The Role of Expectations in Gluten Sensitivity: New Research Findings

People can suffer from gluten without eating gluten. Expectations play a major role in gluten sensitivity. This is what research shows this week The Lancet Gastroenterology and Hepatology stands.

Abdominal pain, bloating or diarrhea, but also fatigue and headache. To prevent these types of complaints, many people avoid bread and other wheat products with gluten. These complaints are real, but it is unclear what causes them.

Gluten, Latin for glue, is a group of proteins found in grains. Researchers from the universities of Maastricht, Wageningen and Leeds gave more than eighty people a breakfast and lunch of sandwiches with or without gluten. These people did have complaints but no celiac disease or wheat allergy. The participants were told whether they would be given gluten or not. Both groups were then split into two subgroups: half got what they were told they would get, the other half did not.

In the group that expected and received gluten, people reported the most complaints. But complaints were also often reported in the group that thought they were eating gluten and was actually given gluten-free products. In the two groups that assumed they were eating gluten-free bread, people in both groups had fewer intestinal complaints.

Between the ears

It’s all in your head, is the simple explanation. The complaints are caused by negative expectations. Researchers then speak of a nocebo effect. “But that does not mean that the complaints are not real,” says PhD candidate Marlijne de Graaf.

The interaction between the brain and the intestines may play a role in gluten sensitivity. The Maastricht study does not show how the communication between the intestines and the brain works in this case and which parts of the brain are involved.

It may also be that something else is causing the complaints. Other substances in wheat may influence the immune system or gas formation by intestinal bacteria. Moreover, the composition of intestinal bacteria is different for everyone. Stress can also influence intestinal complaints. “Many people will recognize that when you are stressed you also get a stomach ache or have to go to the toilet,” adds researcher Daisy Jonkers. “The question is: are certain people more sensitive to this than others?”

Whole grains are a source of energy, fiber, vitamins and minerals

Non-celiac gluten sensitivity is a recognized condition, but it is different from celiac disease, also called gluten intolerance. About 1 percent of the population has celiac disease and these people can become very ill from gluten. Celiac disease is an autoimmune disease in which even a trace of gluten can lead to inflammation in the intestinal mucosa.

The tricky thing about gluten sensitivity is that it cannot be detected with a blood test. There are no clear biological mechanisms known and no harmful effects seen in people sensitive to gluten. Jonkers: “The only way to make a diagnosis is to have people take a double-blind test. But understandably, almost no one does.” For this reason alone, it is unknown how many people are sensitive to gluten. Estimates vary from 0.6 to 13 percent. It is more common in people with irritable bowel syndrome, a condition in which more types of foods can trigger abdominal pain.

Celiac patients are absolutely not allowed to eat gluten. People who think they are sensitive to gluten can receive advice from the Nutrition Center advice not to start a gluten-free diet without a diagnosis. Jonkers. “If you omit gluten from your diet, you no longer get many nutrients.” Whole grains are a source of energy (carbohydrates), fiber, vitamins and minerals. “If we can explain that there are no indications of harmful effects and expectations can also play a role, people can deal with this differently.”

A number of baking companies contributed to the study, but they were not involved in the design of the study or the writing of the report, the researchers write.

2023-11-29 12:35:13
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