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Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial.Am J Gastroenterol. 2011; 106(3):508-14; quiz 515 (ISSN: 1572-0241)
Biesiekierski JR; Newnham ED; Irving PM; Barrett JS; Haines M; Doecke JD; Shepherd SJ; Muir JG; Gibson PR
Monash University Department of Medicine and Gastroenterology, Box Hill Hospital, Box Hill, Victoria, Australia.
OBJECTIVES: Despite increased prescription of a gluten-free diet for gastrointestinal symptoms in individuals who do not have celiac disease, there is minimal evidence that suggests that gluten is a trigger. The aims of this study were to determine whether gluten ingestion can induce symptoms in non-celiac individuals and to examine the mechanism.
METHODS: A double-blind, randomized, placebo-controlled rechallenge trial was undertaken in patients with irritable bowel syndrome in whom celiac disease was excluded and who were symptomatically controlled on a gluten-free diet. Participants received either gluten or placebo in the form of two bread slices plus one muffin per day with a gluten-free diet for up to 6 weeks. Symptoms were evaluated using a visual analog scale and markers of intestinal inflammation, injury, and immune activation were monitored.
RESULTS: A total of 34 patients (aged 29-59 years, 4 men) completed the study as per protocol. Overall, 56% had human leukocyte antigen (HLA)-DQ2 and/or HLA-DQ8. Adherence to diet and supplements was very high. Of 19 patients (68%) in the gluten group, 13 reported that symptoms were not adequately controlled compared with 6 of 15 (40%) on placebo (P=0.0001; generalized estimating equation). On a visual analog scale, patients were significantly worse with gluten within 1 week for overall symptoms (P=0.047), pain (P=0.016), bloating (P=0.031), satisfaction with stool consistency (P=0.024), and tiredness (P=0.001). Anti-gliadin antibodies were not induced. There were no significant changes in fecal lactoferrin, levels of celiac antibodies, highly sensitive C-reactive protein, or intestinal permeability. There were no differences in any end point in individuals with or without DQ2/DQ8.
CONCLUSIONS: "Non-celiac gluten intolerance" may exist, but no clues to the mechanism were elucidated.
I like how they don't like their own conclusions ;) They sound as though they set out to show that we're a bunch of kooks, but lo and behold,
**"Non-celiac gluten intolerance" may exist, but no clues to the mechanism were elucidated.**
(note 'may exist' - that's what they just showed, but they sure were hoping to say it ain't so)
...and this could mean that what the experts "know" about celiac disease isn't entirely right, either.
**There were no differences in any end point in individuals with or without DQ2/DQ8. **
Could it be that they actually don't 'understand' the mechanism in celiac disease properly either?
I think this is actually great news, and am probably just being a bit of a crank because it's lunchtime. Thanks for posting it.
So is gluten bad for everyone or is it just that it's bad for more people than doctors assumed? I've always been curious to see if a gluten-free diet could benefit someone of good health with no digestive problems or other conditions. I'd like to see a study done on that.
Besides a gluten-free diet, has anyone ever used purest colloids as a dietary supplement?
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Annie
I think that's a great question. For sure it's bad for more people than they have thought in the past (because they were addicted to bad thinking... and probably to gluten - oops, that's opinion, not fact). It is certainly true that people react differently to gluten. Whether some of those reactions are unqualifiedly benign, I just kinda wonder.
One researcher showed that the reaction that gluten causes in the gut, wherein the tight-cell junctions between cell walls 'open' because zonulin is produced in the presence of gluten, occurs even in 'normal' people. In everyone. I believe that means that gluten tolerance is a continuum, and not so very many people have it in great reserve (beyond opinion now, into wild speculation). What they concluded in that study was that everyone produced zonulin, and everyone had increased gut permeability, upon exposure to gluten. Those with celiac disease had a much more dramatic and sustained zonulin release than 'normal' people. But those normal people also had increased gut permeability, and I am inclined to think that's not a great idea.
One idea that I was toying with, and later learned that other wiser folks have considered: gluten sensitivity was originally a positive adaptation, because in response to certain pathogens, opening those cell wall junctions to let the pathogens out allows for a much more rapid immune response. Cholera is one pathogen that also 'opens' those tight-cell junctions in a similar way; in fact, it secrets a toxin called 'zot' - zonula occludens toxin. (The extreme diarrhea of cholera is (I believe) the same, secretory type of diarrhea that is so troublesome when MC symptoms are raging, and it's the ensuing dehydration that makes cholera so deadly.)
So - crazier speculation coming here - in a sense, gluten behaves like a pathogen in the body. Because it isn't one, and because we keep eating it, the antibodies that develop don't 'defeat' the foreign protein, or protect us.
My husband's in good health, and has lost a lot of belly fat in a month or two, just from eating less gluten. He hasn't cut out most of the foods I've dropped, but he's eating them at a greatly reduced dose. He hasn't changed anything else. He's always eaten well and exercised, and isn't overweight - but had definitely been carrying some extra around the middle. (I, of course, wonder whether he has truly been tolerating gluten, or just hasn't 'erupted' into symptoms yet... but as you are beginning to see, I have been thinking very dark thoughts about gluten these past few months).
The hard-to-figure thing about such a study as you mention (and I'd love to see that, too) is that many people in 'good health' may *not* be in such good health. They may just be handling the slow drip of what gluten (or other food offenders) turns out to have been doing to them better than us MC folks (and migraneurs, and diabetic patients, and celiac sufferers, and those with multiple sclerosis and thyroid disease... I am feeling as though everyone I know should be avoiding gluten, and just praying I don't start telling 'em so). AND healthy people - let's say, younger people, who've accumulated fewer opportunities for gluten sensitivity to trigger into autoimmune symptoms - may not so much improve on a GF diet, as they would avoid or prevent what *might* have befallen them if they continued eating gluten. That's hard to sell, for most people (compared to junk food, very hard to sell indeed).
Sorry I got so over-enthused about your question ; It's been on my mind for some weeks. If you hear about some crazy woman in Brooklyn getting arrested for snatching bagels out of the hands of babes... that will be me ;)
