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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I would personally like to see a third party study on all the different strains of wheat that is genetically modified using organisms that are in no way related to wheat. The USA pumps out GMO products while many other countries have banned it. I want a study that is done by someone other than a promoter or corporation that develops these GMOs.
Agreed!
It’s not always the gluten in gluten containing foods, what they and many other troublesome non-gluten foods also have in common is their tendancy to contain molds. This is a major overlooked problem that is coming to light in some studies, showing that mold sensitive/allergic people need to stay away from mold prone foods (including some fermented and aged foods that are purposely made with mold) or they have immune reactions much the same as if the mold was breathed in from the environment.
I think this is a great study and thank Chris for sharing it. It is just as easy for people outside of the conventional dogma to be dogmatic as it is for people more adherent to conventional lifestyles. Like Chris, I have avoided gluten ( for 10 years) and notice absolutely no ill effects when I eat some here and there these days (not saying Chirs eats wheat). Most of the time I don’t eat wheat or other gluten containing products because I am still under the impression that they might be harmful in excess, and certainly don’t add much in the way of micronutrients. However, food avoidance is stressful on a number of levels and stress is probably worse for the health than gluten or any other modern-day food villains. I say let’s keep an open mind! Obviously if it doesn’t treat you well, avoid it. But for those of us who notice to benefit from removing it, perhaps the gut processes it differently, perhaps the microbiome renders it harmless/ less harmful etc. I now have Arsenic in my body thanks to eating a lot of rice instead. Perhaps it wasn’t the best trade-off after all? Science is not about assuming, only about having a working hypothesis and testing it.
Yes and No. If one defines gluten as the “protein” molucles, the answer I think is no. If one defines gluten free as just “Wheat, Barley and Rye” then perhaps it is yes. I tested negative for wheat alergies and test negative for celiac (biopsy). However, when I consume wheat based products I will end up with bleeding skin rashes shortly after.
I do believe the book “Low FODMAP” by Sue Shepard, or is it the Fructans that are the cause of my problems. Modern strains of wheat are high in Fructans. Foods high in fructose are also bothersome in me. Could be the combination of Fructans and Fructose are the problem and not gluten in the wheat?
Try finding heritage wheat and see if it bothers you?
Is it the modern strains of wheat that are cause?
My son has intestinal damage from a severe stomach flu he suffered about 8 years ago. We spent years in and out of ER’s, and he carries many labels (severe IBS with gastroparesis is the main one that has stuck). Only last year was his Stanford doc able to find the magic combo of meds that calmed it all down, and now he’s weaning off them too. Basically he’s been tested up one side and down the other for celiac, and tests negative. In fact all his tests come back fine and normal, except for the radioactive-isotope test that finally proved that his lower intestines push food back UP into his stomach, which of course causes his intense pain and inability to digest properly. Nutritionists have told him that eating the most refined grains and avoiding brassicas is best for his system, so he does eat potato bread occasionally, but sticking to a mostly Paleo diet that doesn’t include brassicas or any type of dairy is the only thing that keeps him well. The doctor thinks he may finally be healing and she actually advocates diet health over pills, so this is good news for us. He’s just turning 25 and lost 8 years to this. I suppose you could say he’s an IBS patient who is NOT sensitive to gluten per se, but he does better without it, and so do we all.
Thank you SO much for this article! I’m curious, does the study mention precisely what isolate of gluten it was using? Like alpha-gliadin per se?
The way I understand it is that it is possible to be gluten-sensitive but to have no discernible symptoms from eating gluten-containing foods. The damage can be unbeknownst to the consumer and silently taking place in the background. There are specific stool tests for gluten sensitivity.
Perhaps there was no difference in the results because they had added whey protein isolate. I am lactose intolerant and cannot have the whey without problems. I also have issues with wheat, with the same problems – uncontrollable flatulance – with corn, sorghum and other grains. The only one I can tolerate is rice.
Question: can one follow the Paleo diet WITHOUT loosing weight. Because of dietary problems I am way too thin and would like to try going on the Paleo diet but cannot afford to lose any more weight.
