Background & Aims
Patientswith 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.
Methods
Weperformed 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.
Results
Inall 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.
Conclusions
Ina 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
