Based on the original article published in Science on 23/05/2018.
Over the past decade, the number of people who report some level of gluten sensitivity has continuously increased all over the world. In 2014, around 3 million people in the USA have weaned off of gluten even though they have not been diagnosed as celiacs. This group of patients have what is called NCGS, for “nonceliac gluten sensitivity”, and have been puzzling medical doctors and researchers for years.
Celiac patients have a genetic disorder that when they eat anything that contains gluten, an inflammatory reaction is triggered in their gastrointestinal tract. That reaction is provoked by a component of gluten called gliadin.
People who are allergic to wheat have another type of inflammatory response to wheat proteins. The inflammation is caused by a class of antibodies called immunoglobulin E and the reaction can cause vomiting, itching and shortness of breath.
What’s been puzzling many doctors and researchers is the fact that many people do claim to feel physically better once they cut off gluten-containg food from their diets, even though they lack the genetic composition or the telltale antibodies that are found in celiac and wheat-allergic patients.
Some doctors have thought that this “new wave”of gluten intolerance was purely psychosomatic. A study by Knut Lundin and other gastroenterologists based at the University of Oslo, assessed several patients for unusual levels of psychological distress that might express itself as physical symptoms”, and found there was no indication of metal condition between NCGS and people with celiac disease. Bluntly said by Lundin: “We know they are not crazy.”
Another group of researchers from the University of Chicago Medical Center in Illinois, wanted to understand why people are assuming that gluten is the culprit. Doctors who support that NCGS is a real form of ailment do believe that other components of wheat might cause the symptoms commonly reported, such as: abdominal pain, bloating, and diarrhea, and sometimes headaches, fatigue, rashes, and joint pain.
Dr. Armin Alaedini, an immunologist at Columbia University, was set to determine that some still unidentified wheat component could prompt the intestinal lining to become more permeable – likely due to an imbalance in gut microbes. Therefore, prompting inflammation.
Other researchers blame FODMAPs (a term coined by gastroenterologist Peter Gibson at Monash University in Melbourne). These are poorly-absorbed carbohydrates present in many food items besides wheat, such as Onions and garlic; legumes; milk and yogurt; and fruits including apples, cherries, and mangoes are all high in FODMAPs. These compounds, also present in wheat as fructans, ferment in the gut and cause from gastrointestinal discomfort, bloating and gas, to irritable bowel syndrome.
However, the polarization in the field remains, which worries Dr. Elena Verdù, a gastroenterologist at McMaster University in Hamilton, Canada. She says that instead of trying to find a specific culprit in the case of NCGS sufferers, doctors and researchers should focus on educating society. She is concerned about those people who cannot eat gluten-based food for medical reasons. She also says that scientists are sending the wrong message to nonceliac patients, who might go down a “food-avoidance habit”. These people begin by avoiding gluten, then lactose, and then FODMAPs, which may eventually lead them to a really poor diet, Dr. Verdù warns.
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For information on Dietary fructose intolerance, fructan intolerance and FODMAPs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934501/