You’ve probably seen the recent glut of sensational headlines in the media proclaiming that non-celiac gluten sensitivity is some kind of widespread collective delusion—simply a figment of the imagination of anyone who claims to experience it.
These stories point to a new study which found that a group of patients with irritable bowel syndrome (IBS) were not sensitive to gluten. (1) The researchers who performed this study had previously published a paper showing that IBS patients were sensitive to wheat, and that removing wheat from their diet led to an improvement of symptoms.
Gluten sensitivity: real diagnosis or collective delusion? Read this to find out. #glutensensitivity #gluten #foodintolernance
However, in this new study, the authors specifically isolated gluten and found that there was no difference in symptoms between the patients eating high-gluten diets and those eating low-gluten diets.
Why This Study Doesn’t Disprove Gluten Sensitivity
First, this study examined the effects of gluten in a specific population: people with irritable bowel syndrome. Even if it is true that gluten sensitivity is no more common in people with IBS than in people without IBS (which is premature to conclude on the basis of a single study), it does not overturn the large body of evidence that links non-celiac gluten sensitivity to a variety of health problems ranging from allergies to schizophrenia to autism spectrum disorders. (2, 3, 4, 5)
Second, this study does not suggest that people with IBS—or anyone else with gluten sensitivity—should feel free to start chowing down on wheat. In fact, it suggests the opposite. For the first week of the trial, all patients were put on a gluten-free diet that was also low in FODMAPs (a class of carbohydrates present in wheat, as well as other foods).
After this lead-in period, the participants were assigned to one of three groups: a high-gluten diet, a low-gluten diet, and a placebo. Those on the high gluten diet were given 16 grams per day of purified wheat gluten; those on the low gluten diet were given 2 grams per day of purified wheat gluten plus 14 grams per day of whey protein isolate; and those on the placebo diet were given 16 grams per day of whey protein isolate.
The majority of participants experienced a significant improvement of symptoms during the 7-day gluten-free, low FODMAP lead-in period. But there was no difference in symptoms between the high gluten, low gluten, or placebo groups during the subsequent treatment period. In other words, patients did react adversely to wheat, but they did not react to isolated gluten.
This of course suggests that something other than gluten in the wheat was causing the problems patients experienced. We now know that there are several compounds in wheat other than gluten that could be to blame. These include not only FODMAPs, but also agglutinins (proteins that bind to sugar), prodynorphins (proteins involved with cellular communication), and additional proteins that are formed during the process of wheat digestion, such as deamidated gliadin and gliadorphins (aka gluteomorphins). (6)
However, it is certainly possible for people to react adversely to whey, and in my experience this is more common with patients with digestive problems. If some of the “placebo” and low-gluten patients were, in fact, sensitive to whey, then that would invalidate the results of the study.
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How to Find out If You’re Sensitive to Wheat, Gluten, or Both
This study showed that for people with IBS on a low FODMAP diet, eating isolated gluten does not cause symptoms. But one might ask: who cares? Do you eat isolated, purified gluten? Do you know anyone who does? I doubt it. People eat wheat—not gluten. And as both this study and numerous other studies have demonstrated, there are several components of wheat other than gluten that cause problems.
In practical terms, this study still supports the idea that patients with IBS should avoid wheat, because it contains FODMAPs and possibly other compounds that make them feel worse. What this study does tell us is that it’s possible that IBS patients may be able to tolerate other non-wheat products that contain gluten, presuming they are low in FODMAPs and other compounds that they may react to.
Here’s the best way to determine if this is true for you:
- Remove all gluten-containing foods and products from your diet for 60 days.
- At the end of the 60 day period, cook up a bowl of barley, eat it, and see what happens.
- A few days later, eat a piece of wheat bread.
Barley is a gluten-containing grain that is low in FODMAPs. If you react to it, that suggests you’re intolerant of gluten or other gluten-like compounds. If you don’t react to barley, but you do react to the wheat bread, that suggests you are intolerant to something in wheat specifically.
You may be able to safely consume gluten-containing products other than wheat—though it’s worth pointing out that many of these products (primarily grains and processed foods) would not be foods you should be consuming regularly anyways.
Is “Non-Celiac Wheat Sensitivity” a Better Label?
