Non-Celiac Gluten Sensitivity — A Recent Study Challenges This Condition

Non-celiac gluten sensitivity (NCGS) is a condition that may account for why more and more people are going gluten free. NCGS essentially means you have a problem with gluten but you do not have full-blown celiac disease. However, a recent placebo control trial has challenged this notion. Let’s discuss the details and what this means for you.

If you need help confirming gluten sensitivity and implementing a gluten-free diet, click here

Non-Celiac Gluten Sensitivity—A Recent Study Challenges This Condition

Dr. Michael Ruscio: If you don’t have celiac disease, should you avoid gluten?

Hi, this is Dr. Ruscio. And let’s discuss this question. There’s an entity known as non-celiac gluten sensitivity. And these are people that do not have celiac disease but appear to have a reaction to gluten. So they’re not celiac, but they’re gluten sensitive—so non-celiac gluten sensitive.

So this is a somewhat controversial issue because the previous thinking was that only people that had celiac disease need to avoid gluten. However, there have been a fair amount of randomized clinical trials that are really the gold standard in medicine that have found that non-celiac gluten sensitivity is a legitimate issue. In fact, the majority of the clinical trials that have been done have shown that it does appear to be a legitimate issue.

A study was recently published that challenges this. Another randomized clinical trial took two groups of patients, had them go off gluten. And then one half was given a gluten pill. The other half was given a placebo pill that did not contain gluten.

And the researchers wanted to see if the people receiving the gluten were the ones that had symptomatic flares and the ones that were receiving the placebo did not have symptomatic flares. What was found was that about 35% of the people taking the gluten pill had a flare, had a symptomatic flare whereas 50% of the people receiving the placebo had a symptomatic flare.

Now, this definitely challenges the concept that non-celiac gluten sensitivity is legitimate. However, this is only one study. Right now, the majority of studies still support that non-celiac gluten sensitivity is a legitimate condition.

There are a couple other details about this study that we should talk through just to help people understand this finding. The amount of gluten used in the pill was enough to elicit symptoms. 10 g was used, or was the amount in the pill. Some studies have shown that if the gluten pill contains a small amount of gluten, 1.5 g or less, that may not be enough to elicit symptoms. 10 g was used in this study. So clearly the gluten pill had enough to cause a symptomatic reaction.

It’s also possible that one may react to what’s known as FODMAPs. And the placebo pill was actually high FODMAP or had normal FODMAP content. So it’s possible that the 50% of people reacting in the placebo group, they may have been reacting to FODMAPs.

There are certainly a lot of people that are sensitive to FODMAPs. FODMAPs are fermentable compounds in carbohydrate that can fuel the signs of IBS—abdominal pain, discomfort, bloating, indigestion, constipation, diarrhea. So it certainly may have been the FODMAPs.

Now, there has been another clinical trial that has looked—that has run a similar study as this. And the placebo was low FODMAP. And this study did find that most of the reactions were in the gluten group, and there was very little in the placebo. So it’s possible that the reason why we’re seeing this study find that more people reacted to placebo than to gluten could have been because the placebo was high in FODMAP.

At the end of the day, what I think really matters is what you can do to feel better. It’s a very simple and practical thing to go on a somewhat restricted, very clean diet for about 30 days and then reintroduce some of these foods to see what your tolerance is and what your tolerance is not.

A paleo-type diet can be a great place to start. Reevaluate. See how you feel. Reintroduce grains and gluten and FODMAPs. And usually when people do this and they observe for a little while, they fall into a diet that’s right for them.

I think it is important to mention that while I do see many patients that do well gluten free, I think there may be emerging an equal amount of detriment being done to people that don’t need to practice a high level of avoidance of gluten who are being feared into thinking that they do.

