Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity

Skodje, Gry Irene; Sarna, Vikas Kumar; Minelle, Ingunn Hillestad; Rolfsen, Kjersti Langballe; Muir, Jane G.; Gibson, Peter R.; Veierød, Marit B.; Henriksen, Christine; Lundin, Knut E.A.

doi:10.1053/j.gastro.2017.10.040

Cited by 341 publications

(333 citation statements)

References 42 publications

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“…Everyone eats and has their own opinions of diet, which may not be physiologically accurate. A good example of this is the specific increase in symptoms from FODMAPs and not gluten in blinded IBS subjects who have self‐perceived gluten sensitivity . It is well established that placebo and nocebo responses are high in studies using IBS subjects .…”

Section: Introductionmentioning

confidence: 99%

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

Halmos

Gibson

2019

J of Gastro and Hepatol

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Since its first trial showing evidence of efficacy for managing symptoms of irritable bowel syndrome, the fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet has been gaining popularity but not without criticism. Application of the diet has changed from a rigid list of “allowed” and “not allowed” foods to a structured program of initial FODMAP restriction followed by food reintroduction and finally personalization so that patients are empowered to adjust their diet themselves to achieve good predictability of symptoms. Safety concerns of the diet have centered around its initial elimination leading to compromise of nutritional and psychological health, but careful patient assessment and management, preferably through a FODMAP‐trained dietitian, will reduce the risk of such negative health outcomes. Most negative attention for the FODMAP diet has been the notion that it will ruin the microbiota. Controlled studies have indicated that reducing FODMAP intake has no effects on bacterial diversity but will reduce total bacterial abundance, and higher FODMAP intakes will increase health‐promoting bacteria, supporting the concept of the full FODMAP program, including attaining a minimal “maintenance” level of FODMAP restriction. This review addresses all these concerns in detail and how to overcome them, including the use of a “FODMAP‐gentle” diet, describing restriction of a select few foods very concentrated in FODMAPs. This version of the diet is commonly applied in practice by experienced FODMAP‐trained dietitians but is not clearly described in literature. Careful direction and assessment of response or nonresponse will decrease the risks of over‐restriction and under‐restriction of diet.

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Section: Introductionmentioning

confidence: 99%

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

Halmos

Gibson

2019

J of Gastro and Hepatol

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“…Wheat is a source of fructans, food components excluded by the low FODMAP (fermentable oligo‐, di‐, monosaccharides and polyols) diet; as FODMAPs have been linked with symptom generation in IBS, this diet is now standard treatment for people with this disorder . Many people with SR‐NCWS are sensitive to fructans rather than gluten, which may explain the epidemiological overlap between SR‐NCWS and IBS . The relationship between functional dyspepsia and SR‐NCWS is less clear.…”

Section: Discussionmentioning

confidence: 99%

Incidence and prevalence of self‐reported non‐coeliac wheat sensitivity and gluten avoidance in Australia

