Markers of non-coeliac wheat sensitivity in patients with myalgic encephalomyelitis/chronic fatigue syndrome, 2018, Alaedini et al

Andy

Andy

Retired committee member
...Our results suggest that there may be a subset of patients with ME/CFS who have sensitivity to wheat and related cereals in the absence of coeliac disease, with potential relevance to some of their symptoms. ME/CFS is recognised as a condition with a spectrum of clinical phenotypes and underlying aetiologies. Characterisation of patients into subsets based on clinical and biological data is essential to gaining a better understanding of the condition and identifying useful biomarkers and therapeutic targets. The results of this analysis provide a rationale for examining the clinical and therapeutic relevance of food sensitivity, particularly NCWS, in the context of ME/CFS in future studies.
Click to expand...
http://gut.bmj.com/content/early/2018/03/17/gutjnl-2018-316133

Uses data generated from this study
Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease

Abstract
Objective Wheat gluten and related proteins can trigger an autoimmune enteropathy, known as coeliac disease, in people with genetic susceptibility. However, some individuals experience a range of symptoms in response to wheat ingestion, without the characteristic serological or histological evidence of coeliac disease. The aetiology and mechanism of these symptoms are unknown, and no biomarkers have been identified. We aimed to determine if sensitivity to wheat in the absence of coeliac disease is associated with systemic immune activation that may be linked to an enteropathy.

Design Study participants included individuals who reported symptoms in response to wheat intake and in whom coeliac disease and wheat allergy were ruled out, patients with coeliac disease and healthy controls. Sera were analysed for markers of intestinal cell damage and systemic immune response to microbial components.

Results Individuals with wheat sensitivity had significantly increased serum levels of soluble CD14 and lipopolysaccharide (LPS)-binding protein, as well as antibody reactivity to bacterial LPS and flagellin. Circulating levels of fatty acid-binding protein 2 (FABP2), a marker of intestinal epithelial cell damage, were significantly elevated in the affected individuals and correlated with the immune responses to microbial products. There was a significant change towards normalisation of the levels of FABP2 and immune activation markers in a subgroup of individuals with wheat sensitivity who observed a diet excluding wheat and related cereals.

Conclusions These findings reveal a state of systemic immune activation in conjunction with a compromised intestinal epithelium affecting a subset of individuals who experience sensitivity to wheat in the absence of coeliac disease.
Click to expand...
http://gut.bmj.com/content/65/12/1930
 
MeSci said:
I suspect that I may be sensitive to soya too. But I can't think of any/many other vegan gluten-free, low-sugar things to put on toast for breakfast! (I have tofu)
Click to expand...
baked beans, houmus, marmite, mushrooms, avocado, tahini, peanut butter....

I usually have gluten free cereal for breakfast with nuts, dried fruit and soya or coconut milk. I tried gluten free bread. It was horrible. Like a cross between cardboard and cotton wool.

I've been gluten and dairy free for decades. Long before I got ME. I still have gut problems, but not such acute bloating and pain. I suspect sensitivity to other foods. A low fodmap diet helped a bit but I stopped - you're not meant to stay on it for ever, just use it to calm the gut down, and test which foods cause problems when you reintroduce them.
 
Nice to hear that not everybody is on the paleo / keto / bonebroth hype.
100% vegan here.

Also tried gluten free / soy free / sugar free / low fat for about 6 months.
Think Dr. Mac Dougall diet but without gluten.
I tried this after having an IGG food sensitivity test.

Did not make a difference in energy levels, symptoms or sleep for me.
Lost quite a bit of weight on it though.

FreeSarah said:
:) I hear you. I've tried to go fully veggie a couple of times, but being gluten, soya and meat free is a huge challenge. Doesn't leave that much.
Click to expand...
I agree. And IGG food testing is of course questionable.

So slowly reintroduced gluten and soy containing products.
Glutenfree, soyfree, sugarfree vegan is too restrictive for me.
Eating nice meals is one of the very few remaining joys in life..

But no more meat or dairy. Not willing to try it either after 25 years.
 
Last edited:
Sadly, veganism made me worse. I know some people who do great on it, and others get very worn out and weak from it. I require animal fat at the very least, I've learned.

Some people think non-coeliac gluten intolerance might actually be related to fructan: https://www.sciencealert.com/non-coeliac-gluten-sensitivity-caused-by-fodmap-carbohydrate-fructans

I certainly get lots of IBS problems. The NHS suggested the FODMAP diet, which I thought was too restrictive and too drawn out, so I found an actual hair test for intolerances instead. Much quicker, and it was on offer!
 
