Allow me to share the following scenario and feel free to identify if it resonates with you.
“Sir, can you please find out if this plate has any gluten/wheat in it, please?”
“Are you celiac?”
“Are you allergic to wheat?”
“Well, not necessarily allergic, but I am sensitive to it.”
Scoffs. Eye rolls. Dismissive hand gestures.
If you’ve been through this scenario more times than you care for, don’t despair. You are not alone. Wheat/gluten sensitivity has been a controversial topic for quite some time.
I’ve always had a hard time feigning composure with those who blatantly disregard other people’s symptoms proclaiming “everything is in your head”. They usually argue a variation of the statements below:
- Gluten sensitivity is not a real thing (and how many research articles have you read on the topic?)
- It’s a psychological issue (as if I’ve been greatly traumatized by wheat and I’m psychologically scarred for life).
- You’re such a whiner! There is even an article thoughtfully entitled “Science Says Gluten Sensitivity Isn’t Always Real – Some People Are Just Whiners“.
- Or my particular favorite: there are no scientific studies to to support gluten sensitivity (even though there are plenty – they are just NOT looking for it).
The FODMAPs study
The above mentioned article, and many others, have based their claim on this one study that found that people who believed to have non-celiac gluten sensitivity (NCGS) were apparently intolerant to FODMAPs (a class of carbohydrates that is poorly absorbed by some people and that are present in wheat).
The study was conducted in people with irritable bowel syndrome (IBS), a functional gastrointestinal disorder commonly characterized by stomach pain, gas, bloating, diarrhea and/or constipation(1). IBS is sort of a wastebasket diagnosis for people who have GI symptoms, yet don’t present with structural changes to the GI tract as do people with ulcerative colitis or Chron’s disease.
Regardless of the results, the study does not suggest, at any point, that individuals should proceed to chow down gluten-containing foods in light of their findings. Much to the contraire, the study showed that individuals on a low FODMAP diet achieved symptom relief despite ingesting purified wheat gluten. If you go to any website with information about FODMAPs, you will see that wheat is the first listed item to be avoided from the grains list. Which poses the following questions:
- How does one arrive to the conclusion that because purified gluten was not the culprit of the reported GI distress in subjects, consuming gluten-containing foods (that would still likely cause GI distress) would then be totally ok? In other words, the gluten in your bread is not the culprit of your stomach pain – it’s the FODMAPs, allegedly – so you can go ahead and eat that bowl of pasta. It will still hurt, but hey, it’s not the gluten. It’s a logical fallacy.
- And second, and most importantly, who eats purified gluten???
Gluten doesn’t exist in a vacuum. Gluten is the main storage protein in wheat flour together with other wheat proteins that can potentially also elicit an immune response in sensitive individuals (1, 2). I suppose the controversy has stemmed from placing so much emphasis on the gluten protein to the neglect of the synergistic properties of all wheat components.
New evidence supporting wheat/gluten sensitivity
A study published in Gut sought to determine whether wheat sensitivity in the absence of celiac disease or wheat allergy could induce a systemic immune response and subsequent damage to the gut cells in individuals with non-celiac wheat sensitivity (NCWS).
The study looked at 80 individuals who classified for the criteria of gluten/wheat sensitivity and in whom a diagnosis of celiac disease or wheat allergy was ruled out. Researchers compared these subjects to 40 individuals with celiac disease and 40 control (healthy) subjects. For the analysis, the researchers collected a total of 6 intestinal biopsies of the duodenum (small intestine) for each individual as well as blood samples. Furthermore, 20 of the 80 wheat/gluten sensitive patients were additionally assessed 6 months after a restrictive (gluten free) diet.
The study found systemic immune activation, markers of damage to the gut cells and increased intestinal permeability (leaky gut) in individuals with NCWS.
Particularly, individuals with wheat sensitivity had increased levels of sCD14 and LBP in the blood (which are markers for bacterial translocation) as well as antibody reactivity to microbial antigens, indicating a systemic immune activation. In other words, the immune system was mobilized in response to a “leakage” of bacterial antigens into the circulation (evidencing leaky gut).
Subjects also had an elevated expression of FABP2, indicating increased intestinal cell damage. Additionally, the FABP2 levels correlated strongly with levels of LBP and sCD14, suggesting a link between the gut cell damage and the increased systemic immune activation in response to leaked microbial products.
Finally, researchers found that after 6 months on a restrictive (GF) diet subjects displayed normal levels of immune activation markers, as well as FABP2 expression, which was also associated with symptom improvement. They did not find, however, biopsy abnormalities in NCWS individuals, which they attributed to the intestinal region (duodenum) selected for the study. They hypothesized that cell damage could be found further down the small intestine, in the jejunum, as FABP2 is primarily expressed by the epithelial cells of the jejunum.
In conclusion, this study lends support to the entity of non-celiac wheat/gluten sensitivity that is so often neglected by health practitioners, lay individuals and the mainstream media. It is easy to be dismissive when we don’t understand or are not aware of the existence of a scientifically acknowledged condition, but once that ignorance is shattered by evidence it is up to us to remove the veil of ignorance or continue to cling to old paradigms.