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Non-celiac gluten sensitivity: does it exist?
There's been a fair amount of coverage in the health news on recent research into non-celiac gluten sensitivity (NCGS). A study that appeared to confirm the existence of NCGS was refuted by a later study, performed by the same team. Their conclusion was that despite their earlier research, they could find no evidence that non-celiac gluten sensitivity exists.
Is Any Amount of Gluten Safe for Those with Celiac Disease?
Celiac Disease is essentially an autoimmune disorder that is triggered by eating foods containing gluten, which is in wheat, rye, and barley products. While there are blood tests to detect the disease, the true confirmation of the diagnosis requires doing a biopsy of several sites in the small bowel. If the villi in the small bowel show damage, the diagnosis is confirmed.
Got IBS? You Might Have Celiac Disease
We don't know exactly what causes Irritable Bowel Syndrome (IBS). Those with IBS often have stomach pain, bloating and diarrhea, and their symptoms come and go: people with IBS can go for some time without symptoms and then have flare-ups. The guidelines that doctors use to diagnose IBS vary from country to country and even professional association to professional association.
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When we first added our Gluten Allergies and Celiac Disease section to our site, a Celiac patient I know objected to the heading we use in the Special Diet Information section that appears on every recipe on the site. The label she objected to was "Gluten Sensitivity," under which label we specify whether or not the recipe is gluten-free and if there are any adjustments that should be made to the recipe to make it gluten-free.
She felt that "gluten sensitivity" implied that Celiac is not a serious disorder. While I understood her reasoning (and still do), at the time the jury was still out as to whether there were those whose symptoms, including fatigue and Irritable Bowel Syndrome, were improved on a gluten-free diet. I therefore chose to have the label we used be as inclusive as possible.
Recently a group of researchers in Australia designed a study to test whether those who did not have Celiac Disease - but felt better on a gluten-free diet - would experience symptoms if they consumed gluten without their knowledge (Am J Gastroenterol 2011;106:508-514).
For their study they recruited 34 men and women who definitely did not have Celiac Disease but whose abdominal symptoms had been controlled by following a gluten-free diet for at least the previous six weeks. For the six weeks of the study, half of the participants were given two slices of gluten-free bread and one gluten-free muffin to eat each day. The other half of the participants received the same two slices of gluten-free bread and one muffin, but the researchers had added specific amounts of gluten to their breads and muffins. Neither the researchers nor the participants knew who got the gluten-free breads until the end of the study.
Once per week, all of the participants responded to a survey that evaluated their abdominal symptoms. At the beginning and end of the study, their blood, urine and stools were collected for analysis as well.
So did those who ate gluten without knowing it have their abdominal symptoms return? Nine of the participants had to withdraw from the study early because their symptoms were so intolerable. Six of those were from the group receiving gluten in their breads. Over the course of the whole study, almost 70% of those receiving gluten answered "no" to the question, "Are your symptoms well controlled?"
Interestingly, the results of blood, urine and stool analyses remained the same for both groups at the beginning and end of the study.
This study, though small, is very well designed and certainly supports the idea that there are those who do not have Celiac Disease who react negatively to the presence of wheat gluten in their diet. Unfortunately, we still have no idea why that is.
First posted: March 9, 2011