Can a Gluten-Free Diet Benefit People Without Celiac Disease?
Lately, I've had a number of patients with various irritable bowel symptoms drop gluten from their diet. To my surprise, many have felt significantly better. That they know of, none of these patients have celiac sprue.
So what gives? Do they have celiac disease? Are they sensitive to gluten on some level for some other reason? Is this just a placebo effect?
Fact or Fad?
These patients of mine are not alone. The lay internet is abuzz with suggestions that eliminating gluten can improve symptoms in those with digestive problems such as bloating, gas, and diarrhea. Beyond bowel symptoms, gluten sensitivity has been implicated as a causal agent for problems such as chronic fatigue, skin conditions, and attention deficiency.
Market forces have responded to this business opportunity. Once difficult to find in stores, the gluten-free section is now prevalent with a number of palatable options. Cutting out the gluten is now more do-able, and people definitely going this route. But what is the absence of gluten doing in our bodies?
Gluten and Digestion
Gluten is a component of wheat and is found in all products produced from wheat grain. Wheat, among other grains, is a complex carbohydrate that contains fermentable sugars. These sugars in a digesting, moist, dark, bacteria-rich environment can start to "brew," causing digestive problems. In the case of celiac disease, the body forms an immune response to the gluten, causing a havoc-wreaking inflammatory response in the bowels. Visualization of a celiac diseased colon reveals red, angry, fragile tissue. Symptomatically, this can lead to symptoms beyond poor digestion such as fatigue and anemia. Read more about celiac disease here.
The Question at Hand
Here is where the leap comes in - can people without the inflamed, angry bowels of celiac disease have a body response to gluten products? Studies are relatively limited to give a bona fide answer, but there is some data out there.
One study looked at the prevalence of celiac disease in persons with irritable bowel syndrome symptoms (gas, bloating, diarrhea). The study found no difference between those with IBS and the general population. It did, however, find increased markers for an immune response to gluten about 1.5 times higher in the IBS group.
Another study looked at 34 people who tested negative for celiac disease but reported feeling better since they'd ceased ingesting gluten. These patients were randomly fed muffins with and without gluten. After six weeks of regular muffin consumption, responses were tallied in regard to bowel symptoms and showed a significantly positive response in the gluten-free group compared to the gluten group.
The Bottom Line
If you have digestion problems, or even fatigue or attention deficiency, should you drop gluten from your diet? My answer would be that it is worth a try. I have heard too many success stories to discount the validity, and the supportive science is beginning to emerge. Give it a month, and try to be objective about the response. Journaling helps, so that you can compare the before and after. If you notice a significant improvement, talk to your doctor, see a nutritionist, or research the potential pitfalls that can lead to some minor nutritional deficiencies that can be countered with supplementation.
Chime in! I am interested in any experiences you have had with gluten elimination.
Bieseikierski et al, Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. American Journal of Gastroenterology. 2011;106: 508-514.
Cash et al, The prevalence of celiac disease among patients with nonconstipated IBS is similar to controls. Gastroenterology. 2011; 141: 1187-1193