Non-Celiac Gluten Sensitivity May Not Exist

14 Aug

Posted by Ross Pomeroy May 14, 2014

In 2011, Peter Gibson, a professor of gastroenterology at Monash University and director of the GI Unit at The Alfred Hospital in Melbourne, Australia, published a study that found gluten, a protein found in grains like wheat, rye, and barley, to cause gastrointestinal distress in patients without celiac disease, an autoimmune disorder unequivocally triggered by gluten. Double-blinded, randomized, and placebo-controlled, the experiment was one of the strongest pieces of evidence to date that non-celiac gluten sensitivity (NCGS), more commonly known as gluten intolerance, is a genuine condition.

By extension, the study also lent credibility to the meteoric rise of the gluten-free diet. Surveys now show that 30% of Americans would like to eat less gluten, and sales of gluten-free products are estimated to hit $15 billion by 2016 — that’s a 50% jump over 2013’s numbers!

But like any meticulous scientist, Gibson wasn’t satisfied with his first study. His research turned up no clues to what actually might be causing subjects’ adverse reactions to gluten. Moreover, there were many more variables to control! What if some hidden confounder was mucking up the results? He resolved to repeat the trial with a level of rigor lacking in most nutritional research. Subjects would be provided with every single meal for the duration of the trial. Any and all potential dietary triggers for gastrointestinal symptoms would be removed, including lactose (from milk products), certain preservatives like benzoates, propionate, sulfites, and nitrites, and fermentable, poorly absorbed short-chain carbohydrates, also known as FODMAPs. And last, but not least, nine days worth of urine and fecal matter would be collected. With this new study, Gibson wasn’t messing around.

37 subjects took part, all confirmed not to have celiac disease but whose gastrointestinal symptoms improved on a gluten-free diet, thus fulfilling the diagnostic criteria for non-celiac gluten sensitivity.** They were first fed a diet low in FODMAPs for two weeks (baseline), then were given one of three diets for a week with either 16 grams per day of added gluten (high-gluten), 2 grams of gluten and 14 grams of whey protein isolate (low-gluten), or 16 grams of whey protein isolate (placebo). Each subject shuffled through every single diet so that they could serve as their own controls, and none ever knew what specific diet he or she was eating. After the main experiment, a second was conducted to ensure that the whey protein placebo was suitable. In this one, 22 of the original subjects shuffled through three different diets — 16 grams of added gluten, 16 grams of added whey protein isolate, or the baseline diet — for three days each.

Analyzing the data, Gibson found that each treatment diet, whether it included gluten or not, prompted subjects to report a worsening of gastrointestinal symptoms to similar degrees. Reported pain, bloating, nausea, and gas all increased over the baseline low-FODMAP diet. Even in the second experiment, when the placebo diet was identical to the baseline diet, subjects reported a worsening of symptoms! The data clearly indicated that a noceboeffect, the same reaction that prompts some people to get sick from wind turbines and wireless internet, was at work here. Patients reported gastrointestinal distress without any apparent physical cause. Gluten wasn’t the culprit; the cause was likely psychological. Participants expected the diets to make them sick, and so they did. The finding led Gibson to the opposite conclusion of his 2011 research:

“In contrast to our first study… we could find absolutely no specific response to gluten.”

Instead, as RCS reported last week, FODMAPS are a far more likely cause of the gastrointestinal problems attributed to gluten intolerance. Jessica Biesiekierski, a gastroenterologist formerly at Monash University and now based out of the Translational Research Center for Gastrointestinal Disorders at the University of Leuven in Belgium,* and lead author of the study alongside Gibson, noted that when participants consumed the baseline low-FODMAP diet, almost all reported that their symptoms improved!

“Reduction of FODMAPs in their diets uniformly reduced gastrointestinal symptoms and fatigue in the run-in period, after which they were minimally symptomatic.”

Coincidentally, some of the largest dietary sources of FODMAPs — specifically bread products — are removed when adopting a gluten-free diet, which could explain why the millions of people worldwide who swear by gluten-free diets feel better after going gluten-free.

Indeed, the rise in non-celiac gluten sensitivity seems predominantly driven by consumers and commercial interests, not quality scientific research.

“On current evidence the existence of the entity of NCGS remains unsubstantiated,” Biesiekierski noted in a review published in December to the journal Current Allergy and Asthma Reports.

Consider this: no underlying cause for gluten intolerance has yet been discovered. Moreover, there are a host of triggers for gastrointestinal distress, many of which were not controlled for in previous studies. Generally, non-celiac gluten sensitivity is assumed to be the culprit when celiac disease is ruled out. But that is a “trap,” Biesiekierski says, one which could potentially lead to confirmation bias, thus blinding researchers, doctors, and patients to other possibilities.

Biesiekierski recognizes that gluten may very well be the stomach irritant we’ve been looking for. “There is definitely something going on,” she told RCS, “but true NCGS may only affect a very small number of people and may affect more extraintestinal symptoms than first thought. This will only be confirmed with an understanding of its mechanism.”

Currently, Biesiekierski is focused on maintaining an open mind and refining her experimental methods to determine whether or not non-celiac gluten sensitivity truly exists.

“We need to make sure that this research is as well controlled as possible and is reproducible,” Biesiekierski told RCS, subsequently adding the quintessential adage of proper science.

“Much, much more research is needed.”

Source: 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 Aug;145(2):320-8.e1-3. doi: 10.1053/j.gastro.2013.04.051. Epub 2013 May 4.

