For some gluten sensitive, 'gluten-free' isn't enough

Carbohydrates may contribute to non-celiac gluten sensitivity

A growing body of research suggests that many who think they are suffering from gluten sensitivity may have Non-Celiac Gluten Sensitivity (NCGS)—and they may be sensitive to more than just gluten, Jane Brody writes in the New York Times' "Well" blog.

Gluten is found in wheat, barley, and rye. In people with celiac disease, the protein triggers an autoimmune response leading to intestinal damage. According to the National Foundation for Celiac Awareness, an estimated two to three million Americans suffer from celiac disease, and another 18 million residents have a sensitivity to gluten.

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Some of those gluten-sensitive Americans may have NCGS, according to recent studies. In a 2011 study, Monash University gastroenterologist Peter Gibson examined 34 people with irritable bowel syndrome (IBS) who did not have celiac disease but reacted poorly to gluten-rich grain. They concluded that NCGS "may exist."

Moreover, some research suggests that people with NCGS are not just sensitive to gluten; they are also sensitive to certain carbohydrates: fermentable oligosaccharides, disaccharides, monosaccharaides, and polyols (Fodmaps). Researchers do not yet know whether the issue stems from immunological reactions similar to celiac disease or chemicals exerted by gluten.

In another study, Gibson observed 37 people with IBS and NCGS who were randomly assigned diets low in Fodmaps. Only 8% reacted specifically to gluten, leading researchers to conclude the Fodmap carbohydrates could be responsible for their symptoms.

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People suffering from IBS frequently see their symptoms lessen or dissipate after abstaining from Fodmaps for six to eight weeks. Experts suggest that patients eliminate all Fodmaps and then gradually reintroduce them to determine their sensitivities.  

To make an NCGS diagnosis, Mayo Clinic gastroenterologist Joseph Murray says:

  • Celiac disease blood test must be negative;
  • An intestinal biopsy must show no signs of damage;
  • There must be no other explanation for the symptoms;
  • Symptoms must improve on a gluten-free diet; and
  • Symptoms must reoccur when gluten is reintroduced to the diet (Brody, "Well," New York Times, 10/6).

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