Bloating, nausea, or discomfort: what if gluten isn't the culprit?

The domestication and cultivation of cereals in the Neolithic period allowed human populations to grow and expand, with small villages and settlements becoming permanent, always near water and arable land. Obtaining grain that could be stored allowed people to survive harsher winter conditions or years of poor harvest. Cereal flour, such as that made from wheat, rye, barley, or oats, not only contains carbohydrates that provide energy, but also protein, which in this case is called... gluten Generally speaking, although there are several proteins; and if the flour is wholemeal, in addition to fiber, we also find various vitamins and trace elements. In fact, if The human species has been able to increase in number and survive thanks to the cultivation of cerealsHowever, a small percentage of the world's population cannot consume gluten, either because they have celiac disease (around 2%) or a gluten allergy (less than 1%).

Nevertheless, approximately 10% of the world's population believes they have gluten sensitivity without suffering from either celiac disease or a gluten allergy; this is called gluten sensitivity without celiac disease (The acronym in Catalan would be SGNC). While Celiac disease and gluten allergy These are well-characterized clinical entities for which specific diagnostic tests exist. Non-celiac gluten sensitivity (NCGS) encompasses a set of highly variable symptoms that a significant number of people experience when they eat foods containing gluten-containing cereal flour. These symptoms can vary considerably, appearing immediately or even up to 12 hours after ingestion. Among the most frequent, more than 50% of people with NCGS complain of abdominal pain, bloating, nausea, diarrhea, and flatulence, as well as headaches, malaise, or fatigue, along with a range of other symptoms shared by a smaller number of people, but which indicate overall discomfort.

A self-diagnosed problem

Leaving aside celiac disease and gluten allergy, a comprehensive review of all studies conducted on SGNC in one of the most renowned journals in the medical field, The LancetThis demonstrates that gluten sensitivity is not a clear clinical entity. It is possibly a catch-all term encompassing very disparate cases where the origin of the patient's discomfort is most likely not due to gluten. It should be noted that non-celiac gluten sensitivity (NCGS) has no specific test; it is self-diagnosed. This does not mean that the symptoms are not real, since people who complain of this condition certainly experience physical discomfort, but rather that the cause of that discomfort is not gluten. To rule out whether it is a reaction to gluten or not, some of the analyzed studies give patients a dose of purified gluten (without any other additives) and then observe the effect. In this way, it is possible to distinguish whether it is truly NCGS. Only 16% of these people experience adverse effects, while the majority of patients do not have any reaction.

So, if many people who think they have NCGS don't actually have gluten sensitivity, how do we explain their symptoms? What causes them? Gluten is a protein, but there are other components in cereal flour, such as fermentable carbohydrates (FODMAPs). It is believed that these Fermentable oligosaccharides and fructans can cause symptoms described as NCGS and changes in the microbiota.

Some studies even determine that a proportion of the population with NCGS presents a gut-brain axis dysfunction This causes people to perceive any food they believe contains gluten as dangerous, but they will only experience symptoms of discomfort if they are informed that it contains gluten (whether this is true or not). This is called the gluten effect. nocebo –as opposed to placebo—, in which we perceive certain foods or products as harmful when they are not actually so.

The "gluten-free" trend

What this exhaustive study tells us is that It is necessary to redefine what lies behind the symptoms of NCGS, because in most cases there is no reaction to gluten.What is also true is that there is market pressure. Increasingly so. People choose gluten-free foods thinking that gluten is harmful to the gut. In large supermarkets, foods labeled as "gluten-free" are becoming increasingly common. And they are usually processed or ultra-processed foods: yogurts, tortillas, ready meals… It seems there is a gluten-free trend.

In our developed world, choosing gluten-free foods is no more of a problem than simply filling our shopping basket with alternative products. What's important, and what we should prioritize, is a balanced diet tailored to our individual needs. However, there are countries where maintaining a balanced diet isn't so easy, and people often follow very restrictive diets. giving up foods that are healthy for the vast majority of the population But these foods are also labeled as "harmful." Fads can become dangerous when access to healthy options is limited. For most people, gluten is a protein rich in certain amino acids and has no known contraindications. It would be a good habit to cook our own meals instead of buying ultra-processed foods. Then we would know the origin and composition of what we eat, and whether or not it's right for us.