I was vegetarian for a while, then when I went gluten and dairy free to deal with gut problems (before I had ME), I decided that made a vege diet too restricted, and went back to eating some fish, eggs and meat.

At the moment I have one of these animal protein sources about 4 times a week, and the rest of my meals are vegan. No idea whether this is the best diet for me. Don't have the energy to experiment further. I've tried short periods (2 - 4 weeks) soya free and grain free, but neither seemed to make any difference.

I'm already on the low end of normal BMI for my age and height, so I don't want to go on a very restricted elimination diet to test more thoroughly.
 
A restricted elimination diet takes so long to evaluate everything. I spent well over a year and identified problems with gluten, caffeine and I think alchol, which I now avoid. However I did not get onto looking at many food stuffs such as soya, chocolate which is for me an IBS trigger or various sugars. Eliminating gluten and caffeine has reduced but not completely eliminated my migraines and my IBS.

One issue with food intolerances I feel I have not managed to address at all because it is potentially so complex to monitor, is that one food stuff may trigger an intolerance manifest by changes in gut permeability, but a completely different food stuff getting into the blood as a consequence triggers the symptoms we are more subjectively aware of.

I am also interested in the link between food intolerances and 'addictions'. When doing a detox or when eliminating gluten, the side effects seem to me similar to withdrawal symptoms: migraines, vomiting, etc, though they also overlap with the ME symptoms. Also I get quite strong sugar cravings, though this is probably compounded by not being able to eat often enough to maintain stable blood sugar levels.

More recently I have had not had the energy to look at these issues, especially as I was dependent for quite a while on friends and neighbours buying and preparing food. At least now I am generally able to do online grocer shopping, but am over reliant on ready meals, which are potentially problematic, though I also now have more help with preparing meals from scratch and freezing them. So at present just eating twice a day is my goal without worrying too much what I eat. It is also a continual balancing act, I am trying to work towards eating smaller meals more often, but also balancing that against the other life essentials and eating healthily.
 
Short article on this from the Bateman Horne Center.
A team led by Armin Alaedini published a Letter in Gut titled, “Markers of non-coeliac wheat sensitivity in patients with myalgic encephalomyelitis/chronic fatigue syndrome”. Alaedini’s research explores the immune response in celiac disease and non-celiac wheat sensitivity. Recently he identified biomarkers of intestinal barrier damage and systemic immune activation in people that consumed wheat but did not have celiac disease. Notably these people experience similar symptoms as people with ME/CFS so Alaedini analyzed blood samples from ME/CFS patients and healthy controls.

Alaedini and his team identified a subset of ME/CFS patients that had similar biomarkers including increased serum levels of soluble CD14 and lipopolysaccharide (LPS)-binding protein, and antibodies to bacterial LPS and flagellin. ME/CFS patients in this subset also had severe gastrointestinal symptoms including abdominal pain, nausea and bloating. These are promising biomarkers for identifying this ME/CFS subset to target novel treatment strategies. You can access the full text of this publication here.
Click to expand...
https://batemanhornecenter.org/progress-cfs-subset-identification/
 
I've just seen this thread again. I saw my GP yesterday about a flare up in gut issues and completely forgot to mention my gluten sensitivity and this research when it was one of the things I wanted to raise. And there I was sitting there at my appointment thinking how well my foggy brain was doing and how my notes were working out. I could punch something.
 
Last edited:
FreeSarah said:
:) I hear you. I've tried to go fully veggie a couple of times, but being gluten, soya and meat free is a huge challenge. Doesn't leave that much.
Click to expand...
I am gluten, soy, meat and most of the time dairy free. And yes - it's hard. But I have so much less problems it's worth it. And there are nice alternatives. (By the way, I have problems with too much protein, fat and carbohydrates, too. So that leaves out a high-fat, low-carb or whatever diet.)

Interesting paper @Andy, thanks for posting it!
 
I don't have celiac, but gluten makes my joints hurt, so that's a good incentive for me to avoid it for the most part. I tolerated it just fine for much of my life, though. I've also found that I've developed a dairy intolerance in recent years although I can sometimes have certain things like Parmesan or goat milk yogurt.

I had given up beer when I realized I had the gluten problem, but recently made a happy discovery. A company called Omission removes gluten from their beer. If I had celiac, I'd be really cautious, anyway, but I do just fine with it. I only have one a week because beer makes me gain weight if I have it very often, and I'm vain enough to think of my figure.

