IBS May be Caused by Non-Celiac Gluten Sensitivity – Science Confirms

There is considerable debate regarding gluten allergy. Somewhat recently a new clinical entity called non-celiac gluten sensitivity (NCGS) has emerged. These are people who feel better off gluten but are not diagnosed with celiac. Some have called NCGS a fad or not proven, however a recent placebo control trial suggests otherwise.


IBS May be Caused by Non-Celiac Gluten Sensitivity – Science Confirms - 26056920Dr. Michael Ruscio, DC: Hi, this is Dr. Ruscio, and a recent placebo-controlled trial was published, looking at the relationship between IBS and what’s called Non-Celiac Gluten Sensitivity. Non-Celiac Gluten Sensitivity is a new entity that’s being identified and examined. It’s essentially people that don’t have a full-blown gluten allergy like celiac, but they have a more subtle case of a sensitivity. So, it’s termed “Non-Celiac Gluten Sensitivity”. There’s quite a bit of debate as to whether or not this legitimate or just something that’s just an artifact of the gluten-free fad. Some people want to dismiss the concept of any intolerances to gluten because they are suspicious that it’s probably just a gluten-free fad. This study, however, really showed that Non-Celiac Gluten Sensitivity is somewhat legitimate and it may be very legitimate in causing the symptoms of IBS (or Irritable Bowel Syndrome) which can consist of altered bowel habits: constipation, loose stool and diarrhea, maybe a combination of the two. It may also include abdominal pain, gas, bloating, or flatulence.

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DrMR: What this study did was took 72 people and had them go on a gluten-free diet for six weeks, and then observed the level of improvement that the subjects obtained from that gluten-free diet. Then, and this is the important part, half the subjects were given a powder containing gluten, and the other half were given a placebo powder that contained no gluten. Then, the researchers tracked if the improvements were maintained in both groups or if there was regression. Now, here’s where it gets interesting: in the group that received the gluten, only 25% of those people maintained the improvement from the initial gluten-free diet. In the group that received the placebo (or no gluten), 83% maintained their improvement.

“Digestive symptoms that are consistent with IBS may be caused by Non-Celiac Gluten Sensitivity.”IBS May be Caused by Non-Celiac Gluten Sensitivity – Science Confirms - tweet e1540485375388

So what we see here is a group of people that go on a gluten-free diet, see improvements in their IBS, the patients that are taking gluten again but are unaware of it, 75% of them have a regression, or a worsening of their symptoms. Whereas if you are not receiving gluten, or are gluten-free still, 83% of those people maintained their improvements.

Gluten FreeThis certainly legitimizes the concept that digestive symptoms that are consistent with IBS may be caused by Non-Celiac Gluten Sensitivity. What do you do with this information? my recommendation is to look at this in a three-step process: If you or someone you know has IBS, the first thing I’d recommend you do is change your diet. Try gluten-free, and along with gluten-free, I would try an overall healthy diet, something like the paleo diet or the autoimmune paleo diet is a great place to start. If that resolves your problem, great! You’re pretty much done. If it only yields partial results, or no results at all, you may want to try some digestive enzyme supports and a probiotic. See if fooling around with those is able to elucidate improvement for you. If neither one of those does, there’s a good likelihood that you may have an underlying gut problem, like a gut infection, something like candida or SIBO (Small Intestinal Bacterial Overgrowth), and you should get yourself to a skilled clinician to have those investigated and treated.

This is Dr. Ruscio, hope this helps!

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

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40 thoughts on “IBS May be Caused by Non-Celiac Gluten Sensitivity – Science Confirms

  1. Did the”gluten powder” have FODMAPs in it? Did the “placebo”? There is increasing evidence that much of what is considered NCGS is actually not a reaction to gluten but to the FODMAPs in wheat and other grains. Spelt, which is lower in FODMAPs than wheat, is often tolerated much better by those with purported NCGS than wheat.

    1. Gluten powder was low FODMAP as was placebo, this study controlled for FODMAPs. I think we all need to remember there is more to IBS than SIBO/FODMAPs, definitely very important but lets not forget some simple dietary basics. Hope this helps!

  2. I don’t discount the validity of NCGS by any means, but I thought that it had been proven by Dr. Pimentel’s team that food poisoning was the primary cause of both IBS and SIBO, so where does this finding fit into the picture? He even stated that on last week’s podcast with Chris Kresser. Also, the summary above doesn’t indicate if the 72 people were at random vs. already known to have IBS or NCGS. But assuming the latter, don’t the findings point to gluten making the majority of them worse, but not necessarily at the root cause of their IBS? Thanks in advance for clarifying. I love your articles and podcasts and appreciate your generosity with important health info.

