I was talking with a lady on Monday who told me that she had a ‘gluten intolerance’. Many doctors would assume this meant that the women had coeliac disease (a sensitivity to gluten in foodstuffs like wheat, rye and barley that causes bowel changes, bowel and abdominal symptoms, and may lead to malnourishment if left untreated). However, I believe that individuals can react to gluten and have symptoms from this even if they do not have classical coeliac disease. I have written about this previously here.
This woman gets gut symptoms when she eats gluten, but does not when she doesn’t. Tests reveal that she does not have coeliac disease. Many doctors and other health professionals might be tempted to imagine that this woman’s reaction to gluten are ‘in her mind’. However, as the blog post I link to explains, it is possible to react to foodstuffs in a way that evades conventional testing. Sometimes we doctors simply do not appreciate how limited our methods of testing can be, and are happy to pronounce ‘there’s nothing wrong with you’ when the results of the test we run come back negative. This reasoning is fundamentally flawed.
I was interested to read about a recent study that is pertinent to gluten sensitivity recently [1]. This Australian study focused on individuals just like the lady I met on Monday: they had symptoms of irritable bowel syndrome that were controlled by eating a gluten-free diet, but coeliac disease had been excluded as a diagnosis.
About half this group were fed with bread and a muffin each day containing gluten. The other half were fed with similar bread and a muffin that were gluten free. Almost 70 per cent of those eating gluten containing foods had a recurrence of their bowel symptoms, compared to 40 per cent of those eating gluten-free foods (it is always possible that some or all individuals reacted to something else in the gluten-free foods). The difference was statistically significant.
Those who ate gluten containing food had significant worsening in symptoms such as pain, bloating and fatigue.
The conclusion, “non-celiac gluten intolerance may exist…” Personally, I’d be a bit stronger than this, and say that this disease entity does exist. But nevertheless, the bottom line is that it is indeed possible for individuals to react adversely to gluten but not have celiac disease. Individuals need to be wary of this, I think, because of the risk of being told ‘all is well’ on the basis of negative tests for celiac disease.
References:
1. Biesiekierski JR, et al. Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. Am J Gastroenterol. 2011 Jan 11. [Epub ahead of print]