I drink the lager. I tried the ale, and it was a little sweet for me. I haven't tried the IPA since I'm not a big fan. But the lager's good. Yay beer!

https://omissionbeer.com/
 
Extreme fatigue, in particular one that does not improve with rest, is a hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).3

Questionnaires were used to assess GI symptoms within the past 6 months, including abdominal pain, bloating and nausea. Severity of individual symptoms was scored from 1 to 5 (1=absent; 2=mild; 3=moderate; 4=severe; 5=very severe), and a total score, based on the sum of individual symptom scores, was calculated for each subject.

Are we going to discuss the scientific merits of this paper ...or do we pick and choose what we believe nowadays by reading tealeaves in the toilet bowl?

It seems like a load of speculative woo to me riding on the back of food paranoia generally ....discuss....
 
Trish said:
I usually have gluten free cereal for breakfast with nuts, dried fruit and soya or coconut milk. I tried gluten free bread. It was horrible. Like a cross between cardboard and cotton wool.
Click to expand...
Some make cardboard look appetising. Some, however, are quite good. This appears to vary country by country. Here I eat Burgen or Helgas, but I do not know if those recipes are available elsewhere.

I have a severe non-gluten wheat sensitivity, or perhaps just non-celiac. It causes lots of symptoms, which I promptly forget about for the most part, though my severe breathing issues on wheat is life threatening. If I can manage it I would like to get some of the above biomarkers tested.
 
Last edited:
arewenearlythereyet said:
Are we going to discuss the scientific merits of this paper
Click to expand...
Its only a preliminary investigative paper. It needs much more research to show anything definitive. However all research has to start somewhere. It does not definitively identify the specific molecular pathways involved, but it hints at things - association not causation. We do not know, for example, if wheat sensitivity causes the issues, if its a coincidental finding, or if the issues are exacerbated by wheat but already exist to some extent ... and that is just some of the possibilities.
 
alex3619 said:
Its only a preliminary investigative paper. It needs much more research to show anything definitive. However all research has to start somewhere. It does not definitively identify the specific molecular pathways involved, but it hints at things - association not causation. We do not know, for example, if wheat sensitivity causes the issues, if its a coincidental finding, or if the issues are exacerbated by wheat but already exist to some extent ... and that is just some of the possibilities.
Click to expand...
However if you ‘read the paper’ (to coin a phrase)...there appears to be a lot of wild speculation based on not very much...they seem to brush away the biopsy results for one and rely more on self reported questionnaires? This sounds familiar. Their links to the immune activation stuff all looks a bit woolly too and a bit generic...but I’m no immunologist. Logic dictates though that immune system dysfunction is likely in people with ME’s serum ...why does that directly correlate to gluten though?

I find it difficult to follow their logic that there is a subset of ME when the general results are so spurious.

I believe patients have the symptoms ...just not convinced this is down to a complex reaction to gluten....might be a lot simpler than that and the experimental design made no mention of other things that could cause these symptoms and have nothing to do with gluten. Their reference to some quite poor studies in itself makes me sceptical.

Were the patients on a low fibre diet or high refined carbs? had they been ill for a long time, what was their stomach acid secretions looking like? Had they been on a course of antibiotics? were there any hormonal imbalances, were they eating regular meals and had stable sleeping patterns.?

I would be interested in a lot more details on the cohorts and their reported digestive problems. I’m also worried about their over reliance on Self reported questionnaires. The link to ME looks just concocted to me.

So...
poor literature study
Dubious experimental design using self reported questionnaires
Objective measures (biopsy) showed no correlation and the reasons for this is fudged in the discussion (we didn’t take it from the right place)
Poor correlations and reasoning generally
Shows a lack of understanding of the wider research in ME or the significance of the digestive complaints in context to other more likely areas.

I’ll give it a 3/10.

Perhaps I’m being too harsh?
 
perchance dreamer said:
I don't have celiac, but gluten makes my joints hurt, so that's a good incentive for me to avoid it for the most part. I tolerated it just fine for much of my life, though. I've also found that I've developed a dairy intolerance in recent years although I can sometimes have certain things like Parmesan or goat milk yogurt.

I had given up beer when I realized I had the gluten problem, but recently made a happy discovery. A company called Omission removes gluten from their beer. If I had celiac, I'd be really cautious, anyway, but I do just fine with it. I only have one a week because beer makes me gain weight if I have it very often, and I'm vain enough to think of my figure.

I drink the lager. I tried the ale, and it was a little sweet for me. I haven't tried the IPA since I'm not a big fan. But the lager's good. Yay beer!

https://omissionbeer.com/
Click to expand...

Happily, a lot of brewers are now doing gf beers, some famous names included. Both Peroni and San Miguel gf versions are available at my local supermarket. Like you, I enjoy an occasional beer so it's a really great development
 
You must log in or register to reply here.
Back
Top Bottom