Many people claim to feel better by stopping gluten while they do not have celiac disease. Is this diet really effective on diabetes and inflammatory bowel disease? Does it improve joint problems and cognitive abilities? Does it really help to slim down? Specialists answer us.
Gluten is not welcome? No, clearly, for some of the people who decided to oust him from their plate. What do they blame him for? To cause bloating , spasms and transit disorders , but also headaches , fatigue , itching , joint pain ...
Described for the first time in 1978, what is known today as sensitivity to non-celiac gluten (SGNC) has, for some years, the subject of a scientific consensus. "The doctors define it as a clinical entity in which the ingestion of gluten causes digestive and extra-digestive symptoms that regress under a gluten-free diet ," explains Catherine Grand-Ravel, researcher at INRA. But it does not rely on autoimmune mechanisms like in celiac diseasenor on allergic mechanisms as in wheat allergy. "Symptoms to describe but no diagnostic tool: what is this sensitivity? If eating gluten-free is vital for celiac patients, what about when you do not suffer from this disease?
Is a gluten-free diet more digestible?
It's possible. "Gluten proteins are rich in proline, an amino acid that makes them less accessible than others to digestive tract enzymes," says Dr. Nadine Cerf-Bensussan, research director at Inserm. As a result, gluten digestion leaves small fragments. "In celiac patients and in wheat allergies, some of these fragments can be recognized by the immune system and trigger their disease," she says.
In people with non-celiac gluten sensitivity, an effect on intestinal permeability has been reported. "Since the submucosa is particularly innervated, this permeability can cause symptoms such as bloating or diarrhea," says Prof. Bruno Bonaz, gastroenterologist. However, without knowing why, this does not concern everyone . "One of the tracks explored is the interindividual difference in the perception of sensations: the interoception or awareness of the internal state of one's body," continues Bonaz. It can be assumed that nerve signals sent from the intestinal sphere to the brain can be amplified in some. It could often be peoplestressed, anxious or depressed .
In the absence of characteristic markers such as in celiac disease or wheat allergy, only the exclusion of gluten makes it possible to determine whether the digestive difficulties are related to its ingestion. And again: not certain.
Does it reduce inflammatory bowel diseases?
No , with the exception of celiac disease. "It is only in celiac patients that the ingestion of gluten causes an inflammatory reaction, easily detectable by blood markers," recalls Cellier. This damages the intestinal wall and destroys the villi: this is what requires the total elimination of foods that contain it. "
With respect to other inflammatory bowel diseases or irritable bowel syndrome , gluten is not involved and does not aggravate inflammation . "On the other hand, one can think that its eviction helps to lighten the symptoms, insofar as it is badly digested by some," said Bruno Bonaz. The American Rheumatology Association recommends a gluten-free diet during outbreaks. Thus, people with inflammatory digestive diseases say they feel better without gluten.
Are joint or rheumatic disorders improved?
Yes , some people. Again, no causal link, no scientific evidence, but testimonials . "It is hypothesized that gluten could increase the inflammatory state in these patients by increasing intestinal permeability ," suggests Bruno Bonaz. But without proof. "
Does it have an impact on diabetes?
Not at all , or indirectly. " Only in celiac disease is there a link between gluten and type 1 diabetes ," recalls Christophe Cellier. In both cases, autoimmune diseases. As for the effect that a gluten-free diet can have on type 2 diabetes , it depends mainly on the food hygiene adopted.. "If it is a question of replacing wheat and its derivatives by industrial products like bread, pizzas, cookies ... without gluten, the effect is rather harmful because these products are often enriched in sugar and fats and the flours used have a high glycemic index, "notes Cédric Ménard, dietitian. "If, on the contrary, the elimination of gluten is to eat healthier by reducing the share of industrial products and increasing the share of fresh products, naturally gluten-free such as fruits and vegetables, meat, fish ... the impact on health parameters can be positive, "adds Dr. Nadine Cerf-Bensussan.
Does it help to lose weight?
Sometimes . It all depends, again, what is the gluten-free diet. If, by eliminating foods containing it, it reduces its consumption of industrial products, this may lead to a decrease in energy intake. "If, on the other hand, we do not change the way we eat and that we just swap products with gluten against gluten-free products, the effect could instead be negative," suggests Nadine Cerf-Bensussan . " Gluten does not make you fat or lose weight, " says Cellier.
Are we in better shape, less tired?
Maybe . But this effect is then indirect. "We're looking for a placebo effect ," Cellier says. When one changes one's diet, that one is persuaded to do good, it can generate a certain dynamism. In addition, the easier the digestion, the more light and fit you feel. What about athletes who claim to see their results increased tenfold with a gluten-free diet? "A study was conducted in the United States on this subject with cyclists, notes the gastroenterologist. The latter were blindly submitted to gluten-free and gluten-free diets. Conclusion: There is no difference in performance. "
Professor Bonaz's opinion is less clear: "It is possible that by modifying the permeability of the intestinal wall, the gluten passes through the intestinal barrier and is circulating in the blood. This could act at the level of the cerebral barrier (hematorecephalic) or at the level of the vagus nerve, and thus generate fatigue, headaches ... But these are only hypotheses.
Are allergies diminished?
Not . With the exception of wheat allergy and celiac disease, in which the ingestion of gluten causes an inappropriate reaction of the body's immune system, gluten does not cause allergic reactions. "Here again, the improvement described by some may be indirect," says Pr Bonaz. When we digest better, we are less stressed, which can reduce allergic reactions. Do not dismiss the relationship between the brain and the digestive tract. " "
Does the gluten-free diet positively affect mood and cognitive abilities?
Apparently , some people. Several hypotheses are put forward: the placebo effect, the relations between the intestines and the brain, the composition of the microbiota. "A growing body of evidence shows that it can influence behavior and sensitivity to stress," says Nadine Cerf-Bensussan. Gluten consumption may be able to modulate the composition of the intestinal flora. Nevertheless, nothing is shown. "
What conclusions?
There is sensitivity to non-celiac gluten that manifests itself in digestive and extra-digestive symptoms that arise after ingesting, and disappear when squeezed out. But " there is no objective criterion to establish a diagnosis, " recalls Cellier.
Unlike celiac disease and wheat allergy, this sensitivity is not serious. "Excluding gluten improves the discomfort felt, but it is possible for these people to consume without consequences for their health," notes Bruno Bonaz.
If there is, for the moment, no scientific explanation, several hypotheses are advanced, such as the links between the brain and the intestines or the microbiota . The problem may not be limited to gluten. "Some specialists speak rather of a sensitivity to wheat, notes Bruno Bonaz. It is indeed important to take into account the other components of the foods incriminated in the symptoms experienced (FODMAPs). "
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