In fact, this distinction was originally proposed by researchers in response to another study which found no effects of gluten in patients on a low FODMAP diet. (7)
Please share this article with your friends if you think it might help clarify this issue for them.
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This is not specifically about the gluten but might be helpful to others. I have known that I am definitely sensitive to wheat/gluten, dairy and soy. I never eat any of this unless it’s by accident. I still haven’t felt great and some days where I am just very depressed the minute I wake up. I also have been waking up many mornings at 3:30am wide awake. My Chiropractor found this to be a “cortisol wakeup” from my adrenals. Taking phosphatidylserine or holy basil corrected this for most nights. Though some nights I still woke up. Now after looking deeper into my body, we found several areas of imbalance such as my small intestine, liver and gall bladder. Also my neurotransmitters were high. My Dr suspected that something that I was eating was causing the distress. We were able to dig deeper and pinpoint that my body is very sensitive to the fillers in foods such has guar gum, carrageenan, tapioca starch and corn starch. Of course all the things are in that so natural GF cookie that I had been eating some days at work! Also very sensitive to corn and white rice and white potatoes. These are the foods that I had been eating some of lately and knew I shouldn’t. I kind of became a cycle. I can correlate my off moods and 3:30 AM wake ups from the week before with eating one of this items. Now after eliminating these foods for my diet, I am sleeping through the night and for the most part wake up happy. In a month, we will re-test and see if my systems have improved. My Chiropractor’s uses a electro-dermal screening device to help evaluate how all the systems of the body are functioning. This device electronically measures the biological energies utilized in acupuncture and homeopathy. It is amazing the tiny things this it detect that western medicine cannot. For me it just comes down to eating only “real food” if I want to feel good and be happy:)
I’ve never understood why people need to label this as some sort of Medical Condition. Whether Gluten Sensitivity is a “real” condition or not, eliminating wheat and many grains, and eating nutritionally dense food instead, makes many, many people feel better, lose weight, and eliminate or manage debilitating medical conditions. Period. Why does anyone need a diagnosis to justify a change that has been repeatedly proven to vastly improve your life?
Our entire family – my wife, myself and our 2 boys have gluten sensitivity and our symptoms vary quite a bit. My youngest who is 1.5 has eczema and experienced seizures while breastfeeding if my wife ate gluten. My oldest son is 3.5 and his behavior is atrocious when he has gluten. We assume it is similar to children with extremely bad ADD. He also has little bumps on his skin and there is a term for that. If I eat gluten within 30 minutes my joints ache. My wife noticed that she no longer got migraines. I went paleo in 2012 doing the paleo for athletes protocol as I’m a cyclist and then the sugar monkey got me for quite awhile due to a lot of factors that led me to self medicate using sugar. And while my wife was mostly paleo compliant it really wasn’t until my youngest started having his issues that she went in full speed ahead because she was breast feeding. Now we are in the midst of getting my oldest to transition to paleo which is tough because he is very picky as to what he eats. We’ve seen the benefits of eliminating gluten and I can personally say that there is nothing that I miss.
I found that I am sensitive to all grains. Going off all grains has helped my health in amazing ways. My weight dropped, my thyroid medication was cut by 2/3. My aches and pains disappeared. i had leaky gut and that is now healed. I believe there is something, whether it is gluten and/or other factors in grains that I was reacting to, i don’t care. I am staying away from all grains. They have been so processed and modified from their original genetic makeup now, it is no wonder many of us are suffering from a wide variety of illnesses. Thanks for this article.
I have had blood test, colonoscopies and endoscopy to tell me if I’m sensitive to gluten. After three years of this I decided to remove everything from my diet and reintroduce it back. I found out I have severe reaction to soy sauce. Headache, stomach bloating and vomiting. I can use the gluten free soy and I’m fine. Same thing with breads, pizza things with added gluten. I can eat some breads and bagels then I eventually get the same reaction with headaches, bloating and vomiting.
Let me state first that my experience is not statistically relevant because it only pertains to my daughter. She was constantly sick until we could allergy test, it was a guessing game. At age 2 we tested, all forms gluten, wheat or not showed up medium allergy on an IGG test. We took her off all. She got healthy and gained 5lbs in 2 months. This was at age 2. Not a normal grow trajectory. I know she is not celiac because a reaction based on mistake today is temporary mild discomfort, not 3 days at home in pain. I do believe there is a fad aspect to gluten sensitivity, but in my world it is very real and not fictitious. I wish the press and energy would move on to something else.
