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No impact from gluten in self-reported cases of nonceliac gluten sensitivity
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Patients with nonceliac gluten sensitivity and IBS benefited from diets low in fermentable, poorly absorbed, short-chain carbohydrates but did not experience symptom changes after gluten introduction in a recent study.
In a double blind crossover trial, researchers evaluated 37 adult patients with nonceliac gluten sensitivity (NCGS) and IBS. Participants undertook a 2-week diet including reduced amounts of fermentable, poorly absorbed, short-chain carbohydrates (FODMAPs). They then were randomly assigned a 1-week diet including 16 g gluten/day (high-gluten), 2 g gluten/day with 14 g whey protein/day (low-gluten) or 16 g whey protein/day (control), followed by a 2-week or longer washout period before crossing to another of the diets. Twenty-two patients also underwent a 3-day rechallenge and received 16 g gluten/day, 16 g whey protein/day or no additional protein, followed by a minimum 3-day washout before crossing to the next diet.
All patients experienced consistent, significant improvement to GI symptoms, specifically abdominal pain, bloating and stool consistency, while on the FODMAP diet (P<.0001 for all). Overall symptoms worsened after gluten or whey protein was introduced, regardless of diet.
No dose-dependent gluten effect was observed, and only 8% of participants experienced effects considered gluten-specific. Eleven patients had increased overall symptom severity while in the placebo arm; eight had a similar response in the low-gluten arm and one did so in the high-gluten arm.
No significant differences in overall or individual symptom severity were observed according to diet during the rechallenge (P>.209 for all), and no gluten-specific responses were reproduced. In both trials, the first dietary intervention yielded significantly greater changes to symptoms than subsequent interventions, regardless of the diet.
“Generally, NCGS is viewed as a defined illness … where gluten is the cause and trigger for symptoms,” the researchers wrote. “In such a case, it would be anticipated that removal of gluten from the diet would lead to minimal symptoms and subsequent exposure to gluten would lead to specific triggering of symptoms. The results of the current study have not supported this concept.”
Disclosure: Researcher Peter R. Gibson, MD, has published a book on diet for IBS.
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