As we expand our knowledge of gluten’s impact on extraintestinal regions and systems in the body, diet-based trials will help to elucidate symptoms driven by this exposure. The limitations of current testing for celiac disease have led to a binary consideration of gluten pathology (yes celiac or no celiac), which fails to encompass gluten’s effects on the innate immune system, on enzyme complexes outside the gut, and on the effects of non-gliadin gluten components such as fructans and lectins.
This study evaluated 22 subjects (mostly women) with IBS resolved by a gluten free diet. They did not have celiac disease. Patients had been on a gluten free diet for 6 weeks. After a 3 day baseline of low fodmap, dairy, and gluten free diet, participants were randomized to receive a gluten, whey, or placebo challenge with 3 days in between switching to another challenge. They were assessed with the State Trait Personality Inventory for mood, for gastrointestinal symptoms, and cortisol.
Patients with the gluten challenge developed worsening of mood symptoms within the 3 day challenge.
The authors propose several mechanisms including:
- Alterations in cortisol secretion
- Gluten-induced tryptophan depletion (basing this on the monoamine hypothesis)
- Gluten exorphins or opiate-like peptides that stimulate the brain
- Gluten-mediated changes in gut bacteria
Of interest, the subjects did not have notable gastrointestinal symptoms supporting the evidence that psychiatric manifestations of gluten reactivity may not involve gas, bloating, diarrhea, or constipation acutely.
My practice is largely based on the high-yield, low-risk intervention of a gluten free (and optimally grain, soy, and dairy free) diet for 30-90 days with no cheats for 30 days. When it comes to food’s effects, powerful clinical benefits may precede our true understanding of the mechanisms by many years. Don’t wait!