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A profound change in worldwide consumer behavior has taken hold around the issue of wheat's status in the human diet (to the tune of a burgeoning multi-billion dollar 'gluten free' products industry), and lately, a battery of mainstream articles have come out claiming that the only population legitimately entitled to identify wheat as a cause of their malaise are those with classically defined and diagnosed celiac disease – albeit, an increasingly expanding population.
With articles titled, "Study: Gluten "sensitivity" may not exist," "Study says non-celiac gluten sensitivity may not be real," "Gluten Sensitivity Probably Not a Real Condition, Study Says," proliferating wildly, what is the truth?
The study referred to in the above articles was published in 2013 in the journal Gastroenterology and was lead by an Australian professor of gastroentology who first identified an expanded category of gluten sensitive disorders labeled 'non-celiac gluten sensitivity' (NCGS). His original study, published in the American Journal of Gastroentology in 2011, found that gluten caused significant gastrointestinal distress in patients without celiac disease (CD), and was lauded as strong evidence that gluten avoidance may benefit a larger population than those suffering with CD.
His more recent study, a double-blind cross-over trial of 37 subjects with NCGS and irritable bowel syndrome, but not celiac disease, randomly assigned participants to groups given a 2-week diet of reduced dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates, known by he acronym FODMAPs (fermentable, oligo-, di-, monosaccharides, and polyols), 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.
The researchers 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. Their symptoms were then evaluated by visual analogue scales.
The study results were reported as follows:
"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."
Despite mainstream reporting, the results did show that the reintroduction of gluten and whey caused a worsening of their symptoms, even though gastrointestinal effects and changes in various biomarkers were not reproduced except in one patient, who experienced a gliadin-specific T cell response similar to what is seen in celiac disease patients: "Only 1 patient elicited a positive T-cell response after the high-gluten (16 g/d) challenge, and her day-6 response was a >3-fold change from day 0 (Supplementary Figure 2A), a response similar to those reported in patients with celiac disease. " These exceptions do not support the unsophisticated mainstream reporting on the study which imply that 'gluten sensitivity' in general is an entirely fictitious entity.
Nonetheless, the study found that gluten is likely not alone responsible for all of the adverse health effects many without celiac disease experience as a result of gluten consumption, indicating that other factors beyond gluten in wheat, including fructans (which are reduced in the FODMAPs) diet, enzyme inhibitors (e.g. α-amylase/trypsin inhibitors), and lectins (which we have gone to great length to detail as a critical component of wheat toxicity beyond its 23,000+ proteins), likely play role in explaining why so many who employ a wheat free diet experience self-reported improvements in their health. Another confounder in the veritable explosion of 'gluten sensitivity' disorders over the past decade is the role that Roundup herbicide plays in amplifying dysbios in the gut, enhancing the potential for wheat to contribute to both celiac and non-celiac related adverse health effects.
This is why, although it is correct to state that 'Non-Celiac Gluten Sensitivity' may not be as large a problem as initially anticipated, 'Non-Celiac Wheat Sensitivity' very well is. Throwing out the baby (NCGS) with the bath water is certainly not the answer. While the wild-proliferation of irresponsible 'gluten free' marketing is a concerning trend – not unlike the 'fat free' and 'cholesterol free' nonsense of yesteryear – with 'gluten free' making its way onto obviously non-gluten containing products such as water, the significant toxicity of wheat cannot and should not be discounted.
With over 200 adverse health effects now documented in the biomedical literature linked to wheat consumption, the time has come to point out the obvious: wheat, and all cereal grass 'grains,' have only been a part of the human diet for less than 95% of our existence as hunters and gatherers. When an 'ancestral' context is applied to the question of what we should eat, even the voluminous data we have collected on wheat toxicity may not be necessary to see through the rather reactionary rejection of the gluten free diet, and gluten free products industry. We propose that instead of using terminology such as 'Non-Celiac Gluten Toxicity' to describe the fundamental biological incompatibility between human physiology and the consumption of this mistakenly glorified 'king of grains,' we should be focusing on the thing itself – Wheat and its intrinsic and broad toxicity – instead of getting mired in taxonomical and clinical minutia which still privilege the 'evidence-based' model of absolutely clinical certainty over that of one's own direct experience following wheat removal from the diet. For an in-depth explanation of why wheat is not a health food, read: The Dark Side of Wheat: New Perspectives on Celiac Disease and Wheat Intolerance.
In a previous post, we discussed the critical role that the human microbiome plays in mediating susceptibility to wheat protein's harmful potential, pointing out that like all health conditions, the individual's response to a toxin or toxicant is multifactorial, and in the case of wheat exposure, will depend on factors such as history of antibiotic exposure, agrochemical exposure in grains, tubers, and pulses (glyphosate used in wheat harvesting as a dessicant/herbicide), breastfeeding duration, dysbios, and a wide range of additional known and unknown factors. Waiting around for the conventional medical system to verify there is a problem in face of the widespread certainty of direct experience is a bit ridiculous. In other words, if you think you may have a problem with wheat (or gluten), simply remove it and see how you feel, and how your body responds. Re-challenge yourself, if you think you are ok, or that the improvements were more than just imagined. This is the N-of-1 clinical setting that all truth first flows through when it comes to understanding what the best diet and approach to your health is for you.
The story does not end here. A battery of new studies and reviews have looked at NCGS's role in a variety of disorders. Although the much tauted NCGS study with negative findings is being blown up in the mainstream, research continues to confirm the relevance of this diagnostic category. Feel free to do a little exploration of the research yourself on pubmed.gov.