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Most who avoid gluten lack symptoms of intolerance, sensitivity
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WASHINGTON — Most individuals on a gluten-free diet do not avoid gluten because of specific gluten-related symptoms, according to data presented at Digestive Disease Week.
Barbara Zanini, MD, of the University of Brescia in Italy, and colleagues found that less than one-third of patients without celiac disease currently on a gluten-free diet had a self-reported wheat intolerance (SRWI). Even fewer had a diagnosis of non-celiac gluten sensitivity (NCGS). Zanini presented these findings based on the results from an epidemiologic and clinical study of the prevalence of NCGS and SRWI in a community in northern Italy.
“The avoidance of gluten or wheat products, without medical advice, is an increasing worldwide phenomenon, not supported by good medical evidence,” Zanini said in a presentation.
The investigators recruited patients for the epidemiologic stage of the study by mailing a questionnaire to the adult population of Monticelli Brusati, a town in northern Italy. The survey included a modified version of the gastrointestinal symptom rating scale to identify individuals with SRWI. In the clinical phase, the researchers sought to confirm or rule out a diagnosis of NCGS in those patients.
Of the 739 people that returned the questionnaire, 39 reported that they were on a gluten-free diet (5.3%). Researchers identified from this group 12 people with SRWI (31%) and 27 people that avoided gluten despite the absence of an association between gluten ingestion and clinical manifestations (69%).
In 10 patients that completed the clinical phase of the study, Zanini and colleagues determined that four had NCGS, suggesting a prevalence in the overall population 0.5%.
“People adhering to a gluten free diet are a mixed population,” Zanini said. “Less than one-third of them avoid gluten because of symptoms.” – by Alex Young
Resource :
Zanini B, et al. Abstract 580. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosures: Zanini reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.
Perspective
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Amy Foxx-Orenstein, DO, FACG
Many people are following a gluten-free diet for a variety of reasons, including efforts to lose weight or improve overall health. What many people do not realize is that avoiding gluten may not lead to immediate weight loss or reduction of symptoms such as bloating. There can be several other dietary factors inducing such symptoms.
As a matter of fact, items such as wheat and fiber that contain gluten often act as a prebiotic, supporting the intestinal milieu and helping intestinal organisms create a healthy environment.
As this was a small, single study, it would be interesting to expand research to larger populations and question people on why they have chosen to avoid gluten.
Mayo Clinic College of Medicine in Minnesota
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