For one of Jimmy Kimmel’s Pedestrian Question segments (you can watch the video below), he asked people if they are gluten-free. The responses were eye opening, disconcerting, somewhat funny, and worth the watch. They also demonstrated why people with celiac disease who cannot eat gluten at all become frustrated with people’s lack of understanding of their serious autoimmune disease.
Gluten-free has become a trendy diet. Some think that gluten is bad for you and not eating it will help with their health and help them lose weight. All not true. Gluten is a protein found in wheat, rye, barley, and triticale and provides the elastic texture and shape to foods like bread. Granted, the way our bread is processed now and the prevalence of gluten in processed foods and cosmetics has exposed us to higher amounts of gluten and has increased the number of cases of celiac disease. However, for the majority of the world, a gluten-free diet is not necessary.
That being said, there are some people who do not have celiac disease, but need to eliminate gluten from their diet. What they have is known as Non-celiac Gluten Sensitivity or Gluten Sensitivity. What is this? A better way to answer that question is what isn’t it? It is not celiac disease, is not an autoimmune disease, it does not damage the intestine, and it is not a wheat allergy. However, it does exist and it is predicted that 5-10% of the western population have it, with an estimated 18 million Americans suffering from it. The complicating part of non-celiac gluten sensitivity is that there is no test for it and some scientists question if it is a real clinical issue. Unlike celiac disease, which has clear indicators that there is an immune response and damage to the intestine, there are no biomarkers for non-celiac gluten sensitivity, which makes it hard to diagnose.
The first report of non-celiac gluten sensitivity was in 1978 and then afterwards there were only a few publications on the topic until 2010. Non-celiac gluten sensitivity seems to be more prevalent in young to middle aged females and there is some correlation of those who have it with a family history of celiac disease, malabsorption, and autoimmune disorders. Symptoms can appear after a few hours or days after eating gluten. The symptoms are similar to what is seen with celiac disease, except for the damage to the intestine. These include abdominal pain, gas, stomach distension, diarrhea/constipation, chronic fatigue, brain fog, joint and muscle pain, numbness in extremities, eczema, anemia, and depression. The similarities of some of the symptoms to those of irritable bowel syndrome make it even harder to diagnose. There are also studies indicating that a number of non-celiac gluten sensitivity patients also suffer from schizophrenia, autism, allergies, or autoimmune diseases, with non-celiac gluten sensitivity possibly being the cause.
Since there is no test to diagnose non-celiac gluten sensitivity, doctors need to diagnose it through a process of elimination. They test for wheat allergies and celiac disease. If the patient does not have either, the patient then has to remove gluten from their diet for a span of time and see if there are improvements. The reappearance of symptoms when gluten is reintroduced into the diet is another key indicator.
Research has increased since non-celiac gluten sensitivity resurfaced in 2010 but there is still much to learn and there are studies and discussions about the causes and the best way to treat it.
- FODMAPs: Short chain saccharides and sugar alcohols, which may not be absorbed well in the small intestine.
- Amylase Trypsin Inhibitors: A natural pesticide found in wheat and may cause inflammation in our intestine.
How to treat non-celiac gluten sensitivity has been controversial. Some studies have demonstrated that a gluten free diet will eliminate the symptoms, whereas other studies have shown that a combination of a gluten-free and low FODMAP diet is needed. The low FODMAP diet, developed by Peter Gibson and Susan Shepherd at Monash University is currently recommended to help with irritable bowel syndrome and fructose malabsorption. More studies need to be done to determine what the specific factors are, whether one, all, or a combination of gluten, FODMAPs, and amylase trypsin inhibitors is causing the symptoms to determine a better treatment plan. Additionally, understanding the cause can aid in the development of diagnostic assays so patients can learn if they have non-celiac gluten-sensitivity, rather than simply assuming that they do because they already know that they do not have celiac disease or a wheat allergy.
The best way to manage the symptoms is to keep eating gluten until you get tested because doctors cannot properly determine what you have if you remove gluten from your diet. Once it is determined you have non-celiac gluten sensitivity, then you should work with your doctor and a nutritionist to figure which foods should be eliminated from your diet.
Do you think you have non-celiac gluten sensitivity? If so, what do you think is the cause?
1. Catassi, C et al. (2013) Non-celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders. Nutrients 5, 3839-3853
2. Fassano, A, et al (2015) Nonceliac Gluten Sensitivity. Gastroenterology 148, 1195-1204
3. Milona-Infante, J. et al. (2015) Systematic Review: noncoeliac gluten sensitivity. Alimentary Pharmacology and Therapeutics 41, 807-820
Photo taken by Dominik Martin on Unsplash