Here, I will distill what we know about gluten and gluten-free diets, who may benefit and who may not.
While more popular recently, going gluten-free is not a fad; we know that patients who suffer from celiac disease, an autoimmune disease, benefit tremendously when gluten is removed. In fact, it is the main treatment.
What about people who don’t have celiac disease? There seems to be a spectrum of physiological reaction to gluten. Celiac disease is the extreme of intolerance, but even these patients may be asymptomatic.
Then, there is nonceliac gluten sensitivity (NCGS), referring to those in the middle portion of the spectrum. NHANES data from 2009-2010 tells us that prevalence of NCGS is half that of celiac disease; however, many believe that it is much more prevalent and that its incidence is likely to rise.
The term was not even coined until 2011.
What is the difference between full-blown celiac disease and gluten sensitivity? They both may present with intestinal symptoms, such as bloating, gas, cramping and diarrhea, as well as extraintestinal (outside the gut) symptoms, including gait disturbance, malaise, fatigue and attention deficit disorder.
Surprisingly, they both may have the same results with blood tests.
What is unique to celiac disease is a histological change in the small intestine, with atrophy of the villi (small fingerlike projections) contributing to gut permeability, what might be called “leaky gut.” Biopsy of the small intestine is the most definitive way to diagnose celiac disease.
Before we look at the studies, what does it mean when a food says it’s “gluten-free”? The FDA has weighed in by passing regulation that requires all gluten-free foods to have no more than 20 parts per million of gluten.
Irritable bowel syndrome
Irritable bowel syndrome (IBS) is a nebulous disease diagnosed through exclusion, and treatments are not obvious.
That is why the results from a 34-patient, randomized controlled trial showing that a gluten-free diet significantly improved symptoms in IBS patients, is so important. Patients were given a muffin and bread daily.
Of course, one group was given gluten-free products and the other given products with gluten, though texture and taste were identical.
In six weeks, many of those who were gluten-free saw the pain associated with bloating and gas mostly resolve; significant improvement in stool composition, such that they were not suffering from diarrhea; and their fatigue diminished.
In one week, those in the gluten group were in substantially more discomfort than those in the gluten-free group.
The microbiome in the gut may play a pivotal role in celiac disease. In an observational study using data from the Swedish Prescribed Drug Register, results indicate that those who were given antibiotics within the last year had a 40 percent greater chance of developing celiac disease and a 90 percent greater risk of developing gut inflammation.
The researchers believe that this has to do with dysbiosis, a misbalance in the microbiota, or flora, of the gastrointestinal tract.
Not everyone will benefit from a gluten-free diet. In fact, most of us will not. Ultimately, people who may benefit from this type of diet are those patients who have celiac disease and those who have symptomatic gluten sensitivity.
Also, patients who have positive serological tests, including tissue transglutaminase or anti-gliadin antibodies are good candidates for gluten-free diets.
There is a downside to a gluten-free diet, including potential development of macronutrient and micronutrient deficiencies. Therefore, it would be wise to ask your doctor before starting gluten withdrawal.