People are going to be into fads and then it will fade like everything else. Let it go.
Whatever they want to call it really doesn’t matter to me. All I know is that I tested negative for celiac disease at one of the most renown centers in the US for celiac disease yet they said it could be a gluten sensitivity. When I cut gluten out of my diet, I no longer needed frequent and multiple antibiotics and prednisone for frequent sinus infections. Go figure. Makes no sense. Even the center where I was seen said they weren’t aware of sinus infections being related to a gluten issue. All I know is I rarely get sick anymore, and when I do my immune system seems to be able to typically fight it off in no time! Could this be related to “leaky gut” syndrome as someone recently suggested to me?
I too was plagued by sinus infections for about 3 years. I never had them before that time. I would have to take industrial strength antibiotics and prednisone a few times also. Then i read Wheat Belly in fall of 2012, stopped eating all wheat. I have not had a sinus infection in that time, and had NO colds at all in 2013. However, I did find I had a long time upper tooth abscess in an old root canal and was treated for that in December of 2012 at the same time I eliminated wheat. I asked the oral surgeon if that abscess could cause sinus infections, but he never really had a good answer for that. In any case, many of my health and emotional issues resolved by eliminating wheat and eating Paleo. I have to guess that the wheat/glutin elimination helped the sinus problems also. Doesn’t it feel good to breathe again freely? I can breathe through my nose and not with my mouth plus eat without my sinus/nose automatically filling up.
I have been doing a probiotics/resistant starch regime lately as I was curious. I have indulged in wheat a couple of times since then (started in January) and had no symptoms I usually get after eating wheat/glutin. None. Perhaps my gut has been healed further now and the odd exposure is not bothering me. I still keep away from it, however. Lots of interesting gut stuff going on in science.
I saw Chris on The Thyroid Series recently and decided to try a diet free of the foods most likely to contribute to a thyroid problem I’ve had for about 6 months (all the classic symptoms of hypothyroidism plus high TSH in a recent test). I cut out gluten, dairy, soy, and added sugar. The one thing I didn’t cut out was eggs. After a few days I noticed pain in all my joints. I’ve actually increased my egg consumption (because of stopping so many of my usual foods, and I wonder if that’s the culprit. I’ve only been on the elimination diet about 10 days and so far the only real change I notice (besides the joint pain) is that I feel a lot more hunger more frequently than before. This isn’t helping with the belly fat. I’m hoping it’s just too soon to see the real results of stopping gluten and dairy.
I have had bloid test, colonoscopies and endoscopy to tell me if I’m sensitive to gluten. After three years of this I decided to remove everything from my diet and reintroduce it back. I found out I have severe reaction to soy sauce. Headache, stomach bloating and vomiting. I can use the gluten free soy and I’m fine. Same thing with breads, pizza things with added gluten. I can eat some breads and bagels then I eventually get the same resction with headaches, bloating and vomiting.
Forgot to mention the flu like symptoms I get and that both my antibodies have increased since doing the elimination test.
I didn’t eat grains for weeks, and then realized I wasn’t eating Tums hardly at all. Recently I was curious and ate an English muffin – within an hour I wish I had Tums with me. I don’t know what in the English muffin that I reacted to. At least I can get the nutrients I need without grains!
Chris,
Thank you for shedding a bit more light on this subject. I do think there is something to the argument however that if you remove something from your diet for an extended period of time and then re-introduce it, there could be some acute symptoms of indigestion, fatigue ect…
Much like vegetarians who decide to start eating meat again. They tend to have a tough time digesting it at first for several reasons, but this does not indicate “meat sensitivity”.
A naturopath recently told me I am sensitive to gluten because of an IgA Gliadin Antibody level of 6. In his experience anything over 5 would indicate this. IgE was normal.
Do you have a criteria for determining sensitivity using these antibody tests?
that makes sense because if you’re not eating something, you’re not feeding the bugs that eat it. they die off. then you start eating it again, but now you don’t have the bugs that eat it, so you have problems digesting it.
see this about the hadza gut microbiome: http://www.wired.com/2014/04/hadza-hunter-gatherer-gut-microbiome/
so maybe not necessarily an intolerance but an inability to digest it because of an absence of the bugs that eat that food.
