Where does this news come from?
Hypersensitivity to gluten does exist and leads to serious intestinal inflammation or celiac disease. This disease affects approximately 1 in 50 to 1 in 200 people, many of whom have no complaints. If one only counts people with intestinal complaints, the number is even lower. The diagnosis of celiac disease is made on the basis of an intestinal biopsy. The only possible treatment is a low-gluten or gluten-free diet.
Yet many more people believe that they cannot tolerate gluten and that this is the cause of their intestinal complaints, even if they do not have celiac disease. They also experience that their complaints decrease as soon as they eat a low-gluten diet (1). Researchers investigated why this is the case. They found 80 individuals with self-reported gluten hypersensitivity that excluded celiac disease, willing to participate. The participants were divided into four groups. People who thought they were eating gluten reported gastrointestinal complaints, while people who thought they were eating something without gluten reported significantly fewer complaints. In reality, half of each group was fed gluten and the other half gluten-free. In all participating groups it turned out that people’s expectations played a crucial role in whether or not they experienced gastrointestinal complaints. Anyone who expects negative effects after eating gluten will actually experience them, even if it turns out afterwards that they have not eaten gluten. This is called a nocebo effect.
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How should you interpret this news?
Gluten is a protein found in various grains. Gluten is processed in bread, pastries, pasta, couscous, etc. and can also be found in pre-packed, processed products, such as sauces, stock cubes, prepared meats, breaded products, cookies, milk desserts, and so on. Gluten provides a glue-like structure.
For the past ten years, this protein has been the scapegoat for many stomach complaints. Gluten owes this negative image to ominous media reports following the international bestseller Broodbuik (Wheat Belly) by William Davis and the gluten-free diet books of, among others, the American celebrity Gwyneth Paltrow. Both suggested gluten as the cause of a whole host of chronic vague complaints and thus got the ball rolling.
As a result, more and more people with vague stomach complaints spontaneously avoided gluten. When these people eat gluten, they actually experience abdominal complaints, even when they think they are eating gluten when this is not the case. This effect is called the ‘nocebo effect’, it is the reverse of the ‘placebo effect’. The stomach complaints are indeed real, but the cause has nothing to do with gluten. Expecting that something will trigger intestinal complaints acts on the intestines and causes intestinal complaints. The brain and intestines are closely connected. Exactly how this works has not yet been fully clarified.
Conclusion
Anyone who cannot tolerate gluten and eats gluten will experience problems with the intestinal mucosa and sometimes also intestinal complaints. This condition is called celiac disease and the diagnosis can be made with an intestinal biopsy. Celiac disease is treated with a low-gluten diet. In addition, some people avoid gluten if they have intestinal complaints, in the belief that they are also hypersensitive to it, while after examination they appear not to have celiac disease. Yet they develop intestinal complaints when they think they eat something containing gluten and they feel better when they avoid gluten. This is evident from new research. The complaints are indeed real. The cause is between the ears.
References
(2)De Graaf C, Lawton C, Croden F et al. The effect of expectancy versus actual gluten intake on gastrointestinal and extra-intestinal symptoms in non-coeliac gluten sensitivity: a randomised, double-blind, placebo-controlled, international, multicentre study. Lancet Gastroenterol Hepatol 2023; 28 Nov
2023-12-05 15:43:24
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