Gluten Sensitivity Elimination Diet Not Always Warranted, Study Says

There’s no denying that gluten-free eating is in the zeitgeist. Gluten-free pizza, cupcakes and pasta are all the rage and many celebrities have revealed their revamped diets, rid of gluten and other perceived allergens.

Those with the most profound gluten intolerance suffer from the chronic condition celiac disease, which is diagnosed with blood and bowel tests. That means they have an immune response to gliadin, a gluten protein found in wheat, rye and barley. Symptoms range from chronic fatigue, diarrhea, bloating and headaches to "failure to thrive" in young children.

But what about people who don't test positive for celiac disease, but who still have celiac-like symptoms? Doctors often recommend a trial elimination diet to determine if a food sensitivity is the culprit. Those who say the elimination of gluten helped lessen the severity of their symptoms are often diagnosed with "nonceliac gluten sensitivity" -- something that can't be tested for like celiac disease, but is based on patient reporting.

But is self-reporting enough to justify a restricted diet? A new editorial in the latest issue of the Annals of Internal Medicine says "not necessarily." Its authors argue that there is not enough clinical evidence to support the idea that patient symptoms are alleviated by the absence of gluten.

Instead, they worry that nonceliac gluten sensitivity patients are actually responding to a "nocebo" effect -- influenced by food marketing, celebrity endorsements and inconclusive health research and reporting. Rather than offering an elimination diet, doctors of such patients should conduct double-blind, placebo-controlled, gluten challenge testing, the authors said. This way, the argument goes, neither doctor nor patient will be influenced by the cultural landscape of gluten consumption.

"'Sense' should prevail over 'sensibility' to prevent a gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population," wrote the paper’s authors, Dr. Antonio Di Sabatino and Dr. Gino Roberto Corazza, both of the University of Pavia in Italy. "We must prevent a possible health problem from becoming a social health problem."

Comments

[dems08]

03:52 PM on 05/12/2012

Brought to you by the National Bread Association!

[RosesForObama]

03:17 AM on 02/26/2012

Who paid him off ?

[sicl4015]

06:00 PM on 02/25/2012

might also be due to FODMAPs, fructans in wheat can cause IBS

[HolisticHealthCoachSam]

08:14 AM on 02/24/2012

This is turning out to be misinforming people just like going vegetarian - yes people think they are healthy by not eating meat but instead live on a diet of refined carbs, grains, fast foods and junk (albeit vegetarian options). Again its not so easy just to say giving up gluten without encouraging all other aspects of healthy living such as eating WHOLE foods. Often gluten free foods contain SO many chemicals and are just as loaded with sugars! Answer here is not to jump on the band wagon like food marketers do and be an informed reader; read the labels and if you cant pronounce the ingredients, then I would recommend not eating it!

[DanInAustin]

01:28 PM on 02/23/2012

I just had homemade seitan sausage for lunch. I don't know what I'd do without gluten!

[isabella yessi]

01:02 PM on 02/23/2012

I am eating gluten free due to medical reasons not because some celebrity sold me on it. I would rather eat normal food like normal wheat bread, but I have colitis and causes me breakouts and i am getting tested for the future other stuff. so do your math..is sometimes us people who make our choices and not some stuck up celebirty kissing some fake cookies. plus, the food is gross..why, would i suffer for nothing lol.

[omg wtf lol bbq]

01:32 PM on 02/23/2012

I've been a diagnosed Celiac for 3 years. I miss regular beer, regular hamburger buns, the Kamikaze Burger at Red Robin, chinese buffets, and did I mention regular beer?

As far as the disgusting food goes, everything is hit and miss. I'd avoid anything of the EnerGT brand, as everything they make tastes like cardboard, but stuff from Udi's, Rudi's, and Kinnikinnick are all pretty good; Jovial also makes rice pasta noodles that taste like the real thing. Don't forget that a lot of common foods are also gluten-free; just learn what to look for on the labels.

[robinhood1]

11:40 AM on 02/23/2012

According to William Davis, MD, author of "Wheat belly", gluten free baked goods such as bread, crackers, pastries etc. should be avoided even if you allergic to gluten, or at least minimized, because they still have some of the same negative effects on your body that regular wheat products have on a person who is not allergic to gluten. He says that gluten free products made with corn starch, rice starch, potato starch or tapioca starch increase the body's blood sugar even faster than wheat does and can promote obesity even among people with celiac disease.

