Consider the case of my good friend who developed gluten sensitivity in midlife. Subsequently he went on a gluten-free diet – his wife found this a terrible nuisance. So she surreptitiously re-introduced wheat to his diet. Within no time my friend complained and that he had been wrong, his symptoms had reoccurred despite no apparent exposure to wheat. He was disappointed with his wife when she had to confess to her clandestine challenge to his physiology. But I think she behaved like a true scientist!
The single case represented by my friend has been repeated on a larger-scale many times. The results have been the same; many people with gluten sensitivity manifest symptoms when challenged in blind studies. Furthermore, unlike many types of putative psychosomatic illness, people with gluten sensitivity do not manifest different responses on psychological testing for depression or anxiety compared with those of the general population.
So what is the cause of this somatopsychic condition? It turns out that there are two main theories each with some evidence in their favour. The theory that I prefer is called FODMAPs, based on the idea that wheat is a potent source of fermentable, short chain carbohydrates. These carbohydrates are poorly absorbed and thus ferment in the gut causing the typical symptoms of bloating, distention and discomfort. The alternative theory is that wheat, perhaps in the presence of certain alterations in the microbiome, causes an inflammatory reaction in the liver that is associated with symptoms.
It will be important to discern the cause, since treatment of excessive fermentation would consist of a more general reduction of foods containing large proportions of fermentable carbohydrates.
— Richard Lilford, CLAHRC WM Director
- Skodje GI, Sarna VK, Minelle IH, Rolfsen KL, Muir JG, Gibson PR, Veierød MB, Henriksen C, Lundin KEA. Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity. Gastroenterol. 2018; 154: 529-39.
- Servick K. The war on gluten. Science. 2018; 360: 848-51.