When Gluten Sensitivity Isn't Celiac Disease - NYTimes

6/10/2014
When Gluten Sensitivity Isn't Celiac Disease - NYTimes.com
Personal Health
When Gluten Sensitivity Isnt Celiac Disease

By Jane E. Brody
October 6, 2014 12:03 pm
Personal Health
Jane Brody on health and aging.
My nephew, sister-in-law and several others I know are on glutenfree diets, helping to support a market for these foods that is expected to
reach $15 billion in annual sales by 2016.
Supermarket shelves are now packed with foods labeled gluten-free
(including some, like peanut and almond butter, that naturally lack
gluten). Chefs, too, have joined the cause: Many high-end restaurants
and even pizza parlors now offer gluten-free dishes.
Those who say they react to gluten, a protein in wheat and other
grains, report symptoms like abdominal pain; bloating; gas; diarrhea;
headache; fatigue; joint pain; foggy mind; numbness in the legs, arms or
fingers; and balance problems after eating a gluten-rich food.
I suspected at first that the gluten-free craze was an attempt by some
to find a physical explanation for emotional problems, similar to the
epidemic of hypoglycemia in decades past. But a growing body of
research indicates that many may be suffering a real condition called
non-celiac gluten sensitivity, or NCGS.
It is not celiac disease, a far less common autoimmune condition that
can destroy the small intestine. Indeed, no one has conclusively identified
http://well.blogs.nytimes.com/2014/10/06/when-gluten-sensitivity-isnt-celiac-disease/?_php=true&_type=blogs&action=click&pgtype=Homepage&
1/4
6/10/2014
a physical explanation for gluten sensitivity and its array of symptoms.

Recent studies have strongly suggested that many, and possibly
most, people who react badly to gluten may have a more challenging
problem: sensitivity to a long list of foods containing certain
carbohydrates.
In 2011, Dr. Peter Gibson, a gastroenterologist at Monash University
in Victoria, Australia, and his colleagues studied 34 people with irritable
bowel syndrome who did not have celiac disease but reacted badly to
wheat, a gluten-rich grain. The researchers concluded that non-celiac
gluten sensitivity may exist.
Many of their subjects still had symptoms on a gluten-free diet,
however, which prompted a second study of 37 patients with irritable
bowel syndrome and non-celiac gluten sensitivity who were randomly
assigned to a two-week diet low in certain carbohydrates, collectively
called Fodmaps.
All patients on the special diet improved, but got significantly worse
when fed gluten or whey protein. Only 8 percent of the participants
reacted specifically to gluten, prompting the researchers to conclude that
Fodmaps, not gluten, accounted for most of the distress.
Fodmaps is an acronym for fermentable oligosaccharides,
disaccharides, monosaccharides and polyols, sugars that draw water into
the intestinal tract. They may be poorly digested or absorbed, and
become fodder for colonic bacteria that produce gas and can cause
abdominal distress. They are:
Fructose: A sugar prominent in apples, pears, watermelon,
mangoes, grapes, blueberries, tomatoes and tomato concentrate, and all
dried fruits; vegetables like sugar-snap peas, sweet peppers and pickles;
honey; agave; and jams, dressings and drinks made with high-fructose
corn syrup.
Lactose: The sugar in milk from cows, goats and sheep, present in
2/4
6/10/2014
ice cream, soft cheeses, sour cream and custard.

Fructans: Soluble fiber found in bananas, garlic, onions, leeks,
artichokes, asparagus, beets, wheat and rye.
Galactans: Complex sugars prominent in dried peas and beans,
soybeans, soy milk, broccoli, cabbage and brussels sprouts.
Polyols: The sugar alcohols (sweeteners) isomalt, mannitol,
sorbitol and xylitol, present in stone fruits like avocado, cherries,
peaches, plums and apricots.
People with irritable bowel syndrome often find that their symptoms
lessen or disappear when avoiding foods rich in Fodmaps; however, it
can take six to eight weeks on a low-Fodmap diet to see a significant
improvement.
Experts advise those patients to eliminate all foods rich in Fodmaps
at the start. (You can find a list of foods low in these carbohydrates at
stanfordhealthcare.org.) Once symptoms resolve, individual foods are
returned to the diet one by one to identify those to which patients react.
So what about patients who think they are sensitive only to gluten?
Dr. Joseph A. Murray, gastroenterologist at the Mayo Clinic and an
expert on celiac disease, urges that they first be tested for celiac disease, a
condition that has become dramatically more prevalent in recent
decades. The signs of gluten sensitivity often mimic those of celiac
disease, as well as irritable bowel syndrome.
Tests for celiac disease are less accurate if the diet does not currently
include gluten. Test first, test right, Dr. Murray said in an interview.
Were seeing people with symptoms who go on a gluten-free diet, and
then we cant make a correct diagnosis.
With non-celiac gluten sensitivity, there is no damage to the small
intestine, meaning many people may consume small amounts of gluten
3/4
6/10/2014
without incident. A forthcoming book edited by Dr. Murray, Mayo Clinic

Going Gluten Free, lists the essential requirements for diagnosis of nonceliac gluten sensitivity:
Negative blood tests for celiac disease and no sign of damage on an
intestinal biopsy.
Symptom improvement when gluten is removed from the diet.
Recurrence of symptoms when gluten is reintroduced.
No other explanation for the symptoms.
It is not yet known if the condition results from an immunological
reaction similar to that seen in celiac disease, or whether gluten exerts a
chemical or other negative effect on digestion.
Gluten sensitivity is not the same as a wheat allergy, a far less
common problem with symptoms like swelling, itching, skin rash,
tingling or burning of the mouth, and nasal congestion.
The best way to test for non-celiac gluten sensitivity (after ruling out
celiac disease) is to remove all sources of gluten from ones diet for
several weeks. If the symptoms disappear, reintroduce gluten to see if
they recur. Another option is to keep a food diary for a few weeks,
recording everything you eat and drink and any symptoms that follow.
In addition to the inconvenience and added expense, a gluten-free
diet can result in a poor intake of fiber and certain essential nutrients. It
may be wise to consult a registered dietitian if you plan to go gluten-free.
This is the second of two columns on gluten in our diets.
A version of this article appears in print on 10/07/2014, on page D5 of the
NewYork edition with the headline: A Matter of Some Sensitivity.
2014 The New York Times Company
4/4

When Gluten Sensitivity Isn't Celiac Disease - NYTimes

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

When Gluten Sensitivity Isn't Celiac Disease - NYTimes

Încărcat de

Drepturi de autor:

Formate disponibile

6/10/2014