And it has been published that there is a high degree of social and psychological distress that accompanies having to go strict gluten free for those people that have celiac. So while it’s good to get someone the recommendation to be gluten free or to reduce their gluten intake who needs it, for those that don’t need it, this can create a lot of unintended suffering. So I think it’s important to be practical in our approach and realize that those that have celiac will have to definitely be very strict avoiders.

There is the group of non-celiac gluten sensitive where there is probably a continuum of those that can get away with quite a bit of gluten before they have a reaction and those that are really sensitive. And we should try to get each person to a point where they practice the level of avoidance that’s correspondent with their level of sensitivity.

And then there are those that have no problem at all with gluten. And it’s important that we respect and identify this entire spectrum because the more that we try to fear people or force people into being gluten free that don’t need to be, we run the intended risk of potentially creating a lot of stress in their life.

So gluten free can definitely be helpful. It’s just trying to make sure we make that recommendation reasonably and responsibly so that you can reap all the benefits and not have any negative or any detriment. And remember, there can be the detriment of making your life harder than it has to be by avoiding gluten more excessively than you need to.

So non-celiac gluten sensitivity in my mind and as per supported by the medical literature right now still seems to have the majority of the evidence in its favor. However, there are some other factors like FODMAP that may skew some of the findings like in today’s study.

And it’s also important to be practical and to realize that just because non-celiac gluten sensitivity is being identified as a legitimate condition, it doesn’t mean that we need to be even more overzealous in trying to force everyone into gluten free. So tinker. Do some experimentation. If you need to, work with a nutritionist or a health coach or a doctor to help you figure this out. And then practice a level of avoidance that’s going to feel right for you.

This is Dr. Ruscio. I hope this information helps you get healthy and get back to your life. Thanks!

If you need help confirming gluten sensitivity and implementing a gluten-free diet, click here

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

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

40 thoughts on “Non-Celiac Gluten Sensitivity — A Recent Study Challenges This Condition

  1. What about the study from Harvard recently using 3 different groups and 4 types of wheat, 2 ancient varieties and 2 newer hybrids. 100% of the participants had genes turned on for intestinal permeability. Everyone is negatively affected by wheat no matter if they know it or not.

    I lost 15 pounds when wheat was eliminated and felt much better so I’ll stay where I’m at and just let the science keep marching on.

    Thanks you info is always easy to understand and enlightening.

    1. This studiey is totally useless because it is a short term study that involves GI issues. Gluten sensitivity is much beyond this. Gluten triggers leaky gut in EVERYONE http://www.mdpi.com/2072-6643/7/3/1565
      people with NCGS and celiac disease show more leakiness…leaky gut triggers almost any mess in our body….

      1. Hi Alessio,
        Great question! But I feel like all my teachings have fallen on death ears! Your citing a cell culture study? Is your gut a petri dish? No, of course not. So you shouldn’t be making decisions based upon cell culture studies. Have you seen this post? https://drruscio.com/really-sick-read-labs-use-science-episode-50/ Anyone who has made a similar comment should see this post for perspective. Again, this does not mean gluten is OK for everyone. Going GF can be very helpful for some, somewhat helpful for many and cause no change in others. We should not be so dogmatic on this issue. Please keep an open mind 🙂

    2. Hi Cindy,
      Glad that you have had a positive experience from going GF. That being said I would urge caution with making such strong statements. You are citing mechanism studies which are very low quality support. For example some studies have shown leaky gut genes turn on for potatoes… What does this mean though? To play devil’s advocate – A vast amount of observational research has shown improved health for those who increase their whole grain consumption. If grains were a universal poison then we would not see this observation. GF can be very helpful for many, but we should not make the statement that it is bad for everyone in any amount. A problem for some does not mean a problem for all. Keep an open mind 🙂

    3. The point I want to make is related to yours. Giving up gluten is also giving up a lot of empty calories, Gluten is hard to digest so it makes sense for anyone with GI issues to avoid gluten most of the time. Dr Ruscio point about the social stress involved is well taken. What I do is avoid gluten in general but a small amount (for social reasons) doesn’t seem to be a problem.
      One more point. In my case and I’m sure it the same for many others, there is a cyclical nature to the GI issues and it can be very hard to distinguish the culprits even with elimination diets.

