In 2013, Peter Gibson, a Professor of Monash University’s Department of Gastroenterology at The Alfred Hospital in Melbourne, published a study striving to dispel the mystery surrounding Non Coeliac Gluten Sensitivity (NCGS) in individuals exhibiting symptoms such as abdominal pain, flatulence and bloating that are not associated with Coeliac Disease.
NCGS, which was first proposed in 1980, is a food intolerance that can be defined as a condition in which those who do not suffer coeliac disease have symptoms which improve on a gluten free diet. Coeliac Disease, however, is an autoimmune disease triggered by exposure to gluten, and must be properly diagnosed by a GP.
The ability of gluten to induce symptoms in those with NCGS has been explored in individuals that fulfilled the Rome III Irritable Bowel Syndrome (IBS) diagnostic criteria and had ‘self-reported’ NCGS in which symptoms improved on a gluten free diet. Gibson’s study of a randomised double blind cross over design, did not prove the hypothesised gluten sensitivity thought to be exhibited in symptomatic subjects, instead showing no difference in symptoms between subjects consuming high gluten (16g of gluten per day), low gluten (2g of gluten and 14g of whey protein isolate per day) and no gluten (16g whey protein isolate per day) in the trial.
However, what he found was that during the wash out period leading up to the trials in which all participants consumed a diet low in FODMAPS (fermentable oligo-, di-, and mono-saccharides and polyols) found relief in all of their symptoms. FODMAPS are short-chain carbohydrates that are poorly absorbed and as such pass undigested through the small intestine leading to fermentation further along the gastrointestinal tract causing symptoms such as abdominal pain, bloating and flatulence. It was concluded in this study that it was the dietary inclusion of FODMAPS that were causing symptoms in subjects and symptoms were not specific to gluten ingestion.
Dietary FODMAP’s were first proposed in 1999 many years after NCGS was first proposed and is used as a treatment for IBS sufferers. Furthermore it has been seen that in patients with IBS the prevalence of those who perceive themselves to have a food intolerance such as NCGS is at least two fold higher. Thus, the exclusion of dietary FODMAPs is a necessary consideration for those experiencing IBS symptoms.
Written by Hayley Bell
Illustrator: Veronica Mellere