Round Up Ready: Gluten Edition

Gluten, or rather gluten intolerance, has been making a lot of headlines the past couple of years, and thanks to a recent article there is the suggestion that non-celiac gluten intolerance in bunk. So here is a round-up of some of the information about this recent gluten controversy (not to be confused with “articles” which blame Roundup® for all the ails of the human body, including celiac disease and gluten intolerance, note: reading these articles are a great opportunity to test your critical reading skills).

First up some background information, mainly, what is gluten? Jimmy Kimmel recently asked a bunch of fitness enthusiasts, many of whom practice gluten free diets, that very question.

ASAPScience took a bit more of a scientific approach in answering that question.

Both of these videos rightfully note that there is a significant portion of the population (~ 2 million, or 1 in every 141 Americans) that has celiac disease, for which eating gluten has very serious and unpleasant effects. The latter video also notes that there is a portion of the population that has non-celiac gluten intolerance. This discovery stemmed from a 2011 paper which, based on a double-blind randomized placebo-controlled trial (pretty much a gold standard), concluded that a non-celiac gluten intolerance may exist, but they weren’t able to determine a mechanism by which to support this conclusion. This paper helped usher in an era of awareness about gluten intolerance as well as a boom in the availability of gluten-free products.

However, the authors weren’t quite satisfied with their results and wanted to explore the issue further. They designed a more rigorous study, aiming to control some of the factors they weren’t able to in their 2011 study, involving 37 non-celiac subjects who self reported as feeling better on a gluten-free diet. In this new study (published in August 2013 to little fanfare until Real Clear Science brought it to light on May 14th), subjects were provided with all of their meals which allowed the researchers to removed any other dietary triggers which might confound their results, such as lactose, benzoates, propionate, sulfites, nitrites, and what would turn out to be most import, fermentable, poorly absorbed short-chain carbohydrates or FODMAPs (the short hand coming from fermentable, oligo-, di-, mono–saccharides and polyols). In the study the subjects were fed a diet low in FODMAPs for two weeks to establish a baseline, then they were randomly and blindly assigned to one of three diets (low gluten, high gluten, or placebo, which was whey protein) for a week. Over the course of the study each subject was exposed to each diet, allowing them to act as their own control. The results are a bit confusing, but in each treatment, whether it included gluten or not, subjects reported a worsening of gastrointestinal symptoms. A secondary experiment, where the placebo was the exact same as the baseline diet, still saw subjects reporting a worsening of symptoms! The short of it was, that subjects were reporting gastrointestinal distress without any apparent physical cause, this is not a placebo, but rather a nocebo effect, which New York Magazine writes about quite nicely. This suggests that gluten’s horrible image, which is perpetuated by some best selling books and questionable TV personalities, is enough to set off a very real negative physical response (e.g., bloating, general gastro discomfort) in some people after they have eaten it.

In addition to somewhat exonerating gluten in its role in gastro distress, this paper casts light onto a new food villain, FODMAPs. The results demonstrate that a reduction of FODMAPs in the subjects diets uniformly reduced gastrointestinal symptoms and fatigue. Some of the largest dietary sources of FODMAPs are bread products, so by going gluten-free, you also reduce your FODMAPs intake (and possibly even increase your calorie and fat content as many gluten-free foods, such as gluten-free pizza crust, need to add extra calories and fat to make a crust that tastes good and holds itself together, but that is another issue). While this study does have some very interesting conclusions, it is just one study, with a very small and unique population, and as always, more research is needed.

So for the millions of people who have felt better after going gluten free, consider that it might not have been the gluten that was the culprit, but FODMAPs, or a nocebo. Eating food should be fun, and should only ever be complicated or restrictive when there are valid scientific and medical reasons, and not because of a fad or TV personality claims.

A local Guelph barbershop. I think I will hold out for the FODMAPs free cuts.

A local Guelph barbershop was quick to jump on the gluten free bandwagon. I think I will hold out for the FODMAPs free cuts.

 

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