A recent study took two groups of subjects who were not celiac, but consumed a gluten-free diet because they believed they felt better while gluten-free. Then, in double blind study fashion, they were randomly administered either a placebo pill or a gluten pill for one week. The results? Those receiving the gluten pill reported significantly more symptoms, specifically “abdominal bloating and pain among the intestinal symptoms, and foggy mind, depression, and aphthous stomatitis (canker sores) among the extra-intestinal symptoms were significantly more severe when subjects received gluten than the placebo.” I provide some of my thoughts on this study in this week’s video.
Dr. Michael Ruscio: Non-celiac gluten sensitivity: Is this a legitimate concept?
Hi, this is Dr. Ruscio, and I wanted to take a moment to review a recent study published on the issue of non-celiac gluten sensitivity. Now, if you’ve been toying around with going gluten-free, you’ve probably heard two opposing views.
On the one side, there is that gluten-free can help every health condition under the sun. And at the other side, there is that gluten-free is a fad. And usually with most things, the truth lies somewhere in the middle.
There is a recent study done that I think helps shed some light on this issue. Now, I’m putting the abstract up here on the screen. The name of the study is “Small Amounts of Gluten in Subjects With Suspected Nonceliac Gluten Sensitivity: A Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial.” So, this is the gold standard in science.
And on this next slide, I’m putting up a few of the key notes of the study. 59 patients finished the trial. Again, I’ve highlighted in gold to emphasize the gold standard nature of the trial—the randomized, double blind, placebo-control trial.
Intake of gluten significantly increased overall symptoms, and these symptoms were correlated with abdominal bloating and pain among other intestinal symptoms, and also foggy mind, depression, and aphthous stomatitis (or canker sores) among other extra intestinal symptoms.
And this led the authors to conclude in a cross-over trial of subjects with suspected non-celiac gluten sensitivity, “the severity of overall symptoms increased significantly during 1 week of intake of small amounts of gluten, compared with placebo.”
Now, essentially, what the design of the study looked like in brief was people continued on a gluten-free diet. And then they were given either a pill containing about 4 grams of placebo in the form of rice starch or 4 grams of gluten.
And as we just covered, there was a significant increase in symptoms in those receiving the pill containing the gluten. So, we have very high level scientific evidence substantiating the fact that non-celiac gluten sensitivity is an issue.
Now, the one criticism one could make to this could be the FODMAP content. FODMAPs are fermentable carbohydrates found in a number of different foods that have been shown to provocate symptoms of IBS (or irritable bowel syndrome).
And some studies have shown that it may be the FODMAP and not the gluten. Now, the placebo in this case was a low FODMAP, so the rice being low FODMAP. So, this was a gluten, and gluten has some FODMAP compared to a lower FODMAP, which is rice. But the amount is so small that I have a hard time thinking that that small amount of FODMAPs would really contribute significantly.
At the end of the day, it doesn’t really matter because here’s what I think the take-home of all this is: try cutting something out of your diet. See if you feel better. Then, bring it back into your diet. See if you feel worse. If you do this a few times and notice a consistent relationship, then you have an issue with that food.
Do we need to get overly obsessed with the mechanism? In my opinion, not necessarily. The patients that I see that get the most obsessed with these things actually end up creating more stress in their lives because they’re obsessing over these things rather than just saying, “This works for me. This doesn’t work for me. I’m going to eat accordingly and focus on enjoying my life.” That’s issue A.
Issue B: as your gut health improves—for example, it has been shown that Bifidobacteria species can help with the degradation of gluten—you should see your tolerability, or your tolerance, to gluten increase.
Also, when people go on a low FODMAP diet for four to six weeks, the studies have shown that their tolerability to higher FODMAP foods increases in the future, likely because it deprives the overgrowth of small intestinal bacteria that can cause some of the symptoms that can be provocated by eating large amounts of FODMAPs.
So, I guess the two main points here are, one, I don’t think we need to get overly particular about saying gluten is an issue or is not an issue, or is an issue because of this or is not an issue because of that, because we want to bring this down to the practical. What can you do? How can you use this information to get healthier?
So, it seems like there is certainly evidence that gluten can be an issue for some. You should take gluten out, see how you feel, bring it back in, see how you feel.
If you notice a consistent, negative regression when you bring gluten back in, for whatever the reason, then you probably want to be careful in the amount of gluten that you eat.
Some people will be able to tolerate small amounts. Some people will not. You’ll have to experiment and figure out where you fall on that spectrum.
And then secondary to that, if you take steps to improve your gut health by eliminating inflammatory foods, eating foods that may be anti-inflammatory, maybe using a probiotic to help with these transient anti-inflammatory species, like Bifidobacterium, that can also help with breaking down gluten, then your tolerability may increase.
And finally, if you need to seek out a skilled functional medicine clinician and treat something like a SIBO, like a small intestinal bacterial overgrowth, that should further yet still improve your tolerability to some of these foods that may be questionable and may cause irritation in some.
So, gold standard evidence that gluten can be a problem for some. Does this mean we have to become gluten zealots and everyone needs to be gluten-free? No. And does it mean that people who are trying to claim gluten is a fad are right? I wouldn’t think so either. I think there is the middle ground.
Hopefully, this narrative helps you navigate how to use this information to get healthier in your own life. So, this is Dr. Ruscio, and I hope this helps.
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!
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