Yes, this is quite true. Additionally, the body tends not to expend energy where it is not needed. The body will reduce or stop altogether the necessary enzyme production to digest certain foods if it senses that these foods are no longer being ingested. If these foods are reintroduced, the body will not immediately be armed with the necessary arsenal of digestive enzymes to break down the food. This is indeed not the same thing as a food sensitivity as the body does not look at the food as a foreign invader and it does have the ability to relearn how to produce the necessary enzymes.
I eliminated gluten (and many other things) a year ago to do the Whole30 plan with my husband who we knew had gluten issues. I felt much better and stayed eating primarily that way. But since it wasn’t really MY problem, wheat came back in the form of free pizza at work. Big mistake, but it didn’t explain what food was the problem. I again did a Whole30 and stayed away from gluten and dairy. I have since had testing done and have high IgG and IgA sensitivity to Rye, Barley, Spelt and Wheat (and Hemp, Amaranth and Tapioca). This was despite it not being in my diet but with possible small “contaminations”. I don’t care what the medical establishment wants to end up calling it. What I care about is how it affects me when I eat it. For this reason, I will stay vigilant in keeping it out of my diet.
I have hashimoto’s and have done the elimination test. The results after consuming wheat and gluten were as follows: bloating and gas. I had a lot of pain around the thyroid gland and my goiter was more swollen than usual. The cherry on my “gluten cake” was a severe gastritis attack that had me doubled over in pain for four days. I have been tested for wheat and gluten allergies together with a celiacs panel-all negative. I get immediate heartburn and indigestion when consuming wheat or gluten, together with the abovementioned reaction I experienced, I fully believe that non-celiac gluten sensitivity exists.
Mr. Kresser, the “control” condition in this study seems to be a poor control, rendering the study’s conclusions highly suspect.
Many people report reacting negatively to whey protein, so finding that people who ingest gluten don’t react more negatively than people who ingest whey protein doesn’t prove that the reaction to gluten is a placebo effect. A more plausible explanation is that people react negatively to gluten and to whey protein for physiological—as opposed to psychological—reasons.
Do you agree, or disagree?
Mr. Kresser revised his article, above, to address this criticism. Thank you, Chris Kresser!
The question is of scientific interest , but immaterial in my life. When I stopped eating bread and pasta 8 months ago, my three year digestive struggle ended. This proved to me that wheat or gluten or whatever in these products was causing my symptoms. These problems have not returned. I don’t care what you call it, gluten or wheat sensitivity, abstention works. I don’t worry about tiny “crossover” traces of gluten.
Actually, I am only very mildly sensitive to, say, bread and cake [feel a bit bloated for a bit too long] and that is, also, a recent development which I put down to getting older, especially since I try to eat any such things organic [and rarely eat them at that], but I react horribly to barley! And all types of legumes, even when sprouted. There’s a lot more to all this than seems apparent. Barley either contains something wheat doesn’t, or contains a far higher percentage of something relative to other elements in its structure than the balance for the same elements in wheat. And soaking doesn’t help either. This all gets so scientific that it takes the fun out of eating sometimes … One way to solve this problem is if I don’t eat barley. But I’d love to know WHAT the element is that’s problematic. Maybe then I’d learn what to do to fix the situation!
All I know is that since removing gluten grains from my diet, my lifelong severe depressive disorder disappeared as did my prediabetes. I’d be a fool to start eating that garbage again.
I had the same effect! Over twenty years of depression and mood issues GONE after giving up grains. Its now been 1 1/2 years since my last depressive episode and it still blows my mind that i feel so… normal! I don’t need a test to tell me not to eat that stuff again.
Most people who are gluten sensitive have a concomitant dairy sensitivity. They could have been reacting to the whey protein, no? To me this was not a very well-designed study, period….
I agree. Mr. Kresser, what do you think of this criticism?
Mr. Kresser just updated the article, in response to this criticism 🙂
I had a comprehensive food panel IgG ELISA done that showed I was highly reactive to wheat and minimally reactive to gluten and barley. It was explained that the other proteins in wheat caused my problems. Whenever I eat wheat I get migraines, sinus congestion and indigestion. So I guess I have a non celiac wheat sensitivity. Whatever it is it’s miserable when you grew up and live in a food city such as New Orleans like I do.