  2. Hi Dr. Ruscio,

    I’ve done Cyrex testing and I’m Non Celiac Gluten sensitive, but I have no reaction when eating gluten. It’s my understanding that 86% of NCGS people have no gastrointestinal symtems what so ever, but gluten is attacking their genetic weak link, which may take 20 or 30 years to manifest as disease. it often attacks the brain and nervous system.

    So this study is completely irrelevant .

    Chris Sunders

    1. Hi Chris,
      I’m not sure I would agree with this. It’s more than I can get into in this context but until we release an article that goes into detail on this just keep an open mind on a non-extreme position on gluten. This doesn’t mean GF can’t be extremely helpful, but it does mean we should be cautious in saying it’s a problem for everyone, everywhere, all the time. Great input!

    1. Also, great insights. I always think about what is in placebo, but as far as I have seen, they don’t always say what it is.

  3. What about the study from Harvard recently using 3 different groups and 4 types of wheat, 2 ancient varieties and 2 newer hybrids. 100% of the participants had genes turned on for intestinal permeability. Everyone is negatively affected by wheat no matter if they know it or not.

    I lost 15 pounds when wheat was eliminated and felt much better so I’ll stay where I’m at and just let the science keep marching on.

    Thanks you info is always easy to understand and enlightening.

    1. The point I want to make is related to yours. Giving up gluten is also giving up a lot of empty calories, Gluten is hard to digest so it makes sense for anyone with GI issues to avoid gluten most of the time. Dr Ruscio point about the social stress involved is well taken. What I do is avoid gluten in general but a small amount (for social reasons) doesn’t seem to be a problem.
      One more point. In my case and I’m sure it the same for many others, there is a cyclical nature to the GI issues and it can be very hard to distinguish the culprits even with elimination diets.

    2. This studiey is totally useless because it is a short term study that involves GI issues. Gluten sensitivity is much beyond this. Gluten triggers leaky gut in EVERYONE http://www.mdpi.com/2072-6643/7/3/1565
      people with NCGS and celiac disease show more leakiness…leaky gut triggers almost any mess in our body….

      1. Hi Alessio,
        Great question! But I feel like all my teachings have fallen on death ears! Your citing a cell culture study? Is your gut a petri dish? No, of course not. So you shouldn’t be making decisions based upon cell culture studies. Have you seen this post? https://drruscio.com/really-sick-read-labs-use-science-episode-50/ Anyone who has made a similar comment should see this post for perspective. Again, this does not mean gluten is OK for everyone. Going GF can be very helpful for some, somewhat helpful for many and cause no change in others. We should not be so dogmatic on this issue. Please keep an open mind 🙂

    3. Hi Cindy,
      Glad that you have had a positive experience from going GF. That being said I would urge caution with making such strong statements. You are citing mechanism studies which are very low quality support. For example some studies have shown leaky gut genes turn on for potatoes… What does this mean though? To play devil’s advocate – A vast amount of observational research has shown improved health for those who increase their whole grain consumption. If grains were a universal poison then we would not see this observation. GF can be very helpful for many, but we should not make the statement that it is bad for everyone in any amount. A problem for some does not mean a problem for all. Keep an open mind 🙂

  4. Hi Dr. Ruscio,

    I’ve done Cyrex testing and I’m Non Celiac Gluten sensitive, but I have no reaction when eating gluten. It’s my understanding that 86% of NCGS people have no gastrointestinal symtems what so ever, but gluten is attacking their genetic weak link, which may take 20 or 30 years to manifest as disease. it often attacks the brain and nervous system.

    So this study is completely irrelevant .

