No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 145; no. 2; pp. 320 - 328.e3
• Main Authors: Biesiekierski, Jessica R., Peters, Simone L., Newnham, Evan D., Rosella, Ourania, Muir, Jane G., Gibson, Peter R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2013
• Subjects: Abdominal Pain; Adult; Clinical Trial; Cohort Studies; Cross-Over Studies; Diet, Gluten-Free; Disaccharides; Double-Blind Method; Female; Food Allergy; Gastroenterology and Hepatology; Glutens - adverse effects; Humans; Irritable Bowel Syndrome - chemically induced; Irritable Bowel Syndrome - diet therapy; Male; Middle Aged; Monosaccharides; Oligosaccharides; Wheat; Young Adult; Clinical Trial; D-FIS; GFD; NCGS; Food Allergy; VAS; Abdominal Pain; IBS; Wheat; FODMAP; visual analogue scale; Daily-Fatigue Impact Scale; gluten-free diet; irritable bowel syndrome; fermentable, oligo-, di-, monosaccharides, and polyols; non-celiac gluten sensitivity
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2013.04.051

Patients with non-celiac gluten sensitivity (NCGS) do not have celiac disease but their symptoms improve when they are placed on gluten-free diets. We investigated the specific effects of gluten after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates (fermentable, oligo-, di-, monosaccharides, and polyols [FODMAPs]) in subjects believed to have NCGS. We performed a double-blind cross-over trial of 37 subjects (aged 24−61 y, 6 men) with NCGS and irritable bowel syndrome (based on Rome III criteria), but not celiac disease. Participants were randomly assigned to groups given a 2-week diet of reduced FODMAPs, and were then placed on high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week, followed by a washout period of at least 2 weeks. We assessed serum and fecal markers of intestinal inflammation/injury and immune activation, and indices of fatigue. Twenty-two participants then crossed over to groups given gluten (16 g/d), whey (16 g/d), or control (no additional protein) diets for 3 days. Symptoms were evaluated by visual analogue scales. In all participants, gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein. Gluten-specific effects were observed in only 8% of participants. There were no diet-specific changes in any biomarker. 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. 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 FODMAPs. www.anzctr.org.au. ACTRN12610000524099