COMMENTARY

Going Gluten-Free: Value Beyond Celiac Disease?

David A. Johnson, MD

Disclosures

March 04, 2013

In This Article

What Is Non-celiac Gluten Sensitivity?

When we talk about non-celiac gluten sensitivity, what are we talking about? We are talking about a patient population that has some form of symptoms or morphologic response after exposure to gluten, and they get withdrawal-related benefit. That would be gluten-sensitive non-celiac disease. Associated symptoms have been described as both classic intestinal (ie, gassy and crampy discomfort, bloating, and diarrhea) and extraintestinal (ie, malaise, fatigue, or attention-deficit disorder). An ataxic gait has also been described with gluten sensitivity.

Now let's take it a step further and ask: In patients who have gluten sensitivity and who feel better after gluten withdrawal, is it real or not real? In a very nice study[5] that was published about 2 years ago, investigators looked at patients with d-IBS in whom all the serologic markers for gluten were negative, but they felt better when they had gluten withdrawal. It was a randomized, double-blind, placebo-controlled trial. They only had 34 patients, but they were randomly assigned to receive bread and a muffin with gluten or bread and a muffin without gluten.

At the end of 6 weeks, there was a significant reduction of symptoms in the group that was receiving gluten-free food compared with the group receiving gluten. Gluten withdrawal resulted in a much more satisfactory response, with resolution of diarrhea, stool composure, gassy discomfort, and pain from bloating. Fatigue was also improved, which is interesting. I wonder if many of these patients were having sleep disruption at night.

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