I agree with your criticism of the study. Even if a person isn’t lactose-intolerant, they can still be whey-protein-intolerant, as many people (especially those who are gluten-intolerant) seem to be. Mr. Kresser, what do you think of this?
As for your question, I find that if I eat lots of meat (which is easy to do, on a paleo diet), I lose fat, but gain muscle. If you’re “way too thin,” it suggests to me that you are lacking muscle, so I expect that a high-meat paleo diet would help.
Fortunately, Mr. Kresser just updated his article, in response to this feedback. See above for the latest revision.
Gluten gives me severe joint and muscle aches. I listen to my body and not what others say. I also have severe reactive hypoglycemia (which has been tested) and simply cannot tolerate carbs. So, I look at it this way. If I stay away from gluten products, then I cut my carbohydrate intake way down, so it benefits me whether I am really sensitive to gluten or not. I have also cut out sugar completely. I enjoyed your very informative article.
Thanks for a great article Chris, Yes this is the talk of the town in certain circles these days. My gluten eating friends are LOVING sending me the article w/ a “See????” kind of attitude. My bottom line….if it makes me feel bad, I don’t eat it. It doesn’t matter to me which part of the grain is affecting me, (although if I were interested I would test as you describe, low FODMAPS, other lesser gluten grains, etc)
If I eat even a crumb of gluten I will have severe brain fog and headache the next day, ALL day. Grains don’t bother me as much but I don’t eat them because they are high in carbs and I don’t need them. I stick with 100% Paleo and at age 61 I’m told I look 40 and have never felt better in my life. Thanks Christ for the continued great work you do.
It is common for families to all experience similar issues. I have had digestive issues for as long as I can remember. So does my dad. I remember when he was in his early 40’s and he would have to sleep sitting up because he feared the GERD attacks while sleeping. He had a surgery that helped with the GERD, but now he has a terrible time swallowing food. Many times he chokes and it can be embarassing for him in public while eating out. Beer affects him greatly. Gives him massive indigestion and heartburn if he doesn’t take an acid reducer first. He loves his Beer. After I told him what is going on with me, he is now going to get his blood tested. He is reaching a point where his joints hurt like crazy and has massive headaches all the time. I told him all symptoms of gluten sensitivity. He is taking this more seriously now. He was on Lipitor, which did make his joint pain worse and he had to get off of it. There are so many things going on now, that we need to listen to our bodies instead of demanding quick fixes to our problems though overuse of medications. If the problem is food, we need to eliminate those foods. Another person’s fuel can be another person’s poison.
without going into a long health history, i gave up all gluten about 90 days ago and haven’t felt better in a very long time. i am 57 yo and over the course of the last 20 years, since being diagnosed with fibromyalgia, i’ve had an overall sense of inflammation. my body hurt, and while the hurt was not enough to stop me from living it was enough to slow me down. i would experience waves of feeling better and then worse, but i never made the correlation between my ‘pain’ and gluten/wheat consumption because i eat healthy whole organic foods and when i consumed gluten it was mostly organic or non GMO. apparently, that wasn’t enough.
since giving up wheat and all gluten products, the inflammation is gone. i now sleep through the night and have good energy all day, my belly has not been bloated in over 3 months and the edema i was experiencing is just a bad memory! better yet, i’m not even tempted because the benefit of feeling awesome far outweighs temporary pleasure of eating a butterhorn pastry slathered with frosting.
“gluten free” may not be for everybody, and i will only suggest don’t knock it until you try it.
