Who knew that avoiding a food group could cause so much controversy? Gluten sensitivity or intolerance is a condition that causes a person to react after ingesting gluten, a protein found in wheat, barley and rye. It's different then celiac disease or a wheat allergy, both of which are largely accepted and well understood by the medical community. Gluten sensitivity is relatively new to the scene and just becoming well known now, but it still met with skepticism from much of the medical community.
Little is known about gluten sensitivity so it's hard to make bold statements on the specifics. Many of the answers to common questions associated with gluten sensitivity unfortunately just aren't known yet. Here's what we do know:
What is Gluten Sensitivity?
Gluten sensitivity is neither a food allergy (like a wheat allergy) nor a autoimmune condition (like celiac disease). Once these two have been ruled out by proper testing if you get relief from your symptoms on a gluten free diet then you could have what is officially called non celiac gluten sensitivity.
Symptoms Include gastrointestinal symptoms, such as abdominal pain, bloating and altered bowel habit, and full body symptoms, such as fatigue, headache, bone or joint pain, mood disorders and skin conditions (e.g. eczema or rash) (1)(2)
Is it even real?
It's been questioned whether or not gluten sensitivity is real. There is some evidence that gluten sensitivity may exist, but probably only in a small number of people.
One study, proving it's existence, tracked 59 participants through a placebo phase, when each received a small amount of rice protein every day, and a study phase, when each received gluten. Three patients exhibited more symptoms during the gluten phase.
Another study was done by Peter Gibson, a professor of gastroenterology at Monash University and director of the GI Unit at The Alfred Hospital in Melbourne, Australia. He published a study that found gluten to cause gastrointestinal distress in patients without celiac disease. The experiment was one of the strongest pieces of evidence to date that gluten sensitivity exists. Here's where it gets interesting, a second study was done by Gibson and the results were very different then the first time around.
There was a second study done on 37 people with irritable bowel syndrome and self-reported gluten sensitivity (31). This study placed the participants on a diet low in FODMAPs. Then they gave them isolated gluten instead of a gluten containing grain, like wheat. In this study, isolated gluten did not have any effect on the participants, except for an increase in symptoms of depression in a follow-up study. The conclusion of the study was that isolated gluten did not cause problems in these individuals, and that this self-reported “gluten sensitivity” was more likely to be a sensitivity to FODMAPs.
So is gluten sensitivity real? Is it FODMAPS, or maybe another component in wheat? It's hard to say, hopefully in the future research will show what's truly causing the elimination of symptoms with those on a gluten free diet. It's worth mentioning that many conditions that are well accepted by the medical community now were seen as "all in your head" or "physiological manifestations" and then were later proven to be real. More research is definitely needed when it comes to gluten sensitivity.
Is there a test for gluten sensitivity?
There are some tests available but none of them will prove definitively that you have gluten sensitivity. Some take a food sensitivity blood tests, but these tests aren't reliable and are yet to be backed by any scientific research.
These tests, which can cost hundreds of dollars, look for an antibody reaction to a whole range of foods. When they find a response with an antibody known as immunoglobulin G, or IgG, they say that result are unhealthy, suggesting a sensitivity to that food. There is no proof that these tests are reliable.
The best and only reliable way to see if you indeed have a sensitivity to gluten is to eliminate all gluten products and see if your symptoms go away and then reintroduce them to see if the symptoms return.
** It's important to mention that if you think you may have gluten sensitivity to get tested for celiac disease first before going gluten free. Why? because if you go on a gluten free diet the test that shows if you have celiac disease won't be accurate.
How many people have it?
Given that there's no accepted test for gluten sensitivity, it's impossible to say for sure how many people may actually be gluten sensitive. Researchers have estimated it may be as low as 0.6% of the population or as high as 6% of the population, but there hasn't yet been any definitive research on those numbers.
What are the health risks involved?
It's pretty unclear as of now whether or not gluten sensitivity causes any damage or long term health problems. A recent study found that people with gluten sensitivity developed autoimmune diseases, particularly thyroid disease, at the same rate as those with celiac disease. (4)
In a large medical trial conducted in Ireland, researchers found more deaths from cancer, plus more deaths from all causes, in people they defined as sensitive to gluten. (5) But, It's not clear why. The researchers recommended more studies to determine if the cause is gluten sensitivity itself or another condition.
It appears possible that gluten sensitivity may increase your risk of cancer or other autoimmune diseases. However, not enough research has been done to determine whether or not this is true.
How careful do I have to be?
There's a lot of debate over how strict that diet needs to be for someone who may be gluten sensitive. Some think it's ok to go ahead and cheat on occasion, while others will recommend a very strict gluten-free diet. In celiac disease, cheating can lead to serious conditions such as osteoporosis and, in rare cases, cancer. But with gluten sensitivity is much less clear.
As with everything involving gluten sensitivity, there are only a few studies that provide any insight, and some of the medical research to date has been contradictory. Eventually, science should provide more answers. In the meantime, you'll need to decide for yourself, in consultation with your doctor, whether not to follow the gluten-free diet.
If you've had the proper testing to see if you have celiac disease and it comes back negative and a gluten free diet eliminates your symptoms and you're getting proper nutrition then who's to say you shouldn't be on a gluten free diet. Hopefully in the future there will be more research done on gluten sensitivity that will give a clear answer to many of the questions and controversies that still surround the condition.