[TakeSake]

12:15 AM on 02/23/2012

Questions about their studies:
1. Were all sources of gluten and wheat products eliminated, or only breads and cereals?
2. How long were they eliminated for?
3. Were dairy products also eliminated?
4. What symptoms were looked at and for how long?

[roudy]

11:27 PM on 02/22/2012

Dropped by the local health food store, after wondering around for a few minutes I decided they should rename it The Gluten Free Store. Crazy overreaction to a problem that effects less than one percent of the population.

[jimjits]

12:05 PM on 02/23/2012

Good post RoudyI was unaware that less than 1%of the population had a gluten problem.

[Leslie Franklin Evans]

1 hour ago ( 8:01 AM)

You're right, I'm sure... that health store has totally over reacted to the more than 2 million people who suffer from Celiac disease or non-Celiac gluten sensitivity and have no other option than to by the over-priced gluten free foods it has to offer.

[JuliaKohli]

04:00 PM on 02/22/2012

Yes, self-reporting is enough for me! I tested negative for celiac, and the doctor sent me on my merry way without even suggesting the idea of non-celiac gluten intolerance. I figured it out on my own with an elimination diet a year later, and now I have my quality of life back. It's been two years; I feel great when I stick with it, and I very rarely buy "gluten-free products" because I've learned to just eat real food. I eat very well and I don't feel deprived. Gluten (and grains in general) won't make anyone healthier; I don't get these articles discouraging folks from eliminating it.

[TakeSake]

12:24 AM on 02/23/2012

My elimination diet produced false-negatives for wheat. I found that I was lactose intolerant, and did a few things to avoid that. Things did get better for a while, but then it regressed again. Knowing there was a problem with diary, I did a wheat elimination again, and that's when I got some lasting changes. The improvement was noticeable within a week, and took probably 6 months to really settle in. Over the next couple years I tracked down - due to my reactions - wheat and diary products hidden in all sorts of places.

What made my initial elimination diet fail was that I react similarly to both wheat and diary. Only by eliminating both, for long enough, was I able to get a clear indication.

[TeamSanity]

11:37 AM on 02/22/2012

It's absolutely true that food-fads are inescapable aspects of our information-saturated lives. But considering the unique health problems of first world citizens who are clearly anything but malnourished, we cannot lay all the blame at merely over-consumption.

Considering the vast numbers of individuals self-reporting how much better they feel when they make this diet switch, it's also important to address the ancillary changes. No bread = a replacement food that's likely to be a healthier choice (e.g., quinoi or millet or roasted vegetables or ...). These changes might be just as relevant to improved health or perceived good health. Nevertheless, the changing genetic landscape of basic foods such as wheat isn't something to be ignored - it's up to every individual to educate him or herself and not be seduced by food-fads while also not being silenced by the "voices of authority" which can equally be wrong or too focused on a small question (case in point - when I struggled with an undiagnosed GI problem, my pre-internet research focused on ulcers and I read the JAMA article about the Australian doctor who identified helicobacter bacteria that caused many ulcers. My doctors (many consulted that year) all either didn't know about the article or patted my head and told me not to worry my little ol' self, while they gave me centuries old and ineffective treatments for how they understood ulcers).

[westcoastprog]

09:15 AM on 02/22/2012

FAIL! "Born with an immune response" is wrong. An acquired immune response can also be the cause.

[KT31]

12:06 PM on 02/22/2012

Yeah - something like 'born with a predisposition toward' would have been much better. Most celiacs aren't diagnosed as children anymore.

[sirreal73x]

01:26 AM on 02/22/2012

I am President of the Central Kentucky chapter of the Celiac Disease Foundation. It's worrisome to me that an article which is this dangerously inaccurate could appear in the Huffington Post.

The article questions the existence of non-celiac gluten sensitivity, a very real condition which was reconfirmed in a landmark study released by a team of medical experts, led by internationally renowned celiac expert Dr. Alessio Fasano, at the University of Maryland last year. By conservative estimates, the condition exists in at least 6% of our population. This is old news, which makes this article's mistakes older than old.