Thank you so much for this article Chris! I myself eliminated gluten from my diet 8 years ago and have never looked back! I used to have severe ulcerative colitis, asthma, Hashimoto’s thyroiditis, multiple miscarriages, migraines, joint pain…etc…I could go on forever! Basically in my mid 20’s my health was completely failing! I was luckily told by my lactation consultant when my son was born that no one with any autoimmune disease should eat wheat/gluten. So, I went gluten free back in 2006, and within 6 months never had a symptom of UC ever again and within days and months all the rest of those terrible symptoms disappeared!! I had a normal pregnancy after being gluten free and not another miscarriage again!! Had a follow up colonscopy and it showed no signs of inflammation at all! I can’t stand when people say there is no such thing as gluten sensitivity!! It really upsets me!!! If there is no such thing, how did my failing health completely turn around after it was out of my diet? After being gluten free for a while, I found Paleo and now I feel better than I have ever in my life! Haven’t even had a cold in over 2 years!! The body will heal itself when the hidden stressors are removed!!
Melissa – FDN (Functional Diagnostic Nutrition) Trainee
The controls ate whey….many people sensitive to gluten are also sensitive to dairy…this also sounds like a real study design flaw….who funded this study? The American Wheat Growers Association or ??????
I agree. Mr. Kresser, what do you think of this critique?
Whey is >99% casein and lactose free, so even dairy sensitive people shouldn’t react to it. That said, I have a lot of patients that do react to it nonetheless, so I agree that it shouldn’t have been used as a placebo.
Mr. Kresser, I’m glad you agree that whey shouldn’t have been used as a placebo, since many people do react to whey (arguably people whose intestines have been damaged by wheat, most of all).
Given this, would it make sense for you to add this caveat to your article itself?
As your article stands, it seems to imply that the researchers’ conclusion is valid, when you write, “These stories point to a new study which found that a group of patients with irritable bowel syndrome (IBS) were not sensitive to gluten.”
Though I appreciate your other caveats about the research, the way your article is written does seem to provide *some* support for the notion that non-celiac gluten sensitivity does not exist—which encourages readers to disbelieve the diagnoses of those who have been diagnosed with non-celiac gluten sensitivity, like myself.
I see that you updated your article, in accordance with this feedback. Thanks for your open-mindedness, and responsiveness to feedback, Mr. Kresser. I really appreciate it.
I assume that by “whey” you mean “whey powder,” as whey itself is full of lactose.
Good point. I was told by a dietitian that in those with celiac disease or gluten sensitivities, the gluten actually damages the part of the intestine which processes milk.
Yes, I remember buying bags of gluten to add to my freshly-ground wheat, to make the bread springier. Some meat substitutes such as seitan are made entirely of dried/processed gluten. I don’t know how they isolate it, but they do. Nature puts things in foods in a mixture, then we isolate it out. Not necessarily smart.
After a few years of Perfect Health Diet/Paleo mix, and a serious health-compromising experience, I have at present a few operative “conclusions.” (In quotes because they may change with new data.)
First is that for most of us, but of course not all of us, the dose does make the poison. We tend to rely heavily on certain foods that we like, perceive as “healthy,” and that are easy (cereals, eggs, pasta, dairy). So we eat them every day, setting up a metronomic effect …. every day the body has to deal with this set of foods.
Depending on our age and health status, at some point the body will be overtaxed by the requirement to deal with them, and symptoms will appear. Thus begins the quest to find which food is bothering us, when in fact ….
If we had but alternated these foods in wider spaced intervals, we might have delayed or even prevented the taxing of the body and the onset of symptoms.
This is a well known strategy for allergies. Many people can have eggs, wheat, milk, etc. with no problem at all if they allow a few days to elapse between eating them. Of course, some people cannot. I’m talking here about most people in generally good health who want to improve and maintain their health conservatively and reasonably.
Supplements and powders and such should be approached with great reluctance and kept to a minimum. There’s something called “Amazing Grass” green drink that has DOZENS of finely-ground ingredients across a large plant/mineral/bacterial spectrum, that is gaining popularity for use in smoothies. It’s easy, and it’s perceived as a shortcut from cooking and eating real food, but there is no way a person could isolate which, if any, of those ingredients are causing a digestive issue, other than just stopping using the powder. If leaky gut exists, those dozens of powdery substances would be having a toxic heyday in the bloodstream.
It is also important not to create a new set of “everyday” foods, which I, stupidly, did with coconut flour, coconut butter (both heavily processed foods), nuts and coconut chips. With any food, we should alternate it out and not consume large amounts of it one time.
