Joseph Murray, M.D., discusses a journal article published in Gastroenterology about non-celiac gluten sensitivity. The results of the study show non-celiac gluten sensitivity is a misnomer that should be labeled as a wheat intolerance to fructan.
About three years ago, a group from Australia published a paper saying there was non-celiac gluten sensitivity. This study was conducted with a group of volunteers who reported benefits of their irritable bowel syndrome (IBS) symptoms from going gluten-free. The researchers made sure the patients didn't have celiac disease and then put them in a double blind, placebo controlled challenge with gluten. The results showed people could get symptoms from gluten that was not predicted by the usual factors that predict celiac disease. This study started an interest in non-celaic gluten sensitivity.
The same research group undertook a similar, more detailed study that came out last year. This study again recruited people that had IBS symptoms who reported benefits of going gluten-free. Before the researchers started the patients on a gluten challenge, they recorded the patients intake of FODMAPs. FODMAPs are components of foods that are small sugars, fermented, and have osmotic properties. The researchers restricted the patients intake of FODMAPs for a couple of weeks and during that time period, the patients didn't have the residual symptoms they had been having. Once the researchers challenged the patients with gluten, the patients didn't get symptoms in response to gluten. The researchers challenged the patients a second time on a more restrictive diet and the patients, again, didn't have symptoms from gluten.
What does all of this mean? Perhaps the patients thought to be gluten sensitive aren't affected by the gluten. The researchers of this particular study suggest it might be fructan causing the gluten-responsive symptoms. Fructan is a component of wheat that act like a FODMAP. Perhaps non-celiac gluten sensitivity patients have a wheat sensitivity due to fructan. A lot more research needs to be done to figure out how much of a role fructan is playing in creating non-celiac gluten sensitivity symptoms.
What does this matter to patients? If patients feel better by avoiding gluten, it is still important to tested for celiac disease. Physicians need to find that out before a patient goes gluten-free. A patient that has celiac disease has chronic inflammation of the intestine and could have complications.
Read the full study online here.
For more information on celiac disease, visit mayoclinic.org/celiacdisease.
Dr. Murray is a gastroenterologist and celiac disease expert at Mayo Clinic.