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."