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Was Gluten Framed?

Eric Trexler | MA, CSCS, CISSN

May 15, 2018


For a decade now, the anti-gluten surge has been unmistakable. Like a rising tide, gluten-free products fill our stores, “GFs” cover our menus, and wheat-less diet books creep onto our shelves. So many people report problems with gluten that it’s no wonder it’s demonized, feared, and chased out by a mob.

But what if we’re afraid of the wrong thing? What if there’s something else that could explain why so many people get stomach upsets after eating? What if gluten was framed?


Gluten & the Non-Celiac Problem

Gluten is a protein found in wheat, rye, and barley. People with celiac disease have to avoid these grains because their body mounts a powerful immune response against gluten, leading to debilitating gastrointestinal problems. There’s no disputing that part—celiac disease is real. Luckily, while it may be increasing, it’s still pretty rare [8].

But then there are a growing number of people who claim to have a condition called “non-celiac gluten sensitivity” (NCGS). These people don’t suffer from celiac disease, but still report unpleasant (less extreme) symptoms after eating gluten. And while actual celiac disease remains rare, the prevalence of people without celiac disease who follow gluten-free diets has more than tripled since 2009 [1]. In fact, one survey from 2013 found that almost 30% of adults in the U.S.  were trying to avoid eating gluten [2], probably because they believed it was unhealthy [3]. Like the majority of market trends, this isn’t a coincidence. The public is more than preoccupied with the problem of gluten, and they want to get to the bottom of it.

Now, these people are not crazy—they’re not delusional hypochondriacs, and we’re not going to dismiss their suffering. But there’s mounting evidence that gluten isn’t really the culprit.


Science: The Scene of the Crime

The buzz surrounding NCGS really picked up in 2011 when a landmark study seemed to prove its existence [4]. The investigation compared two groups of people who claimed to have symptoms of NCGS. During the study, one group ate gluten while the other followed a gluten-free diet. Over six weeks, the subjects who ate gluten reported significantly greater gastrointestinal symptoms than the gluten-free group. While we have to note that 40% of the gluten-free group still reported negative symptoms, this study suggested that, scientifically, NCGS really exists.

Case closed? Not so fast.

No single study can really prove something in science—we have to replicate it, which means we have to see the same result from a different study. If we can’t replicate it, then the first results could have been just a fluke. In this case, one study isn’t enough to say (with our scientist hats on) that NCGS is real. So, in a really respectable move, the same lab attempted to replicate their findings in a follow-up study [5].

This time, the researchers looked at how much gluten it took to make a difference in symptoms. (They also threw in another variable—FODMAPS—which we’ll talk about soon.) The results surprised them: no amount of gluten—high, low, or zero—made a difference in the subjects’ gastrointestinal symptoms. But what did make a difference was eating a low-FODMAP diet, which, like gluten-free diets, involves avoiding a list of foods that may cause stomach upset and other symptoms ascribed to the evils of gluten… but that’s the next section.

Let’s do a quick sum-up: At this point, NCGS is a vaguely-defined disease, has no clinically useful way of being detected, and may not be caused by the thing it’s named after (gluten). To muddy the waters even more, people who report having NCGS often don’t meet the criteria for “diagnosis” [6]. So, we still have a lot of stuff to figure out.


Are FODMAPs the Real Villains?

“FODMAP” stands for “fermentable oligo-, di-, mono-saccharides and polyols.” Basically, all that gibberish is a group of carbohydrates that are hard for your body to digest and absorb. As a result, they make it all the way to the large intestine before fermenting and finally breaking down. If that follow-up study is right [5], then the “sensitivities” often blamed on gluten might not be caused by gluten at all, but FODMAPs. To strengthen this argument, another lab found that fructan, a type of FODMAP, caused gastrointestinal symptoms in 59 people who reported having NCGS [7]. The other subjects ate either a diet with gluten or a placebo. The ones who ate fructan had significantly worse symptoms than those created by gluten or the placebo.

So, there’s good news and bad news. Bad news number one: People with gluten sensitivity probably aren’t sensitive to gluten, which means they could have been treating their symptoms more effectively with a different diet all along. Bad news number two: It’s definitely easier to avoid gluten than FODMAPs, which are present in lots of different foods like vegetables, fruits, legumes, grains, and dairy.

The good news (finally!) is that most people can probably just limit (without completely eliminating) FODMAPs from their diet to get relief [9]. And if you think all this might apply to you, talk to a doctor, registered dietician, or other credentialed healthcare professional.


Up for Parole

Justice is being served, and gluten is up for parole. But we don’t have all the facts yet. It’s really important to note that everything we think we know is really new, and “new” in science is as good as saying “unclear.” But what we do know is that it makes more sense to try avoiding FODMAPs than blaming gluten.

And let’s be clear about one thing: you don’t need to eat gluten. It’s not necessary for your body, and if you want to avoid gluten, go for it. But keep in mind that you might be making your diet tougher, more expensive, less convenient, and lower in whole-grains… for no good reason.

Court adjourned.




1. Kim HS, Patel KG, Orosz E et al.: Time Trends in the Prevalence of Celiac Disease and Gluten-Free Diet in the US Population: Results From the National Health and Nutrition Examination Surveys 2009-2014. JAMA Intern Med. 2016;176(11):1716-7.
2. Lebwohl B, Cao Y, Zong G et al.: Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ. 2017;357:j1892.
3. Miller D: Maybe It’s Not the Gluten. JAMA Intern Med. 2016;176(11):1717-8.
4. Biesiekierski JR, Newnham ED, Irving PM et al.: Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011;106(3):508-14; quiz 15.
5. Biesiekierski JR, Peters SL, Newnham ED et al.: No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology. 2013;145(2):320-8 e1-3.
6. Biesiekierski JR, Newnham ED, Shepherd SJ et al.: Characterization of Adults With a Self-Diagnosis of Nonceliac Gluten Sensitivity. Nutr Clin Pract. 2014;29(4):504-9.
7. Skodje GI, Sarna VK, Minelle IH et al.: Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterology. 2018;154(3):529-39 e2.
8. Ludvigsson JF, Rubio-Tapia A, van Dyke CT, et al.: Increasing incidence of celiac disease in North American population. American Journal of Gastroenterology. 2013;108:818-824.
9. Halmos EP, Power VA, Shepherd SJ, et al.: A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. 2014;146(1):67-75.