Helps flour water with diarrhea

A lot of problems: intolerance to flour products

The symptoms are not very specific: gas, abdominal pain, diarrhea, and headache and fatigue. For many of those affected, the diagnosis is still clear, at least from their own perspective. You do not tolerate gluten and put yourself on a diet. They are often better off with that.

When such patients go to the doctor, the picture is often ambiguous. In most cases, doctors find no evidence of celiac disease, hereditary gluten intolerance or a classic gluten allergy, also known as baker's asthma, no traces of an immunological reaction in the blood, and the intestinal mucosa also looks healthy. However, the investigator insists that the consumption of foods containing gluten causes discomfort. So what is the cause?

Malfunction of the immune system

Gluten is a protein complex found mainly in wheat, but also in barley and rye. In some people, the protein molecules trigger a false reaction in the immune system in the small intestine. The person concerned suffers from celiac disease. Severe intestinal inflammation is the result. It is a rare disease that affects less than one percent of the population in Europe.

Since the beginning of the millennium, however, gluten seems to have been causing a veritable epidemic of health problems. More and more contemporaries are avoiding commercial bread and pasta, "some patients even claim that they cannot even walk past a bakery without getting a headache," explains gastroenterologist Chris Mulder from the VU Medisch Centrum in Amsterdam.

The phenomenon now has an official name: Non-Celiac Gluten Sensitivity (NCGS). Experts estimate the frequency among adults to be up to seven percent. Children are also increasingly affected. "This is not just a problem in western countries," explains Chris Mulder. The specialist was recently in New Delhi, where colleagues from private clinics also told him about rising NCGS numbers. In wealthy patients.

Gluten free options

The fear of gluten as an alleged health risk has already assumed hype-like proportions in some countries. Countless forums on the Internet deal with the topic of the booming market for gluten-free products. According to a survey from the United States, 15 to 25 percent of the local population would like such foods because they believe they are healthier.

The manufacturers of gluten-free food are looking forward to increasing sales. According to estimates, their global volume could be up to 850 million euros. Per month. Other industries are also jumping on the bandwagon. There are now even contact exchanges for gluten-sensitive singles. Just don't kiss a bread eater, it can supposedly spoil the whole week for some.

Doctors feel in the dark

However, when it comes to the exact causes of NCGS, medical professionals are in the dark. There are no clear indications in the metabolism or changes in the blood count. Antibodies against gliadins were found in individual NCGS patients.

Gliadins are wheat proteins, so this could be an indication of a harmful immunological response - similar to celiac disease. Chris Mulder and his Amsterdam colleagues have tested more than 50 NCGS sufferers for the appearance of gliadin-specific antibodies in recent years and found none.

Another theory suggests that amylase trypsin inhibitors rather than gluten could be the triggers of NCGS. These are natural defense substances of grain against molds and bacteria, α-amylase-trypsin inhibitors can apparently cause a direct activation of immune cells in the intestine. Possible connections between these substances and the development of NCGS symptoms have not yet been clarified.

Chris Mulder is skeptical. In his opinion, 70 to 80 percent of gluten sensitivity cases could be psychosomatic.

Psychosomatic causes

It is also noteworthy that most of those affected are female. David Sanders, a gastroenterologist at Royal Hallamshire Hospital in Sheffield, England, suggests a genetic background instead. NCGS patients might have a kind of "celiac disease light". However, Sanders does not rule out psychosomatic factors.

An Australian study from 2011 appeared to prove the existence of NCGS as an independent physiological disease for the first time and accordingly caused a sensation. A few months ago, however, the same working group followed up. As part of a further investigation, 37 NCGS sufferers were initially placed on a special diet. This was not only gluten-free, but also low in so-called FODMAPS, easily fermentable sugars such as fructose and polyols, which are often added with sweeteners.

After two weeks, the test subjects were given either food with a high gluten content, food with small amounts of gluten or gluten-free food with whey protein as a placebo additive for a week. The result: practically all test participants reported increased NCGS symptoms as a result of the switch - including those who continued to eat gluten-free but did not know this - a nocebo effect. A deterioration was expected, which then occurs promptly.

Similar to irritable bowel syndrome

Interestingly, the test subjects reported a noticeable improvement in their condition after the introductory diet, despite a previous gluten-free diet (see: Gastroenterology, vol. 145, p. 320). It is possible that it is the FODMAPS that trigger NCGS disorders, explains first author Jessica Biesiekierski.

Symptoms could develop in a similar way to irritable bowel syndrome, including a psychosomatic component. Disturbance of the autonomic nervous system as a result of stress would lead to a reduced production of digestive enzymes. As a result, the FODMAPS would not be absorbed, but fermented and thus lead to intestinal problems. But this has not yet been proven either. (Kurt de Swaaf, DER STANDARD, 11/26/2013)