Non-celiac gluten sensitivity: is it really gluten?

Posted on Tue, 26 Aug 14

Although there is increasing awareness of so-called non-celiac gluten sensitivity, it is still a controversial term. Research suggests that gluten might not be the problem after all.

Non-celiac gluten sensitivity is very commonly reported problem affecting anywhere from 3 to 13% of people (1,2). Unlike celiac disease which can be diagnosed with medical tests there are currently no tests for gluten sensitivity, which is typically characterized by irritable bowel syndrome (IBS) symptoms and improvement with a gluten-free diet.

Controversially there is some argument over whether or not non-celiac gluten sensitivity actually exists. A study in people with gluten sensitivity suggested it might be sensitivity to fermentable carbohydrates, not gluten, that is the problem (3). While another study found that people with IBS who replaced modern wheat with an ancient wheat variety had significant reductions in digestive symptoms and fatigue, which may be due to more nutritious flour, and not less gluten or fermentable carbohydrates (4). And to confuse things even further, some research suggests non-gluten proteins in wheat may actually be to blame (5).

In any case, does any of this really matter for the gluten sensitive? Not really. If you find significant improvement from a gluten-free diet it is all somewhat irrelevant. But perhaps non-celiac gluten sensitivity should be more correctly termed non-celiac wheat sensitivity.

References:

1. Volta U, Bardella MT, Calobro A, Troncone R, Corazza GR. An Italian prospective multicentre survey on patients suspected of having non-gluten sensitivity. BMC Med. p. 85.
2. Aziz I, Lewis NR, Hadjivassiliou M, Winfield SN, Rugg N, Kelsall A, Newrick L, Sanders DS. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroenterol Hepatol. 2014 Jan;26(1):33-9.
3. Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;12:320–328. doi: 10.1053/j.gastro.2013.04.051.
4. Sofi F, Whittaker A, Gori AM, et al. Effect of Triticum turgidum subsp. turanicum wheat on irritable bowel syndrome: a double-blinded randomised dietary intervention trial. Br J Nutr. 2014 Feb 13:1-8. [Epub ahead of print]
5. Junker Y, Zeissig S, Kim SJ, Barisani D, Wieser H, Leffler DA, Zevallos V, Libermann TA, Dillon S, Freitag TL, Kelly CP, Schuppan D. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J Exp Med. 2012;12:2395–2408.