Often times, people without celiac disease or wheat allergy experience gastrointestinal and extra-intestinal symptoms after they ingest wheat, rye or barley. Scientists at the Columbia University Medical Center (CUMC) have found an explanation for the curious case of wheat sensitivity. According to their new study the body-wide inflammatory immune response symptoms occur due to a weak intestinal lining.
“Our study shows that the symptoms reported by individuals with this condition are not imagined, as some people have suggested,” said study co-author Peter H Green.
In celiac disease, an autoimmune disorder, the lining of the small intestine is mistakenly attacked by the immune system after an afflicted person eats gluten in wheat or other cereals like barley or rye, leading to gastrointestinal symptoms like abdominal pain, diarrhea, and bloating. However, people who do not have the characteristic markers determined from blood, tissues and genes, still report experiencing such symptoms and the unknown phenomenon is called non-celiac gluten sensitivity (NCGS) or non-celiac wheat sensitivity (NCWS). Other celiac-like GI symptoms experienced by such individuals include fatigue, mood swings, and cognitive problems. In the past the only possible explanation seemed that somehow wheat triggers an acute immune response all over the body.
There are no biomarkers for NCWS and thus determining its exact statistical prevalence is not possible. Estimates of gluten sensitivity range from 1% (3 million) to 6% (18 million) individuals of the American population.
In the study under discussion the team at Columbia carried out an analysis on a wide variety of subjects. 80 subjects with NCWS, 40 with Celiac disease and 40 completely healthy controls were compared with each other. The results showed individuals with celiac disease do not show the same immune biomarkers seen in NCWS. The intestinal damage was of the same kind in patients with celiac disease or NCWS, but the immune activation, determined through blood markers, was not of the same kind. Specifically, it was seen the microbial content which can pass from the damaged intestinal barrier was neutralized in patients with celiac disease, but not in those with NCWS. This is why in celiac disease there isn’t a systemic inflammatory response, like in cases of NCWS. Patients with NCWS also lacked the cytotoxic T cells usually present in celiac diseases patients. This indicates in NCWS the microbial and dietary components directly travel from the gut into the blood stream, due to cell damage in a weak intestinal barrier.
In the same trial people suffering from NCWS were put on a diet excluding wheat or any other gluten containing cereals for six months, which normalized their immune activation and cell damage markers, leading to a substantial improvement in their symptoms.
“The data suggests that in the future we may be able to use a combination of biomarkers to identify patients with non-celiac wheat sensitivity, and to monitor their response to treatment,” said study leader Armin Alaedini, PhD, assistant professor of medicine at Columbia.
The study was carried out in collaboration with the University of Bologna in Italy, and according to them their results have shifted the standard understanding of NCWS. Dr Alaedini has shared their next plan to explore the mechanism of intestinal damage in gluten sensitivity.
Gluten sensitivity or non-celiac gluten sensitivity (NCGS) is often wrongly referred to as gluten intolerance; however, in 2012 a meeting held in Oslo, Norway, by celiac disease researchers and experts decided to call the gluten-related disorder as ‘gluten sensitivity’ and not gluten intolerance.
The term ‘gluten’ is derived from the word ‘glue’ and refers to a protein found in wheat, rye and barley, responsible to maintain the shape of the cereal foods, since it acts as a natural adhesive to hold the food together. Gluten can be found in all sorts of wheat, barley or rye based food products and people with NCGS should avoid all such foods like breads, baked goods, soups, pasta, sauces, salad dressings, malt, food coloring, vinegar, beer etc. However, if such food products are made without gluten or have substituted gluten then they can be eaten without any fear. But keep in mind food products labeled ‘Wheat-Free’ may not necessarily mean ‘Gluten-Free’ and still have the ability to cause adverse symptoms.
Since there is no cure for gluten sensitivity, the best possible treatment for these individuals is to eliminate gluten from their diet. Although cutting gluten from the diet may seem problematic, with a few measure it can be relatively easy and cost-effective, since there are numerous food groups which naturally exclude gluten from their biological chemistry. Foods such as fruits, vegetables, meat, seafood, dairy beans, legumes and nuts do not contain gluten and increased consumption of these fiber rich foods is extremely beneficial for people with gluten sensitivity. Some starchy grains and other foods are also naturally gluten free such as rice, corn, quinoa, flax, chia etc.