    1. Hi Susan. Great question but there is absolutely more to IBS than SIBO. Diet can be a major factor, as can other types of infections.
      http://www.ncbi.nlm.nih.gov/pubmed/17070814
      I think its most accurate to say – after you have changed your diet, SIBO or other infections are the most common cause of IBS. In accordance with Pimentel’s findings, I have found SIBO to be much more common than other infections.

      The design of the study showed that gluten made the IBS symptoms worse, through a randomized and double blinded process. **The effect of gluten was isolated because the gluten challenge was low FODMAP.** This is very important because it removes the confounding response from a FODMAP/SIBO induced reaction.

      So in this study it looks like NCGS truly was responsible for the IBS symptoms. If someone in the study went GF and did not improve fully, lets say they improved 50%. Its highly likely the remaining 50% is caused by SIBO or another GI infection.

      Hope this helps! Key question!

  3. Hi Dr. Ruscio – thanks for this (and, thank you for the transcript, as I love reading more than watching). Can you provide a link to the study? I’d love to read it. Thanks! 🙂

  4. Did the”gluten powder” have FODMAPs in it? Did the “placebo”? There is increasing evidence that much of what is considered NCGS is actually not a reaction to gluten but to the FODMAPs in wheat and other grains. Spelt, which is lower in FODMAPs than wheat, is often tolerated much better by those with purported NCGS than wheat.

    1. Gluten powder was low FODMAP as was placebo, this study controlled for FODMAPs. I think we all need to remember there is more to IBS than SIBO/FODMAPs, definitely very important but lets not forget some simple dietary basics. Hope this helps!

  5. I don’t discount the validity of NCGS by any means, but I thought that it had been proven by Dr. Pimentel’s team that food poisoning was the primary cause of both IBS and SIBO, so where does this finding fit into the picture? He even stated that on last week’s podcast with Chris Kresser. Also, the summary above doesn’t indicate if the 72 people were at random vs. already known to have IBS or NCGS. But assuming the latter, don’t the findings point to gluten making the majority of them worse, but not necessarily at the root cause of their IBS? Thanks in advance for clarifying. I love your articles and podcasts and appreciate your generosity with important health info.

    1. Hi Susan. Great question but there is absolutely more to IBS than SIBO. Diet can be a major factor, as can other types of infections.
      http://www.ncbi.nlm.nih.gov/pubmed/17070814
      I think its most accurate to say – after you have changed your diet, SIBO or other infections are the most common cause of IBS. In accordance with Pimentel’s findings, I have found SIBO to be much more common than other infections.

      The design of the study showed that gluten made the IBS symptoms worse, through a randomized and double blinded process. **The effect of gluten was isolated because the gluten challenge was low FODMAP.** This is very important because it removes the confounding response from a FODMAP/SIBO induced reaction.

      So in this study it looks like NCGS truly was responsible for the IBS symptoms. If someone in the study went GF and did not improve fully, lets say they improved 50%. Its highly likely the remaining 50% is caused by SIBO or another GI infection.

      Hope this helps! Key question!

  6. Hi Dr. Ruscio – thanks for this (and, thank you for the transcript, as I love reading more than watching). Can you provide a link to the study? I’d love to read it. Thanks! 🙂

    1. Good point and thanks for sharing paper, I will give it a read. Not specifically but I do recommend patients opt for organic and minimally processed which should do a good job at minimizing exposure.

  7. it’s all well and good saying try a gluten frtee diet have you seen how much the glutrn free foods cost its a rip off

    1. I totally agree with you on the “gluten-free” labelled products costing more. Don’t fall into that trap. Go with products that don’t contain gluten. Myself, I just went grain-free to eliminate the temptations to cheat on “gluten-free” products and cross contamination.

    2. Going gluten free doesn’t necessarily mean eating lots of gluten free substitutes; Victor makes a great point in the comments section here. Also, as demand for and volume of gluten free food production increases the prices should continue to come down. I would recommend running a 30 day gluten free trial if you have any lingering health complaints to determine if this is even something you need to worry about. If it does help, I’m confident you can find a cost effective way of incorporating this into your diet. Hope this helps! 🙂

      1. Going on a gluten free diet doesn’t have to cost a lot of money. Stores such as ALDI and Wegmans label almost all of their store brand products without any additional cost and their store brand gluten free products are almost always superior to the “name brands” in both cost and taste.
        I suspect that part of the cost of making gluten free products is in production in order to prevent contamination. And now, it must be tested to be less than 20ppm to be labeled as such. Wheat is a really cheap food while other grains are more costly as well.
        We are also spoiled in this country with cheap food costs. In other countries a much larger percentage of income is spent on food. I guess we’d rather spend it on gadgets and crap we don’t need.
        Just my thoughts.

