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No effects of gluten in non-celiac gluten sensitivity after carbohydrate reduction

A study in the issue of Gastroenterology reports no effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.

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Patients with non-celiac gluten sensitivity do not have celiac disease but their symptoms improve when they are placed on gluten-free diets.

Dr Jessica Biesiekierski and colleagues from Australia investigated the specific effects of gluten after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates fermentable, oligo-, di-, monosaccharides, and polyols in subjects believed to have non-celiac gluten sensitivity.

The researchers performed a double-blind cross-over trial of 37 subjects with non-celiac gluten sensitivity and irritable bowel syndrome, but not celiac disease.

Participants were randomly assigned to groups given a 2-week diet of reduced fermentable, oligo-, di-, monosaccharides, and polyols, and were then placed on high-gluten, low-gluten, or control diets for 1 week, followed by a washout period of at least 2 weeks.

Gluten-specific effects were observed in only 8% of participants
Gastroenterology

The doctors assessed serum and fecal markers of intestinal inflammation/injury and immune activation, and indices of fatigue.

The team reported that 22 participants then crossed over to groups given gluten, whey, or control diets for 3 days.

Symptoms were evaluated by visual analogue scales.

In all participants, gastrointestinal symptoms consistently and significantly improved during reduced fermentable, oligo-, di-, monosaccharides, and polyols intake, but significantly worsened to a similar degree when their diets included gluten or whey protein.

The researchers observed gluten-specific effects in only 8% of participants.

There were no diet-specific changes in any biomarker.

The team found that during the 3-day rechallenge, participants’ symptoms increased by similar levels among groups.

Gluten-specific gastrointestinal effects were not reproduced.

An order effect was observed.

Dr Biesiekierski's team, "In a placebo-controlled, cross-over rechallenge study, we found no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in fermentable, oligo-, di-, monosaccharides, and polyols."

Gastroenterology 2013: 145(2): 320-328
13 August 2013

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