In the era of Shakespeare, the question from his legendary work Hamlet was “to be or not to be, that is the question.” In our current society, the pivotal diet related conundrum has changed such that many are saying to themselves “to be gluten free or not to be gluten free, that is the question.” Gluten is one of the hottest topics in health care these days, with passionate and heated opinions on both sides of the argument. Positive reports from celebrities in the news as well as loved ones and friends who have gone gluten free and feel “amazing” has prompted a gluten free revolution. Studies estimate that 25-30% of Americans tried a gluten free diet at some point in the last year or feel that it is not nutritious, which is upwards of 100 million people in the US alone, leaving scientists to question the validity of this dietary movement in the absence of having Celiac disease.
Celiac disease is a condition where the immune system attacks the gastrointestinal tract following the ingestion of gluten. Gluten is a protein found in wheat, barley, oats, and rye. With the immune reaction to gluten in Celiac disease, there can also be “extraintestinal” effects including neurologic symptoms such as depression and neuropathy (numbness and tingling in the feet, legs, and or hands) as well as skin manifestations such as dermatitis herpetiformis. Celiac disease affects about 1% of the population. However, the prevalence of Celiac disease is far lower than the proportion of individuals reporting relief from a gluten free diet.
Due to doctors receiving repeated reports that patients felt better living a gluten free lifestyle, scientists were forced to study why this could be occurring. In 2011 a group of noteworthy gastroenterologists put a label on this group of people who felt better going gluten free, and termed them to be suffering with Non Celiac Gluten Sensitivity (NCGS). Diagnosing NCGS consists of an individual going on a gluten free diet, observing if there is improvement in their symptoms (these can range from abdominal bloating, diarrhea, constipation, depression, migraines, and brain fog), and then introducing gluten back into the diet and again observing if there is an exacerbation of the individuals symptoms.
Unfortunately, the Achilles heel of this condition termed Non Celiac Gluten Sensitivity is the lack of a blood test to specifically diagnose it. In medicine, alternative medicine, and research, doctors love blood tests. It makes the job easier of telling a patient you have “condition X” or you simply don’t have it. Because of the lack of a blood test and the wide array of symptoms Non Celiac Gluten Sensitivity sufferers report (ranging from bowel symptoms to depression), a tremendous amount of confusion and frankly misinformation has been disseminated by parties on both sides of the argument.
One study that is frequently cited by mainstream media sources comes from a research group in Australia. The study focused on patients with irritable bowel syndrome, also known as IBS, who reported experiencing gastrointestinal pain, bloating, cramps, or changes in bowel function such as diarrhea following the ingestion of gluten. Study participants were placed on a diet that restricted foods such as wheat, dairy, and other fruits and veggies which cause bacteria in the gastrointestinal tract to produce gas or byproducts that attract water, termed FODMAPS, for a period of two weeks. After the two weeks were completed, participants unknowingly ate a diet either high in gluten, containing a low amount of gluten and high amounts of dairy proteins termed whey, or whey protein only. All patients felt better on the diet low in FODMAPS and felt worse when eating gluten and dairy rich foods. From this the authors concluded that gluten has no effect on Non Celiac Gluten Sensitivity sufferers (1).
Obviously foods rich in FODMAPS as well as dairy increased IBS symptoms in these patients, yet consumption of gluten did as well, but because gluten was not the only cause of the problem, the mainstream media reports that the gluten free movement is a “fad diet” and lacks credibility.
The real travesty is that we are over a year out from a follow up study by many of the same scientists in Australia, which confirmed that Non Celiac Gluten Sensitivity patients felt worse when eating gluten, but likely you have not heard about this as we have not observed it to be reported in any of the mainstream media publications. In essence, these same scientists from Australia placed patients unknowingly on a gluten free diet, gluten containing diet, or whey rich diet. They found that those who consumed gluten did feel depressed after consumption of gluten, and that this is likely a reason why people with Non Celiac Gluten Sensitivity do not feel well after the ingestion of this dietary protein found in wheat, barley, oats and rye. In essence, the research is strongly associating gluten with an “extraintestinal” manifestation, which is depression (2).
As one of our close friends has brought to our attention, breaking bread is a way that we humans get together, socialize, and enjoy each other’s company. Pushing away the bread creates tension for all involved at a social gathering, and unfortunately those attempting to go gluten free are often lambasted for their efforts because others at the table may have read an article debunking gluten. Today’s article was written so that the Non Celiac Gluten Sensitivity sufferer has some defensible data for their dietary choices. We will continue to write these articles as with the passing of each month more and more information is learned about the deleterious effects gluten can have for the Non Celiac Gluten Sensitivity patient.
- Biesiekierski JR1, 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 Aug;145(2):320-8.e1-3. doi: 10.1053/j.gastro.2013.04.051. Epub 2013 May 4.
- Peters SL1, Biesiekierski JR, Yelland GW, Muir JG, Gibson PR. Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity – an exploratory clinical study.See comment in PubMed Commons belowAliment Pharmacol Ther. 2014 May;39(10):1104-12. doi: 10.1111/apt.12730. Epub 2014 Apr 1.