Non-Celiac Gluten Sensitivity Might Be Placebo Effect

In the last few years, the world of food has taken off. Foodies, amateur chefs, and intolerant eaters are staples among our group of friends. Organic this and gluten-free that are now commonplace among restaurants and grocery stores across the country, but in all the commotion of the "I hate fast food world," and butter is bad for you syndrome, could we have gone too far? Perhaps, just maybe, there might even be a chance that such cases of gluten intolerance are a figment of our imagination?

A study conducted by Peter Gibson, a professor of gastroenterology at Monash University found that a gluten intolerance might be in your head. Although celiac disease, an autoimmune disorder triggered specifically by gluten, is a real issue plaguing many Canadians, others who claim to have a “gluten sensitivity” might be experiencing a psychological sensitivity rather than a medical issue.

In an original study written by Gibson, he found that gluten, which is a protein found in grains such as rye, wheat, and barley, can cause gastrointestinal distress in patients without celiac disease. Upon finding several inconsistencies in his study such as, the effect of placebo on participants, lack of evidence pointing to the direct cause of gastrointestinal inflammation, and the rise in gluten-free product sales, Gibson decided to conduct the study again.

“While celiac disease is a well-established entity, the evidence base for gluten as a trigger of symptoms in patients without celiac disease (so-called 'non-celiac gluten sensitivity' or NCGS is limited,” read the report. “The problems lie in the complexity of wheat and the ability of its carbohydrate as well as protein components to trigger gastrointestinal symptoms, the potentially false assumption that response to a gluten-free diet equates to an effect of gluten withdrawal.”

Recent randomized and controlled re-challenged trials were conducted, suggesting that gluten may worsen gastrointestinal symptoms, but failed to confirm patients with self-diagnosed gluten sensitivity.

So how did Gibson tackle the new study? He took 37 participants who were all confirmed not to have celiac disease yet did state they experienced gastrointestinal inflammation after ingesting gluten. All 37 participants vouched for a gluten-free diet, as they believed their stomach issues improved as a result.

In a controlled setting, Gibson fed the subjects a diet consisting of a low FODMAP count for two weeks, and during this time, participants reported minimal gastrointestinal issues. FODMAP is an acronym for common dietary triggers, such as lactose and common preservatives—benozates, fructose, sulfites, and nitrates.

After the initial two week period, participants were fed one of three diets for a week. One diet consisted of 16 grams per day of added gluten, another diet included 16 grams of whey protein isolate, and the third diet had no additional protein. The last diet was the same as the initial diet given to the participants and was designed as a way to test the placebo effect. Participants rotated through these three diets throughout the week.

After analyzing the data, Gibson found that participants reported worsening symptoms due to gluten. Although, the fun thing is, participants reported gastrointestinal issues even when they were ingesting the placebo diet. Gibson discovered that subjects were complaining of bloating, pain, nausea, and gas yet had a severe lack of apparent physical inflammation.

In a nut shell, the whole sensitivity issue turned out to be a psychological matter. Going into the study, participants had it in their head that gluten will make them sick, and in a matter of speaking, it did.

“In conclusion, these consecutive double-blind, randomized, placebo-controlled, cross-over rechallenge studies showed no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed on a low FODMAP diet,” said Gibson.