  8. While I appreciate awareness being brought to the issue, I have to say I was disappointed in reading the second sentence to which ‘Celiac’s’ is referred to as a food allergy. Celiac’s disease is an autoimmune disorder and seeing as there is enough stigma about the condition in the first place, it is very important to acknowledge it correctly, especially in a medical/educational article.

    1. Thanks for the feedback Michelle. I’m not sure I agree that there is a stigma around Celiac. I think everyone is pretty on board with that being a serious and legitimate condition. I also think I have been consistent in framing it as such in all of my communications. In any case, your feedback is noted 🙂

    1. Good point and thanks for sharing paper, I will give it a read. Not specifically but I do recommend patients opt for organic and minimally processed which should do a good job at minimizing exposure.

  9. it’s all well and good saying try a gluten frtee diet have you seen how much the glutrn free foods cost its a rip off

    1. I totally agree with you on the “gluten-free” labelled products costing more. Don’t fall into that trap. Go with products that don’t contain gluten. Myself, I just went grain-free to eliminate the temptations to cheat on “gluten-free” products and cross contamination.

    2. Going gluten free doesn’t necessarily mean eating lots of gluten free substitutes; Victor makes a great point in the comments section here. Also, as demand for and volume of gluten free food production increases the prices should continue to come down. I would recommend running a 30 day gluten free trial if you have any lingering health complaints to determine if this is even something you need to worry about. If it does help, I’m confident you can find a cost effective way of incorporating this into your diet. Hope this helps! 🙂

      1. Going on a gluten free diet doesn’t have to cost a lot of money. Stores such as ALDI and Wegmans label almost all of their store brand products without any additional cost and their store brand gluten free products are almost always superior to the “name brands” in both cost and taste.
        I suspect that part of the cost of making gluten free products is in production in order to prevent contamination. And now, it must be tested to be less than 20ppm to be labeled as such. Wheat is a really cheap food while other grains are more costly as well.
        We are also spoiled in this country with cheap food costs. In other countries a much larger percentage of income is spent on food. I guess we’d rather spend it on gadgets and crap we don’t need.
        Just my thoughts.

  10. While I appreciate awareness being brought to the issue, I have to say I was disappointed in reading the second sentence to which ‘Celiac’s’ is referred to as a food allergy. Celiac’s disease is an autoimmune disorder and seeing as there is enough stigma about the condition in the first place, it is very important to acknowledge it correctly, especially in a medical/educational article.

    1. Thanks for the feedback Michelle. I’m not sure I agree that there is a stigma around Celiac. I think everyone is pretty on board with that being a serious and legitimate condition. I also think I have been consistent in framing it as such in all of my communications. In any case, your feedback is noted 🙂

  11. Whoops, meant to add quote from the study:

    Analysis of fecal microbiota and dietary intake indicated that numbers of healthy gut bacteria decreased, while numbers of unhealthy bacteria increased parallel to reductions in the intake of polysaccharides after following the GFD. Fecal samples of subjects under a GFD, which represent an altered microbiota, also exerted lower immune stimulatory effects on peripheral blood mononuclear cells than those of subjects on a regular gluten-containing diet.

    1. Thanks for sharing Ed. There have been a few studies like this, but also some studies showing MB shifts toward a healthier state on a GFD in those with celiac. Much more to come on this in my coming ebook on the microbiota.

  12. Whoops, meant to add quote from the study:

    Analysis of fecal microbiota and dietary intake indicated that numbers of healthy gut bacteria decreased, while numbers of unhealthy bacteria increased parallel to reductions in the intake of polysaccharides after following the GFD. Fecal samples of subjects under a GFD, which represent an altered microbiota, also exerted lower immune stimulatory effects on peripheral blood mononuclear cells than those of subjects on a regular gluten-containing diet.

    1. Thanks for sharing Ed. There have been a few studies like this, but also some studies showing MB shifts toward a healthier state on a GFD in those with celiac. Much more to come on this in my coming ebook on the microbiota.

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