By now you’ve seen the headlines. “Unless You Have Celiac Disease Gluten Sensitivity is Probably Just in Your Head” from PBS and “Researchers Who Provided Key Evidence For Gluten Sensitivity Have Thoroughly Shown That It Doesn’t Exist” from Business Insider were two of the most sensational and most-shared on my facebook feed.
So, is there no such thing as gluten sensitivity after all? Are all of us gluten-free non-celiacs just a bunch of hypochondriacs?
I thought I’d take a look at the study itself before I made up my mind. You’re going to have to purchase the article or get access through an academic library to read the whole thing. Here is the abstract: No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.1
Here are some things to think about when deciding whether this study debunks your supposed gluten sensitivity:
What Question Did The Study Set Out to Answer
Good studies ask specific, well-defined questions, and this was no exception. I’ll break it down for you:
- There are people who have gut problems but who test negative for celiac disease and other known GI diseases.
- Some of those people think gluten is the cause of their gut problems, and that they have “gluten sensitivity.”
- Is gluten really the thing that causes those “gluten-sensitive” people’s gut problems, or is it their reaction to FODMAPs?
This is a worthy question. If gluten itself is not the main cause of the gut problems, then it could be safe for people who see themselves as “gluten sensitive” to not worry too much about cross contamination. And if gluten itself is not the problem, but FODMAPs are, it gives people with those gut issues more direction in avoiding and healing their gut problems!
Even if the study is perfectly designed and gives clear negative results, that answer does not prove there is no such thing as non-celiac gluten-sensitivity. Why? Because there may be *other* ways to be sensitive to gluten. Gluten has been linked to a number of mental health problems. It has also been linked to arthritis, Hashimoto’s thyroidosis, Grave’s disease, and more.
Interestingly, one of the authors of this very study just put out another study showing that gluten sensitivity may cause depression!2
What Method was Used, and Do I Trust it?In this study the 37 participants tested negative for celiac but had digestive problems which they believed to be mediated by gluten. This is a very small sample size, focused on one specific question.
These participants were given 3 different diets over time, with a break between each diet. One diet had gluten added, another had whey and some gluten added, and the third had FODMAPS removed. The study was double-blind, meaning that neither the researchers nor the participants knew which diet was which.
The participants gut problems persisted whether on the gluten added or gluten and whey added diet, but subsided on the low-FODMAPs diet. Rather than using large groups of participants that had the different foods, each patient served as his or her own control. Their individual experience of each diet was compared to their individual experiences of the other diets.
A couple possibilities could have confounded the results. First, the length of time between diets was just a few days. Many people feel that their symptoms take a while to show up, and that when they make changes it takes time to settle into the new normal. Another issue is that whey protein could have affected people similarly to gluten. There was no control for that, so far as I could see.
No quick study of 37 people can “thoroughly show” anything. A study of this size and scope provides one thing – not proof of a sweeping generalization, but a starting place for more questions.
Despite all this, the method wasn’t terrible and the results are interesting. But you can see how this method definitely doesn’t mean results of a gluten-free diet are “all in your head!” Gluten-free diets often inadvertently remove a lot of FODMAPs! That could be one reason supported by this study that so many people with digestive problems feel better gluten-free!
Do the Recommendations of the Study Suggest Better Testing & Treatment Ideas
This study gives us a lot of good stuff to think about! So many people go gluten-free and still have digestive problems. That is even true for many people with celiac disease! There is a simple breath test which you can take that will measure your response to FODMAPs. (It is the same test that is used to diagnose SIBO.)
If you test negative for celiac disease and don’t have other autoimmune issues, wouldn’t it be nice to be able to solve your gut problems without being vigilant about gluten cross-contamination? You may still end up cutting out most grains, but you wouldn’t have to be so careful. This study suggests that is a viable treatment option!
The Big Takeaway
It’s awesome that there are scientists out there looking critically at gluten and what it does (or doesn’t do) to our bodies. We need to review their research critically. Just as we shouldn’t believe everything we read in a headline about the latest research, we shouldn’t dismiss research automatically when it fails to confirm our assumptions.
If you have digestive problems or fibromyalgia, it is definitely worth figuring out if FODMAPs are a part of your problem.
If you feel better gluten-free, stick with it – it’s helping!
1 – Biesiekierski JR1, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013 Aug;145(2):320-8.e1-3. doi: 10.1053/j.gastro.2013.04.051. Epub 2013 May 4.
2 – Peters S, Biesiekierski J, Yelland G, Muir J, Gibson P. Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity – an exploratory clinical study. Alimentary Pharmacology & Therapeutics [serial online]. May 15, 2014;39(10):1104-1112. Available from: Academic Search Complete, Ipswich, MA. Accessed May 27, 2014.