Potter

Jones

Walker

et al. 2020

Medical Journal of Australia

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Objectives To determine the incidence of self‐reported non‐coeliac wheat sensitivity (SR‐NCWS) and factors associated with its onset and resolution; to describe the prevalence of factors associated with gluten avoidance. Design Longitudinal cohort study; analysis of responses to self‐administered validated questionnaires (Digestive Health and Wellbeing surveys, 2015 and 2018). Setting, participants Subset of an adult population sample randomly selected in 2015 from the electoral rolls for the Newcastle and Gosford regions of New South Wales. Main outcome measures Prevalence of SR‐NCWS (2015, 2018) and incidence and resolution of SR‐NCWS, each by demographic and medical factors; prevalence of gluten avoidance and reasons for gluten avoidance (2018). Results 1322 of 2185 eligible participants completed the 2018 survey (response rate, 60.5%). The prevalence of SR‐NCWS was similar in 2015 (13.8%; 95% CI, 12.0–15.8%) and 2018 (13.9%; 95% CI, 12.1–15.9%); 69 of 1301 respondents (5.3%) reported developing new onset (incident) SR‐NCWS between 2015 and 2018 (incidence, 1.8% per year). Incident SR‐NCWS was significantly associated with a diagnosis of functional dyspepsia, and negatively associated with being male or older. Gluten avoidance was reported in 2018 by 24.2% of respondents (20.5% partial, 3.8% complete avoidance); general health was the most frequent reason for avoidance (168 of 316 avoiders, 53%). All 13 participants with coeliac disease, 56 of 138 with irritable bowel syndrome (41%), and 69 of 237 with functional dyspepsia (29%) avoided dietary gluten. Conclusions The prevalence of SR‐NCWS was similar in 2015 and 2018. Baseline (2015) and incident SR‐NCWS (2018) were each associated with functional gastrointestinal disorders. The number of people avoiding dietary gluten exceeds that of people with coeliac disease or SR‐NCWS, and general health considerations and abdominal symptoms are the most frequently reported reasons for avoidance.

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“…The recent report of Skodje et al [23] clearly highlights the importance of FODMAPs in patients’ symptoms. They performed a double-blind crossover challenge in 59 adults with self-reported gluten sensitivity (celiac disease was formally excluded) with a random assignment to receive muesli bars containing placebo, fructan (2.1 g), or gluten (5.7 g) for 7 days.…”

Section: Clinical Presentation and Diagnosis Of Ncgsmentioning

confidence: 99%

Non-Celiac Gluten Sensitivity: A Challenging Diagnosis in Children with Abdominal Pain

Ruemmele

2018

Ann Nutr Metab

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Several disorders related to the ingestion of gluten are well recognized despite overlapping clinical presentations: celiac disease, an autoimmune enteropathy triggered by gluten ingestions in susceptible individuals, allergy to wheat, and more recently non-celiac gluten sensitivity (NCGS). While celiac disease and wheat allergy are well-known disorders with a clear-cut diagnosis based on clinical tests and biological parameters, NCGS is a more difficult diagnosis, especially in children with functional gastrointestinal (GI) complaints. NCGS is considered a syndrome of intestinal but also extraintestinal symptoms occurring within hours, but sometimes even after several days of gluten ingestion. In children, the leading symptoms of NCGS are abdominal pain and diarrhea, while extraintestinal symptoms are rare, in contrast to adult patients. No precise diagnostic test nor specific biomarkers exist, except a rather cumbersome three-phase gluten-exposure, gluten-free diet, followed by a blinded placebo-controlled gluten challenge with crossover to provoke symptoms elicited by gluten in a reproducible manner that disappear on gluten-free alimentation. Recent data indicate that the peptide part of wheat proteins is not necessarily the sole trigger of clinical symptoms. Mono- or oligosaccharides, such as fructan and other constituents of wheat, were able to provoke GI symptoms in clinical trials. These new findings indicate that the term gluten sensitivity is probably too restrictive. The incidence of NCGS was reported in the range of 1–10% in the general population and to increase steadily; however, most data are based on patients’ self-reported gluten intolerance or avoidance without a medically confirmed diagnosis. Treatment consists of gluten avoidance for at least several weeks or months. Patients with NCGS require regular reassessment for gluten tolerance allowing with time the reintroduction of increasing amounts of gluten.

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Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity

Abstract: In a randomized, double-blind, placebo-controlled crossover study of individuals with self-reported non-celiac gluten sensitivity, we found fructans to induce symptoms, measured by the GSRS-IBS. Clinicaltrials.gov no: NCT02464150.

Cited by 341 publications

References 42 publications

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome

Incidence and prevalence of self‐reported non‐coeliac wheat sensitivity and gluten avoidance in Australia

Non-Celiac Gluten Sensitivity: A Challenging Diagnosis in Children with Abdominal Pain

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