Keywords
1. Non-coeliac gluten sensitivity
2. Gluten-free diet
3. Nutritional deficiencies
4. FODMAP intake
5. Quality of life with NCGS
In recent years, non-coeliac gluten sensitivity (NCGS) has emerged as a clinical entity distinct from coeliac disease (CD) and wheat allergy, yet its mechanisms and dietary implications have been enveloped in a veil of mystery. Renowned for provoking a range of gastrointestinal and other systemic symptoms despite the lack of autoimmune responses characteristic of CD, NCGS has become the subject of intense research and public interest. A recent study published in Clinical Nutrition ESPEN sheds light on the dietary patterns, nutritional intake, and quality of life of adults who self-report NCGS and adhere to a gluten-free diet (GFD).
DOI: 10.1016/j.clnesp.2019.02.012
The study in question conducted by Gry Irene Skodje and colleagues at the Oslo University Hospital and University of Oslo, aimed to explore the dietary intakes, including those of fermentable oligo-, di-, monosaccharides and polyols (FODMAPs), in subjects who self-identified with NCGS who were on GFD, upon exclusion of CD and wheat allergy. Concurrently, the researchers assessed clinical symptoms and measured the health-related quality of life (HR-QoL).
Upon the study’s undertaking, 65 adults with self-reported NCGS adhering to GFD were enlisted, from those recruited for a randomised placebo-controlled challenge trial at Oslo University Hospital. Baseline characteristics were gathered, and dietary intake was evaluated via a seven-day food record, alongside symptom recording through questionnaires. The striking discovery was the energy proportions gleaned from their diets – a mean of 43 E% from fat, 40 E% from carbohydrate and 17 E% from protein. Most concerning, though, were the findings that the intakes of vital nutrients, including vitamin D, folic acid, calcium, iodine, and iron, were all below the recommended levels. The mean intake of FODMAPs was assessed to be 11.6g per day, which remains within moderate consumption.
Despite the removal of wheat from their diets, the NCGS subjects reported experiencing a constellation of gastro- and extra-intestinal symptoms and noted a decreased HR-QoL. Symptoms including tiredness, concentration difficulties, fatigue, and muscle/joint pain were considerably marked among the non-intestinal symptoms, while gastrointestinal discomfort was predominantly characterized by wind and bloating.
The implications of this study are profound as they underscore an urgent reality for individuals adopting a GFD in response to self-reported NCGS; namely, the risk of macro- and micronutrient deficiencies, and the persistent array of symptoms which appear to contradict the elimination of gluten-containing foods. The unintended consequence of a high-fat energy ratio and the potential shortcomings in fibre, vitamins, and minerals highlight the need for meticulous dietary planning and professional nutritional guidance for those omitting gluten from their diet.
Notably, the gastrointestinal symptoms quantified by the gastrointestinal symptom rating scale – irritable bowel syndrome version (GSRS-IBS), exhibited a correlation with mild depression and a negative correlation with five sub-domains of HR-QoL. This interplay between gastrointestinal discomfort, mental health, and overall quality of life reiterates the intricate web of influences diet has over one’s holistic well-being.
The revelations of Skodje and colleagues’ study warrant attention within the healthcare sector, emphasizing the necessity for practitioners to be vigilant when recommending dietary restrictions and to ensure that individuals are informed of the potential nutritive pitfalls associated with self-imposed diets. It also calls for an interdisciplinary approach where dieticians and nutritionists become integral contributors to managing NCGS effectively.
In view of the study’s findings upon the negative health impacts of unsupervised gluten restriction, an analysis of governmental dietary policies may be pertinent. There exists an opportunity here for public health officials to harmonize efforts with medical professionals to cultivate comprehensive education programs and to curate resources that advocate balanced nutrition, especially among those prone to dietary exclusions.
Moreover, food industry stakeholders have a role to play. The growing market for gluten-free products has not uniformly translated to nutritively equivalent options compared to their gluten-containing counterparts. Research and development divisions within food manufacturing entities are challenged to ideate and produce gluten-free offerings rich in the nutrients identified as deficient in the NCGS population, such as iron, calcium, and vitamin D.
The broader implications for society are equally significant. With dietary choices becoming increasingly personalized, and with a substantial uptick in the adoption of exclusion diets for various health-related reasons, public discourse on nutrition is vital. Understanding the fine balance between removing offending foods and maintaining a wholesome diet is paramount. The study further fuels the discourse on NCGS and underlines the truth that going gluten-free is not merely a fad but can indeed be a complex nutritional tightrope.
To encapsulate, Skodje et al.’s study is a pronouncement and a clarion call to action. It advocates for bolstered dietary education and targeted nutritional follow-up for subjects on GFD, revealing patterns that, if unaddressed, may culminate in a cascade of nutritional deficiencies and impaired quality of life. It’s a study that confirms what has long been suspected: in the enigmatic world of NCGS, the removal of gluten is just the beginning of a nuanced nutritional journey.
References
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