    Chris Sunders

    1. Hi Chris,
      I’m not sure I would agree with this. It’s more than I can get into in this context but until we release an article that goes into detail on this just keep an open mind on a non-extreme position on gluten. This doesn’t mean GF can’t be extremely helpful, but it does mean we should be cautious in saying it’s a problem for everyone, everywhere, all the time. Great input!

    1. Hi Anne,
      Good points. The study that I am referring to has much better methodology, so I think the better evidence suggest that a lower amount of gluten can elicit symptoms. Not to mention the large amount of anecdotal reports that show less than 50g/day can cause reactions. Don’t think about this ‘proving’ or ‘disproving’ but rather that we should not think of this as black and white. Some can’t do any gluten, some can do a little, and some have no problem at all. The evidence shows a spectrum of reactivity so this is what we should acknowledge. Hope this helps!

  5. So, I’m confused…. there are many health care practitioners, researchers and clinicians who state that EVERYONE should avoid gluten due to its effect on influencing zonulin, leaky gut, inflammation and molecular mimicry. If consuming gluten influences zonulin to open up channels in the intestinal lining, allowing undigested protein (including gluten) to enter the blood stream, shouldn’t gluten be avoided by everyone whether you have NCGS and GI distress or not?

    1. Hi Veronica,
      Good questions, but the big problem with your question is you are citing mechanism research. Observational data, which is higher level science than mechanism data, has shown that in some cases increased whole grain consumption correlated with improved health. If gluten was a universal poison we would not see this. This doesn’t mean gluten should be consumed by all, but it means we shouldn’t be so fanatical about GF. We should all find our personal level of tolerance and practice avoidance correspondingly.
      Hope this helps!

  6. So, I’m confused…. there are many health care practitioners, researchers and clinicians who state that EVERYONE should avoid gluten due to its effect on influencing zonulin, leaky gut, inflammation and molecular mimicry. If consuming gluten influences zonulin to open up channels in the intestinal lining, allowing undigested protein (including gluten) to enter the blood stream, shouldn’t gluten be avoided by everyone whether you have NCGS and GI distress or not?

    1. Hi Veronica,
      Good questions, but the big problem with your question is you are citing mechanism research. Observational data, which is higher level science than mechanism data, has shown that in some cases increased whole grain consumption correlated with improved health. If gluten was a universal poison we would not see this. This doesn’t mean gluten should be consumed by all, but it means we shouldn’t be so fanatical about GF. We should all find our personal level of tolerance and practice avoidance correspondingly.
      Hope this helps!

  7. Dr. Ruscio, I love your articles and continue to learn so much from them. I( just wish that you had a quick and easy way to print a version of your articles. A handy printable version link would be VERY much appreciated.

  8. Dr. Ruscio, I love your articles and continue to learn so much from them. I( just wish that you had a quick and easy way to print a version of your articles. A handy printable version link would be VERY much appreciated.

  9. Brilliant! I love the idea of considering FODMAPs as well as the gluten. Thank you for sharing! Very insightful.

  10. Ten grams of gluten/day may not be enough to elicit a reaction. Currently it is thought that those with celiac disease should not eat more than 10g gluten/day. This link mentions a study where subjects with celiac disease were given 0, 10 or 50g/day. Only one of the 49 people enrolled had a relapse on 10g gluten. I don’t think the study you mentioned proves anything. http://www.glutenfreedietitian.com/how-much-gluten-is-20-parts-per-million/

    1. Hi Anne,
      Good points. The study that I am referring to has much better methodology, so I think the better evidence suggest that a lower amount of gluten can elicit symptoms. Not to mention the large amount of anecdotal reports that show less than 50g/day can cause reactions. Don’t think about this ‘proving’ or ‘disproving’ but rather that we should not think of this as black and white. Some can’t do any gluten, some can do a little, and some have no problem at all. The evidence shows a spectrum of reactivity so this is what we should acknowledge. Hope this helps!

Leave a Reply

Your email address will not be published. Required fields are marked *