Going on a totally gluten free diet eliminates important minerals and nutrients, which must then be replaced, and is best done under supervision of a physician or a registered dietitian.

The facts I have referenced above are easily confirmed. Please either pull this article, or rewrite it. Judging from the early comments posted beneath it, you are already influencing people.

[ManforFreedom]

11:54 AM on 02/22/2012

If you are worried about an article being this inaccuate, being reported in the Huffington Post, you must not of read to many articles in the HP.

[sirreal73x]

03:36 PM on 02/22/2012

You're right. I was led here by a Google Alert. I DON'T usually read the HP. But if YOU think it's that bad, why are YOU reading it??? :-O

[jimjits]

12:08 PM on 02/23/2012

Thanks for telling it like it is sirreal73x

[pstanfield38]

08:28 PM on 02/21/2012

It's not the gluten. Yes, there is the problem of Gluten sensitivity. The culprit is the wheat itself. In the U.S., Dwarf Wheat is what is used in everything that has wheat as an ingredient. Dwarf Wheat is a genetic frankenstein created with the goal of increasing yield. It worked, but it also changed the genetic structure of the plant, causing what many scientists call "wheat belly", or in other words, one of the causes of obesity. Regular, long stalk wheat does not cause this problem. So it's easy. Stop eating wheat and anything with wheat as an ingredient and you should start losing weight.

[vandation]

08:49 PM on 02/21/2012

I heard that same thing. My friend who has siblings that are celiac .. They all took a trip to Italy and brought medicine so they could eat the pasta and pizza and not be so affected. They never took the medicine and they ate whatever they wanted to and never had a reaction. I am celiac and after she told me that I bought pasta that was imported from Italy and had no problem with it. I have two other autoimmune disorders that go along with Celiac .... so it wasn't a surprise. The surprise was in how GREAT I felt just being gluten free. It's night and day.

[KT31]

12:06 PM on 02/22/2012

That's a crazy thing to do. Italy has a higher rate of celiac disease than the U.S. does, and Italian celiacs can't eat the wheat over there anymore than they could eat it here. Also, there isn't any medicine that will allow you to eat gluten and not be affected if you have celiac. Your relatives are playing a very dangerous game with their health.

[ManforFreedom]

11:58 AM on 02/22/2012

I have stop eating wheat and have lost weight and feel ALOT better.

[fifiwereking]

07:03 PM on 02/21/2012

i realized that i had a bad reaction to my favorite food, pasta, many years ago, and avoid gluten if possible.... gluten is also contra-indicated for such conditions as my fibromyalgia, as it increases pain and inflamation...

gluten causes or exacerbates a number of health problems - so many people are gluten-intolerant that i don't understand why this insidious ingredient has not yet gone the way of the dinosaurs... check the lables of your processed foods, gravies and sauces, cereal - even ketchup... it's almost impossible to avoid...

[sashaxoxo]

07:21 PM on 02/21/2012

better wear your tin foil hat while eating gluten-free food, too. i hear that keeps the thetans out

[vandation]

08:52 PM on 02/21/2012

Oh look everyone .... A Troll. Isn't there a Village missing you somewhere ? Celiac is a serious disorder. Either have something constructive to bring here or be gone Troll.

[swoboda]

09:12 PM on 02/21/2012

There is no evidence anyone but those with Celiac Sprue ( GSE) should avoid gluten. If you have it eating Italian pasta isn't healthful for those with GSE. That isn't to say people with GSE don't knowingly and unknowingly consume gluten and seem to get away with it at times. Fibromyalgia is primarily a disorder of neurotransmitters
( http://neurotransmitter.net/fibromyalgiagenetic.html ). It almost always is accompanied by other mental disorders. These type of people are highly susceptible to all sorts of quackery including the latest gluten is bad for everyone fad. Now too much carbohydrates isn't good for you. So If you restrict gluten it could be beneficial because of the reduction of carbohydrates associated with it.

[sirreal73x]

01:32 AM on 02/22/2012

The reality of non-celiac gluten sensitivity was confirmed in a landmark study published by a team of internationally recognized medical experts at the University of Maryland last year. It affects at least 6% of the population. The truth about gluten is going from bad to worse.

[jimjits]

12:10 PM on 02/23/2012

Great post swoboda,tell it like it is