivity are found, the condition is defined as the “clinical condition in which wheat allergy has been ruled out using specific tests, and celiac disease has been ruled out by both the absence of specific autoantibodies and also by an endoscopy showing normal intestinal mucosa.”
- Gluten sensitivity (unlike CD) is not linked to the HLA-DQ2 and D8 genes.
- Dr. Fasano also stresses the usefulness of an elimination diet in diagnosing gluten sensitivity. When negative symptoms are relieved after elimination of gluten, and a subsequent double-blind gluten challenge reveals symptoms return when gluten is consumed, this is another piece of the diagnostic puzzle for those with gluten sensitivity. (Note: a double-blind gluten challenge is one where gluten is reintroduced but neither patient or person administering the food knows which foods contain gluten and which do not. This helps eliminate any placebo effect.)
- Based on a review of 6,000 patients from the Center for Celiac Research between 2004 and 2010, it is estimated that 6% of Americans may be affected by gluten sensitivity.
- More research is needed, and in my recent interview with Dr. Fasano, he revealed the search for those biomarkers indicating gluten sensitivity is ongoing.
Regardless of which side of this discussion you’re on, I believe it is helpful to see both sides of the story and to read beyond headlines. Very often, there is so much more going on.
I find it sad that the media was so eager to take a very small, single study and exploit the results in an effort to create sensational headlines. What’s even more sad is that those articles shame a significant portion of the population for suffering from legitimate health issues.
It is behavior like this, and comments like those from Michael Pollan (“Gluten, I think it’s a bit of a social contagion.”) and Charlize Theron (“The whole gluten-free thing is bullsh*t,” Theron said to Chelsea Handler on a recent episode of Handler’s TV show. The video has some questionable images at the end and I want a site you can share with everyone, even the kiddos, so I’m not linking, but if you Google it, you will see it pop up on YouTube and can watch at your own discretion.) that are harmful to those of us with a medical need to live gluten-free.
Whether you have celiac disease, like I do, or gluten sensitivity, or any number of other gluten-related health issues, I want you to now that I take you and your health seriously. Our best reaction to these articles, flippant remarks and negative comments is positive action, moving forward together to educate others about what it means to live gluten-free when it is all about your health.
Be well and be informed,