Gluten Sensitivity Without Celiac Disease — A New Twist

Some people without celiac disease report gastrointestinal intolerance to gluten-containing foods. In 2011, Australian researchers conducted a controlled-diet study that boosted the case for “nonceliac gluten sensitivity” (NEJM JW Gen Med Apr 5 2011). Now, the same group has explored whether “FODMAPs” (Fermentable, Oligo-, Di-, Monosaccharides, And Polyols) might confound the perceived response to a gluten-free diet. FODMAPs are fermentable, poorly absorbed, short-chain carbohydrates that include fructose, lactose, fructans (found in wheat), galactans, and polyol sweeteners.

The trial included 37 patients with irritable bowel syndrome who reported gluten sensitivity, and whose evaluations for celiac disease were negative. During a 2-week run-in period, all patients followed a gluten-free, low-FODMAP diet. Then, in a randomized, double-blind, crossover format, each patient received high-gluten, low-gluten, and no-gluten diets (1 week for each diet, separated by 2-week washout periods).

During the low-FODMAP run-in period, mean symptom scores improved significantly. However, symptoms worsened during each of the three double-blind treatments — with no differences between the high-gluten, low-gluten, and no-gluten periods. Twenty-two patients repeated the whole study with 3-day (rather than 7-day) food challenges, and with dairy products and chemical food additives also eliminated from their diets. Again, symptoms worsened just as much with the no-gluten diet as with the gluten-containing diets.