Is Non-Celiac Gluten Sensitivity a Figment of the Imagination?

Decades ago, American doctors believed they would never see a case of celiac disease because it was considered too rare. Over the years, though, research showed that celiac disease is not rare. Now, there are many Americans following a gluten-free diet even though they do not have celiac disease. They say they simply feel better when they avoid gluten. Many physicians are skeptical about this condition, termed non-celiac gluten sensitivity. We have heard them describe these patients as nut jobs. They consider this a fad that will fade with time. Is non-celiac gluten sensitivity all in people’s heads?

What Is Gluten and When Is It a Problem?

About 1 person in 100 with European ancestry has celiac disease and cannot tolerate gluten. This protein is found in wheat, barley and rye. When a person with celiac disease consumes food containing gluten, the immune system goes a bit haywire and attacks the lining of the small intestine. The tiny cellular “bumps” that are part of the lining called villi are destroyed, and the ability of the intestine to absorb nutrients becomes seriously impaired.

The consequences of celiac disease can be severe: osteoporosis, anemia, joint pain, headache, fatigue and itchy dermatitis in addition to digestive distress including diarrhea or constipation, nausea and vomiting, flatulence or heartburn. People with celiac disease are also more susceptible to cancers such as lymphomas. Following a strict gluten-free diet can make a huge difference for such people. Doctors no longer think this is a rare condition. Learn more about the complications of celiac disease and find out: “Are You Suffering from Celiac Disease?” at this link.

Should People Without Celiac Disease Also Avoid Gluten?

In the past few years, as word has gotten out about celiac disease and gluten-free foods have become more readily available, many people have decided to avoid gluten themselves even though they do not have a diagnosis of celiac disease. For some of these individuals, it just seems like a good idea. Others, however, report that they have definite symptoms that disappear if they don’t eat foods containing gluten.

Gastroenterologists worry that people self-selecting a gluten-free diet that is unnecessary may be compromising their nutrition by limiting their fiber intake. Some doctors think this is the “disease du jour” and should be dismissed as nothing but a fad.

Non-Celiac Gluten Sensitivity Gets Attention:

A new study from Columbia University Medical Center (New York City) and the University of Bologna (Bologna, Italy) shows that some of these individuals are objectively reacting to gluten even though they really don’t have celiac disease. The researchers recruited 80 people with non-celiac gluten sensitivity, 40 people with celiac disease and 40 healthy individuals.

Those with celiac disease had intestinal damage, but markers of immune system activity were not elevated in their blood. The people with non-celiac gluten sensitivity, on the other hand, had high levels of CD14, a compound signaling systemic immune system activation. They also had higher levels of lipopolysaccharide-binding protein and antibody reactivity to microbe antigens. The researchers believe that this is due to microbes or bacterial toxins slipping through the intestinal wall into the circulation.

Leaky Gut?

Presumably this is triggered by damage to the intestine triggered by gluten. It weakens the intestinal barrier and leads to intestinal permeability. A simple (and less elegant) way of describing this is to say “leaky gut.” Elevated levels of fatty acid-binding protein 2 found in some of these non-celiac disease patients also indicate increased intestinal wall permeability.

What Should People Do?

This research demonstrates that doctors should not automatically dismiss people who report problems with gluten even though they do not have celiac disease. If the physicians are truly skeptical of their patients, there are now objective markers that can be measured. The researchers who discovered this inflammatory immune response are among the best celiac scientists in the world.

There is also a straightforward treatment: people with non-celiac gluten sensitivity can greatly improve their symptoms and reduce their markers of inflammation and intestinal damage by following a gluten-free diet, according to the study. Twenty of these individuals were asked to follow a diet free of wheat, rye and barley for six months, and after six months the markers had dropped significantly. Oddly, there was not a significant link between symptom improvement and change in biological markers.

Because it may be tricky to follow a nutritionally balanced diet without any gluten, we suggest that a person starting on such a project may want to schedule a session with a dietitian for guidance. Share your own experience with gluten in the comment section below and please vote on this article at the top of the page.

Gut, online July 25, 2016