Source: Biesiekierski JR, Muir JG, Gibson PR. “Is gluten a cause of gastrointestinal symptoms in people without celiac disease?” Curr Allergy Asthma Rep. 2013 Dec;13(6):631-8. doi: 10.1007/s11882-013-0386-4.

*Section updated 5/15 to reflect Dr. Biesiekierski’s new position.

**Section updated 5/16 to clarify that all of the subjects fulfilled the diagnostic criteria for NCGS.

Unless You Have Celiac Disease, Gluten Sensitivity is Probably Just in Your Head

14 Aug

By now, you’ve probably heard of gluten-free diets. They’re a necessity for the estimated 2 million Americans with celiac disease. For them, eating gluten can trigger an immune response in their small intestines, damaging the organ’s villi that help absorb nutrients. Excluding the protein from their diets saves celiac disease sufferers from intense bouts of intestinal discomfort and other symptoms.

But for many other Americans, eliminating gluten probably does little to ease their symptoms.

That finding comes from a new study led by Peter Gibson, a professor of gastroenterology at Monash University in Australia. Gibson is the same researcher who published a paper in 2011 that reported gluten sensitivity in non-celiac patients. The results of that paper didn’t sit well with him, so he designed a more rigorous study involving 37 patients who didn’t have celiac disease but reported feeling better when on a gluten-free diet.

Ross Pomeroy, writing at Real Clear Science:

Subjects would be provided with every single meal for the duration of the trial. Any and all potential dietary triggers for gastrointestinal symptoms would be removed, including lactose (from milk products), certain preservatives like benzoates, propionate, sulfites, and nitrites, and fermentable, poorly absorbed short-chain carbohydrates, also known as FODMAPs. And last, but not least, nine days worth of urine and fecal matter would be collected. [...]

They were first fed a diet low in FODMAPs for two weeks (baseline), then were given one of three diets for a week with either 16 grams per day of added gluten (high-gluten), 2 grams of gluten and 14 grams of whey protein isolate (low-gluten), or 16 grams of whey protein isolate (placebo). Each subject shuffled through every single diet so that they could serve as their own controls, and none ever knew what specific diet he or she was eating. After the main experiment, a second was conducted to ensure that the whey protein placebo was suitable. In this one, 22 of the original subjects shuffled through three different diets — 16 grams of added gluten, 16 grams of added whey protein isolate, or the baseline diet — for three days each.

After the subjects moved off the baseline diet and onto one of the treatment diets, they reported more intestinal pain, bloating, gas, and nausea, regardless of whether the treatment diet was high-gluten, low-gluten, or placebo.

The placebo results were what really stood out to Gibson—patients who received the same diet in the baseline and treatment phases still reported a worsening of symptoms. Gibson says this is a nocebo effect—in other words, it was all in their heads.

So what’s causing these symptoms? Gibson and his co-authors Jessica Biesiekierski and Jane Muir think FODMAPs are a leading candidate. Gluten-free diets seem to help people who report gluten sensitivity because those foods often happen to be free of FODMAPs, the researchers report. Though FODMAP may be an ominous sounding acronym, compounds in the group are found in many everyday foods, nearly all of which are unprocessed and include apples, asparagus, artichokes, milk, pistachios, pears, and lentils.

Funding for NOVA is provided by David H. Koch, the Corporation for Public Broadcasting, and PBS viewers.

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BISTRO NOLAH MONTREAL CANADA

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Montreal-10 Restaurants Totally Worth Travelling Outside Of Montreal For

27 Jul Featured Image -- 1852

Originally posted on cookingislife:

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10 Restaurants Totally Worth Travelling Outside Of Montreal For

 Not all the best places to eat at are downtown Montreal.

 http://www.mtlblog.com/2014/07/10-restaurants-totally-worth-travelling-outside-of-montreal-for/2/

Bistro Nolah

3669 Boulevard Saint-Jean, Dollard-des-Ormeaux, QC H9G 1X2

Who knew the West could provide Southern Soul? If you’re in the mood for some good ol’ fashion Louisiane Creole grub this place is definitely worth checking out. They even serve you an amuse-bouche of fried jambalaya balls. They’ve got some true grit or at least real grits with shrimp.

P1030938

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Montreal-10 Restaurants Totally Worth Travelling Outside Of Montreal For

24 Jul xl.jpg.pagespeed.ic.Ik_f7lBVuu
xl.jpg.pagespeed.ic.Ik_f7lBVuu

10 Restaurants Totally Worth Travelling Outside Of Montreal For

 

 Not all the best places to eat at are downtown Montreal.

 http://www.mtlblog.com/2014/07/10-restaurants-totally-worth-travelling-outside-of-montreal-for/2/

 

Bistro Nolah

3669 Boulevard Saint-Jean, Dollard-des-Ormeaux, QC H9G 1X2

Who knew the West could provide Southern Soul? If you’re in the mood for some good ol’ fashion Louisiane Creole grub this place is definitely worth checking out. They even serve you an amuse-bouche of fried jambalaya balls. They’ve got some true grit or at least real grits with shrimp.

P1030938

 

Chef Richard Taitt Montreal Canada

22 Jul P1030831

P1030831

 

 

Callao | Peruvian Restaurant Montreal / 114 avenue Laurier Ouest, Montreal

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114 avenue Laurier Ouest, Montreal, Qc, · H2T 2N7 info@callaomontreal.com 514-227-8712

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Peach and goat cheese salad

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Bistro Nolah Montreal Canada

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