Reference Number: 147
Background & Aims
Non-celiac gluten sensitivity is characterized by symptom improvement after gluten withdrawal in absence of celiac disease. The mechanisms of non-celiac gluten sensitivity are unclear, and there are no biomarkers for this disorder. Foods with gluten often contain fructans, a type of fermentable complex carbohydrate (oligo-, di-, monosaccharides and polyols). We aimed to investigate the effect of gluten and fructans separately in individuals with self-reported gluten sensitivity.
We performed a double-blind crossover challenge of 59 individuals on a self-instituted gluten-free diet, for whom celiac disease had been excluded. The study was performed at Oslo University Hospital in Norway from October 2014 through May 2016. Participants were randomly assigned to groups placed on diets containing gluten (5.7 g), fructans (2.1 g), or placebo, concealed in muesli bars, for 7 days. Following a minimum 7-day washout period (until the symptoms induced by the previous challenge were resolved), participants crossed over into a different group, until they completed all 3 challenges (gluten, fructan, and placebo). Symptoms were measured by gastrointestinal symptom rating scale irritable bowel syndrome (GSRS-IBS) version. A linear mixed model for analysis was used.
Overall GSRS-IBS scores differed significantly during gluten, fructan, and placebo challenges. Mean scores for bloating were 9.3±3.5, 11.6±3.5, and 10.1±3.7, respectively, during the gluten, fructan, and placebo challenges (P = .004). The overall GSRS-IBS score for participants consuming fructans was significantly higher than for participants consuming gluten (P = .049), as was the bloating score (P = .003). Thirteen participants had the highest overall GSRS-IBS score after consuming gluten, 24 had the highest score after consuming fructan, and 22 had the highest score after consuming placebo. There was no difference in GSRS-IBS scores between gluten and placebo groups.
SIGNIFICANCE OF THIS STUDY
The results of the current study found that fructans and not gluten induced symptoms of non-coeliac gluten sensitivity (NCGS). The study indicates that fructans are more likely to induce symptoms in those reporting sensitivity to wheat, rye and barley. The finding weakens the use of the term “NCGS” and raises doubt about the need for a gluten-free diet in such patients.