The coconut products and nuts are heavy with insoluble fiber. You can chew coconut all day and still end up with a wad of it in your mouth. I wish I hadn’t relied on them for the bulk of my snacking, fat, and satiation. I think it was the chief instigator of my diverticulitis.
If I had it to do over again, my strategy would be to eliminate highly processed and packaged foods, vegetable oils, and sugar, and just eat spaced-out and more reasonable portions of all whole foods. I dearly wish I would have tried that instead of eliminating all grains and legumes, which, when I tried to replace them with something else that was “easy and tasty,” probably harmed me more than reasonable and occasional portions of grains and legumes ever would have.
In fact I find the study a bit strange, but I have only access to the abstract and I’m not an expert in the field, so I might be wrong:
1. “patients with self-reported non-celiac gluten sensitivity”
Why do they take self-reporters, and not well tested subjects?
2. the time on the gluten diet was ONE week. Aren’t there a lot of people that need a lot of time to build up gluten sensitivity? Actually I don’t know if I am gluten or grain sensitive, but I do know that I needed decades to develop my sensitivity.
3. “Gluten-specific effects were observed in only 8% of participants”
Well, assuming (the abstract doesn’t say anything about that, but I’m sure it would if it were otherwise) that the gluten-specific effects were observed only in the high gluten group, it would be a quarter of the participants in the high gluten group (8% of the total participants equals roughly a quarter of a third), and after only one week a quarter I would not dare to call “no effect”.
So to me it looks just like another poor set up study that doesn’t say anything at all. Any corrections/enlightenment welcome.
4. 16g gluten on an otherwise low FODMAP diet is not really much, that’s the amount that’s contained in a burger bun or so. Most people consume more than that in their normal diet.
Chris – similar question to Prouddaddy… Is the lack of observable symptoms or signs rationale for there being no negative effects from gluten intake? Is there research that looks at cellular function and other markers in response to gluten intake? If so, is it also possible the more overt symptoms could take years of accumulative impact or more significant damage at the cellular level before “feeling” the negative impact?
It seems to be the case in other processes within the body like heart disease or cancer in which the lack of symptoms does not mean something negative isn’t happening.
I look forward to your thoughts as always.
i’m interested to hear the answer to this. also, what if someone is not as tuned in to their body as they need to be in order to pick up symptoms. that wouldn’t mean that gluten or wheat (or whichever food) is ok for them.
For years I would have major gut cramps on and off. When it started happening more often I went to see my doctor. He felt my colin was spasming for some reason but didn’t know why. He sent me to the gastroenterologist who sent me for the barium tests. Nothing showed up. It was getting so bad that I’d have to leave work and go home and lay down until the pains went away. It sometimes took until the next day. Soon after, my son told me he read in Runner’s Magazine about the Paleo diet and discovered that he no longer gets asthma when running through fields of grass. I thought I’d try cutting out breads, pastas, etc. That was 3 years ago and I have not had an attack since. I now get a Paleo diet and never felt better. Doctors don’t know anything.
Thanks Chris for this article. Your readers (including me) really hate when scientific studies are used to sensationalize the findings. Thanks for pointing out that’s what happened after this study. Gluten capsules. ugh!
Per Enterolab testing, I am genetically non-celiac gluten sensitive, been on a gluten-free diet for two years, vegetarian for 45 years. This is the first time I’ve heard a possible explanation for why, prior to giving up gluten, I never had a bad GI upset after eating seitan (straight gluten!), but was violently ill after bread and or pasta. Same for gluten-containing, soy-based meat substitutes. Never had a problem with those – again, non-wheat, isolated gluten. The world gets curiouser and curiouser.
I have Hashimoto’s and recently learned the link between gluten intolerance and autoimmune diseases. I’ve recently gone Paleo in accordance to your recommendations, and I’m curious after seeing this study if it is just the gluten that I need to eliminate or other FODMAPS as well? Can you provide some insight on what this study shows for people with Autoimmune diseases?