Monday, March 21, 2011

Gluten Proven to Cause Digestive Symptoms and Fatigue in Non-Celiacs




Copyright © 2011, The Food Doc, LLC, All Rights Reserved.
Gluten causes digestive symptoms and fatigue in people without Celiac disease.

In the first double blind randomized placebo-controlled study of gluten and symptoms in people without celiac disease, researchers from Australia have confirmed that gluten is a trigger of digestive symptoms and fatigue. They concede that “non-celiac gluten intolerance” may exist.

The researchers challenged and re-challenged people with IBS in whom celiac disease had been excluded whose symptoms were controlled on a gluten-free diet. These individuals were randomized to gluten-free diet with daily supplements of muffins and bread with a standard amount of gluten added or not added. Both the patients and the investigators were blinded to whether they were getting gluten containing muffins or bread and taste tests were done confirming that the two forms were indistinguishable. Symptoms were tracked by analogue scale. Patients were significantly worse within one week of gluten ingestion and had significantly worse bloating, abdominal pain, altered bowel pattern and fatigue.

In an editorial following this article in the March 2011 issue of the American Journal of Gastroenterology, Dr. Elena Verdu, MD, PhD., states “…gluten may be one of a multitude of triggers of low-grade inflammation and/or gut dysfunction in IBS” and “Gluten sensitivity could be raised as a possible cause of functional symptoms in patients with a positive anti-gliadin antibodies, and gluten restriction advised as a therapeutic trial.”

There is accumulating evidence that IBS does in fact involve low-grade inflammation and immune activation. Mast cells have been implicated for several years but only recently has there been studies showing increased activated mast cells present in the duodenum, ileum and/or colon of individuals with IBS symptoms. The trigger in these individuals is believed to be some type of immune stimulating event such as an intestinal infection (hence the post-infectious form of IBS) or proteins in the gut such as foods and/or microbes that are sensed by the body as being foreign attackers. The role of microbes is getting a lot of scientific and research attention whereas food proteins as a cause of IBS, has generally been doubted by US scientists or ignored until just recently.

Quoting research findings of Wahnshaffe et al, Dr. Verdu points out the presence of genetic markers for celiac disease predicted responsiveness to a gluten-free diet (GFD) in people with IBS. This is consistent with my clinical research findings of positive responsiveness to a GFD in individuals with at risk genetics (HLA DQ2 and/or DQ8) without proven CD, though many had positive AGA tests. Furthermore, my data indicates a higher prevalence of these genetics in individuals with increased mast cells in their intestinal lining, that is so-called mastocytic enterocolitis (MCE) or as I prefer mastocytic inflammatory bowel disease (MIBD). MCE or MIBD is gaining attention as an inflammatory process in some people with IBS. Treating such with medications and a gluten free diet has resulted in very favorable response in most the patients I have diagnosed and treated.

The role of mast cells and gluten in IBS is something I will continue to explore as I have now accumulated almost 400 patients with MIBD, many of whom have had celiac genetic testing and tried a GFD. Stay tuned for more information on mast cells in gastrointestinal disease.

Selected References:

Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double Blind Randomized Placebo-Controlled Trial. Biesiekierski, J. et al. Am J Gastro 2011;106:5080514.

Can Gluten Contribute to Irritable Bowel Syndrome? Verdu, E. Am J Gastro 2011;106516-518.

Mast Cells in Gastrointestinal Disease. Ramsay D., et al. Gastro and Hepatol 2010;6(12):772-777.

Mastocytic Inflammatory Bowel Disease ( MIBD ) : Increased Prevalence of Celiac - Related HLA DQ Genetics, CBir1 and Antigliadin Antibodies Associated With Response to Gluten Free Diet. Lewey, S. Am J Gastroenterol 2009; 104:S431–S484

Scot M. Lewey, D.O., FACG, FASGE, FACP, FACOI, FAAP, FACOP, CPE
Clinical Associate Professor of Medicine
Rocky Vista University-College of Osteopathic Medicine
Gastroenterology Associates of Colorado Springs
4110 Briargate Parkway, Suite 100
Colorado Springs CO 80920
719 387 2110

Author Bio

Dr. Scot Lewey is a digestive disease specialist doctor (board certified gastroenterologist) whose medical practice focuses on digestive and food related illness. Also, known as Dr. Celiac, the Food Doc, Dr. Lewey shares his experiential knowledge for a healthy gut, healthy life on-line. He is one of the few GI doctors who also is gluten sensitive and dairy sensitive. He has nearly a quarter of century of experience in the diagnosis and treatment of food allergy & intolerance, colitis, Crohn's disease and IBS. He and his family live gluten free in Colorado.

1 comment:

Shreela said...

Nice to see drs and science proving stuff like this. I hope there's more testing into other things that trigger inflammatory reactions in gut lining, since I've figured out carrageenan hates me with a passion.

Back to wheat though, when I was doing a gluten rule out, I noticed I had less sinus and low blood sugar problems (mostly because I follow Dr. William Davis Heartscan blog - he's pretty against wheat). But unless I ate whole wheat when my gut lining was irritated, I don't think I had severe or even moderate gluten symptoms in my gut, just the sinus and blood sugar symptoms.

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