 If you don't have celiac disease, should you avoid gluten? Hi, this is Dr. Ruscio, and let's discuss this question. There's an entity known as non-celiac gluten sensitivity, and these are people that do not have celiac disease but appear to have a reaction to gluten. So they're not celiac with their gluten-sensitive, so non-celiac gluten-sensitive. So this is a somewhat controversial issue because the previous thinking was that only people that had celiac disease need to avoid gluten. However, there have been a fair amount of randomized clinical trials that are really the gold standard in medicine that have found that non-celiac gluten sensitivity is a legitimate issue. In fact, the majority of the clinical trials that have been done have shown that it does appear to be a legitimate issue. A study was recently published that challenges this. Another randomized clinical trial took two groups of patients, had them go off of gluten, and then one half was given a gluten pill, the other half was given a placebo pill that did not contain gluten. And the researchers wanted to see if the people receiving the gluten were the ones that had symptomatic flares, and the ones that were receiving the placebo did not have symptomatic flares. What was found was that about 35% of the people taking the gluten pill had a flare, had a symptomatic flare, whereas 50% of the people receiving the placebo had a symptomatic flare. Now, this definitely challenges the concept that non-celiac gluten sensitivity is legitimate. However, this is only one study. Right now, the majority of studies still support that non-celiac gluten sensitivity is a legitimate condition. There's a couple other details about this study that we should talk through just to help people understand this finding. The amount of gluten used in the pill was enough to elicit symptoms. 10 grams was used, or it was the amount in the pill. Some studies have shown that if the gluten pill contains a small amount of gluten, 1.5 grams or less, that may not be enough to elicit symptoms. 10 grams was used in this study, so clearly the gluten pill had enough to cause a symptomatic reaction. It's also possible that one may react to what's known as FODMAPs. The placebo pill was actually high FODMAP or had normal FODMAP content, so it's possible that the 50% of people reacting in the placebo group, they may have been reacting to FODMAPs. There are certainly a lot of people that are sensitive to FODMAPs. FODMAPs are fermentable compounds in carbohydrate that can fuel the signs of IBS, abdominal pain, discomfort, bloating, indigestion, constipation, diarrhea. It certainly may have been the FODMAPs. There's been another clinical trial that has run a similar study as this, and the placebo was low FODMAP. This study did find that most of the reactions were in the gluten group and there was very little in the placebo. It's possible that the reason why we're seeing this study find that more people reacted to placebo than to gluten could have been because the placebo was high in FODMAP. At the end of the day, what I think really matters is what you can do to feel better. It's a very simple and practical thing to go on a somewhat restrictive, very clean diet for about 30 days and then reintroduce some of these foods to see what your tolerance is and what your tolerance is not. A paleotype diet can be a great place to start, re-evaluate, see how you feel, reintroduce grains and gluten and FODMAPs. Usually when people do this and they observe for a little while, they fall into a diet that's right for them. I think it is important to mention that while I do see many patients that do well gluten-free, I think there may be emerging an equal amount of detriment being done to people that don't need to practice a high level of avoidance of gluten who are being feared into thinking that they do. It has been published that there's a high degree of social and psychological distress that accompanies having to go strict gluten-free for those people that have celiac. While it's good to get someone the recommendation to be gluten-free or to reduce their gluten intake, who needs it? For those that don't need it, this can create a lot of unintended suffering. I think it's important to be practical on approach and realize that those that have celiac will have to definitely be very strict avoiders. There's this group of non-celiac gluten sensitive where there's probably a continuum of those that can get away with quite a bit of gluten before they have a reaction and those that are really sensitive. We should try to get each person to a point where they practice the level of avoidance that's correspondent with their level of sensitivity. Then there are those that have no problem at all with gluten. It's important that we respect and identify this entire spectrum because the more that we try to fear people or force people into being gluten-free that don't need to be, we run the unintended risk of potentially creating a lot of stress in their life. Gluten-free can definitely be helpful. It's just trying to make sure we make that recommendation reasonably and responsibly so that you can reap all the benefits and not have any negative or any detriment. Remember, there can be the detriment of making your life harder than it has to be by avoiding gluten more excessively than you need to. Non-celiac gluten sensitivity in my mind and as per supported by the medical literature right now still seems to have the majority of the evidence in its favor. However, there are some other factors like FODMAP that may skew some of the findings like in today's study and it's also important to be practical and to realize that just because non-celiac gluten sensitivity is being identified as a legitimate condition, it doesn't mean that we need to be even more overzealous in trying to force everyone into gluten-free. So tinker, do some experimentation. If you need to work with a nutritionist or a health coach or a doctor to help you figure this out and then practice a level of avoidance that's going to feel right for you. This is Dr. Ruscio. I hope this information helps you get healthy and get back to your life. Thanks.