A new study published in the journal Gut has found that wheat can cause an immune reaction in people without celiac disease, confirming that there appears to be a biological explanation for non-celiac wheat sensitivity.
"Our study shows that the symptoms reported by individuals with this condition are not imagined, as some people have suggested," explained Dr. Peter H. Green, director of the Celiac Disease Center at Columbia University Medical Center. "It demonstrates that there is a biological basis for these symptoms in a significant number of these patients."
People without an official diagnosis of celiac disease can face a lot of judgment and ridicule for claiming to be sensitive to wheat products. "Allergy or preference?" is a question we're all familiar with, but for people without celiac who feel certain that gluten is causing their symptoms, the answer is complicated.
But this new study by Columbia University research scientists may explain why certain grain products can cause intestinal discomfort in some people, even if they don't have celiac disease.
"What we're studying is to help identify individuals who may really benefit from certain treatment strategies," explains lead researcher Armin Alaedini. Alaedini hopes that his findings will one day lead to a definitive test that could distinguish between wheat sensitivity and garden variety discomfort.
Currently, the only diagnosis for non-celiac wheat sensitivity involves filling out a questionnaire and maintaining a diet without wheat to see if symptoms improve. Now, thanks in part to Alaedini's study, a physical test could soon be a possibility.
Alaedini and his team recruited 80 people with non-celiac wheat sensitivity and compared samples of their blood to 40 people with celiac disease and 40 healthy people. These samples were drawn while all three groups were on a non-restrictive diet.
They found that people with NCWS had certain biomarkers in their blood, distinct from those with celiac disease, that indicated intestinal cell damage. Other cells showed that their immune systems had been activated against microbial antigens that may have leaked from their guts to the rest of their bodies.
The researchers then took a subset of 20 people with NCWS and asked them to eat a diet free of wheat, rye and barley for six months. Afterwards, they tested the participants' blood again and found lower levels of the biomarkers that indicated immune system activation and intestinal cell damage. The participants also reported that they were suffering from significantly fewer symptoms.
"The data suggest that, in the future, we may be able to use a combination of biomarkers to identify patients with non-celiac wheat sensitivity, and to monitor their response to treatment," Alaedini stated.
What this Study Could Mean for NCWS
"These results shift the paradigm in our recognition and understanding of non-celiac wheat sensitivity, and will likely have important implications for diagnosis and treatment," head researcher Umberto Volta detailed in a press release.
A test is sorely needed to differentiate between celiac disease, wheat allergy, non-celiac wheat sensitivity and other conditions like irritable bowel syndrome. A test would also help to legitimize the frustrations experienced by patients and doctors in diagnosing and understanding this condition that isn't properly recognized and even sometimes laughed at.
Dr. Christina Tennyson, an associate physician at Mount Sinai Hospital in New York who specializes in celiac disease, praised the design of Alaedini's study and agreed that his results could potentially be used to develop a test for wheat sensitivity.
"The gluten-free diet is sometimes portrayed as a fad diet," Tennyson explained. "It is not. I think this study helps validate that non-celiac gluten sensitivity indeed is a real condition, and that is very important."
What Else May Explain People's Symptoms?
It is also important to recognize that there could be other reasons for a perceived sensitivity to wheat. High carb meals in general can trigger a steep increase and subsequent crash in blood sugar levels, which could make a person feel unusually tired. An intolerance certain types of carbohydrates found in foods labeled as FODMAPS may also be a culprit. People who are intolerant to FODMAPS have to avoid food with fructans like wheat, garlic and onions, to avoid symptoms.
Research on NCWS is so preliminary that scientists don't even have a solid estimate on how many people are affected by by the condition (although estimates are at around 3 million), nor are they certain if it's gluten or another wheat compound that is to blame for triggering discomfort. There are many unknowns and many questions remaining, such as which biological pathways could be causing some people to experience symptoms.
Alaedini hopes that his results can serve as a basis for an eventual diagnostic blood test that can definitively answer if someone should be eliminating wheat, barley and rye from their diets. "We are now doing more studies to identify additional markers that will help us be able to test with greater sensitivity and specificity," he explained.
If you are experiencing symptoms that you think are related to consumption of wheat or gluten, it is important to test for celiac disease before eliminating gluten from your diet. If celiac has been eliminated as the cause, non-celiac wheat sensitivity could be the culprit and it is important to come up with a diagnostic and treatment plan with your doctor.