Should we all eat gluten-free?


By eating gluten-free foods even those who do not suffer from celiac disease could improve their gastrointestinal symptoms.

Eating gluten-free food is fashionable, as evidenced by the fact that in the US there are already 100 million consumers of gluten-free products. In addition to those with celiac disease or wheat allergies, gluten-free diets for those with non-celiac gluten sensitivity (NCGS) and those with sensitivity to non-celiac wheat or wheat intolerance syndrome could also benefit from a gluten-free diet.

Neolife medical management


“Gluten-free” products are currently experiencing widespread growth thanks to the potential health benefits available to the entire population.

Gluten is a small protein that is present in many cereals such as wheat, barley, rye or oats. Since these cereals are omnipresent in our regular diet, their removal is often difficult to achieve.

Today there are three clinical pictures which describe the intake of gluten: celiac disease (autoimmune), wheat allergy (an allergy mediated by immunoglobulin E (IgE) and non-celiac gluten sensitivity which is characterized by an intolerance to gluten, but does not meet the criteria of the preceding two. In the first two clinical pictures above, the gluten-free diet is necessary; however, for gluten sensitivity, removal of gluten from the diet is optional.

Gluten-free foods

Although only 1% of the US population is celiac, 60% believe that a gluten-free diet would improve their physical and mental health, strengthen the immune system, improve digestion, help them to lose weight and stimulate physical and mental performance. The trend of eating gluten-free food has skyrocketed during the last 10 years. It represents the most followed nutritional trend in the US with close to 100 million consumers of gluten-free products. This spectacular nutritional trend can be traced back to the testimonies of famous people and Olympic athletes. About 40% of North American Olympic athletes eat a gluten-free diet to improve their digestion, physical performance and health in general. However, it must be stated that this has not been scientifically proven (1), only based on a relatively small group of 13 athletes during a 1-week gluten-free diet. On the other hand thought the gluten-free food industry has taken notice of the rising trend and now offer all types of gluten-free food alongside announcements of the health benefits and the damage gluten can do to people in general.

Non-Celiac Gluten Sensitivity (NCGS) is defined as a “clinical entity produced by the intake of gluten that generates intestinal and extraintestinal symptoms and resolves once the gluten has been removed from the diet, provided that celiac disease and an allergy to wheat have also been ruled out” (2). The intestinal symptoms include abdominal pain, gastroesophageal reflux, flatulence, nausea, diarrhea and/or constipation and the extradigestive symptoms include headaches, fatigue, rashes, muscle aches, anxiety, depression and mental slowness.

Although there is still no scientific evidence, by eating gluten-free foods even those who do not suffer from celiac disease could improve their gastrointestinal symptoms.

Although the pathophysiological mechanisms of NCGS remain unclear, it seems that this is due to an activation of the innate immunity within certain cytokines in the digestive mucosa. As always, researchers and clinicians need to analyze and measure before they can confirm a diagnosis and they cannot simply state the patient’s symptoms. Although for now we do not have one or several clear diagnostic biomarkers for NCGS, the medical interest in this area is gaining followers as they strive to alleviate the symptoms described once gluten has been removed from the diet; to move beyond a placebo or purely fashionable dietary trend.

Some authors have related NCGS to irritable bowel and chronic fatigue syndrome (3). They have suggested that the removal of gluten from the diet of patients with irritable bowel syndrome (IBS) substantially improves the symptoms in the patients concerned. But gluten may not be the only culprit. It could be that other components within wheat, such as fiber are jointly responsible for the symptomatology. There is even a theory that the symptoms of abdominal distension, principally water retention in the intestine caused by the osmotic effect, the production of gases due to bacterial fermentation, an increase in intestinal permeability, an alteration in the microbiota and immunity could be the result of poor absorption and fermentation of carbohydrates (oligosaccharides, disaccharides, monodaccharides and polyols) in the small intestine, rather than the direct effect of gluten (4). Given that wheat contains both gluten and carbohydrates and that any of the components could be responsible for the symptomatology, perhaps we should also discuss Non-Celiac Wheat Sensitivity and Wheat intolerance (5).

In the end, there is no doubt that a high percentage of the population are concerned about the symptoms described without being strictly a celiac or having an allergy to wheat. Whether you have Non-Celiac Gluten Sensitivity (NCGS), Non-Celiac Wheat Sensitivity or Wheat Intolerance, treatment is likely to include removal, to a greater or lesser extent, of gluten, and even of wheat. It is quite possible that in the near future all these symptoms, as well as irritable bowel and chronic fatigue syndrome, converge and become a well-defined clinical entity which can be diagnosed and treated.

At Neolife we suggest that patients with gastrointestinal symptoms first take steps to rule out that they do not have celiac disease. Then we consider the removal of gluten and/or wheat to determine the effect said removal has on the symptoms presented.


BIBLIOGRAPHY

(1) Lis, d., Stellingwerff, T., Kitic, CM. et al. “No Effects of a Short-Term Gluten-free Diet on Performance in Nonceliac Athletes”. Med Sci Sports Exerc. 2015 Dec; 47(12):2563-70.

(2) Fasano A, Sapone A, Zevallos V, Schuppan D, Nonceliac gluten sensitivity. Gastroenterology. 2015;148:1195-1204.

(3) Aziz I, Lewis NR, Hadjivassiliou M, et al. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroenterol Hepatol. 2014;26:33-39.

(4) Biesiekierski JR, Peters SL, Newnham ED, et al. No effects of gluten in patients with self-reported nonceliac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145:320-328.

(5) Guandalini S, Polanco I. Nonceliac gluten sensitivity or wheat intolerance syndrome? J Pediatr. 2015;166:805-810.