Is gluten really that bad for you? A review of an article.

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I am getting so tired of reading articles that spread incorrect information about gluten, coeliac disease and non coeliac gluten sensitivity. I try to ignore them but I just tend to check the references (if any exist), and my fingers just start typing out of their own accord.

 

Today I came across this article, coincidentally on the same restaurant facebook page that I wrote about in my last piece, Jumping on the gluten free bandwagon to make a profit (17th April, 2014).

Is Gluten Really that Bad for you? by Dr John Dempster, Naturopathic doctor

http://www.huffingtonpost.ca/dr-john-dempster/gluten-sensitivity_b_4377546.html

 

Articles like this contain sweeping statements with little or no evidence based information.

 

Before continuing to read this piece, I urge you to read the article by Dr Dempster by clicking on the link above. Below I have explained some of the inaccuracies written.

 

The prevalence of gluten sensitivity.

The overall prevalence of non coeliac gluten sensitivity (NCGS) in the general population is still unknown. This is mainly because many people self-diagnose and start a gluten free diet without medical advice or consultation (1). It has been estimated to be six to ten-times more prevalent than that of coeliac disease (3),  so I do not know how the author came up with the 1 in 4 statistic. More research is needed to determine the true prevalence of this relatively newly accepted condition.

 

55 diseases linked to gluten?

The review paper from The New England Journal of Medicine that the author spoke about is from 2002 so is now 12 years old. It actually listed 55 “diseases” (as the author called them) that are linked to coeliac disease. The author’s wording in this piece is misleading and would lead one to think that gluten causes diseases in healthy individuals. The 55 diseases listed in the Journal, were actually the features, associated conditions and complication of coeliac disease (also known as coeliac sprue) (1).

This chart, is extracted from the NEJM article Dr Dempster is talking about http://www.nleducation.co.uk/wp-content/uploads/some-conditions-linked-to-CD.jpg

 

Wheat belly and Grain brain

Although awareness about the subject of non-gluten sensitivity has increased with popular books such as Wheat Belly (Dr. William Davis) and Grain Brain (Dr. David Perlmutter), these two books have little or no evidence backing. They actually seem to do more harm than good, by spreading incorrect information and by using fear mongering tactics. This has lead to perfectly healthy individuals self diagnosing gluten sensitivity and eliminating healthy fibre rich and nutrient containing grains from their diet for no reason. Others, who have a real problem with gluten have also been encouraged to eliminate gluten without getting tested for coeliac disease, wheat allergy and other medical conditions beforehand. This can be dangerous.

 

Modern wheat is unfriendly?

Dr Dempster claims that wheat has changed and this modern wheat is not recognized as ‘friendly’ by our immune system any more. This new ‘food’ may be deemed as a toxin by many of us sequestering an inflammatory immune response. Yet there are no references to this claim.

 

How to test for coeliac disease and non-coeliac gluten sensitivity.

 

The current gold standard for coeliac disease diagnosis is a blood test followed by an endoscopy and biopsy if the blood test is positive. Dr Dempster claims that an intestinal biopsy is rarely needed if gluten antibodies are positive. Here he showed just how clueless he is about diagnostic guidelines.  To diagnose coeliac disease, one must still be consuming gluten for results to be accurate or else they must undergo a gluten challenge which involves eating gluten for 6-8 weeks. This can be very distressing once gluten has already been eliminated.

NCGS is still being researched and there are still many unanswered questions. Dr Dempster claims that there are various tests to diagnose gluten sensitivity. Some doctors are offering saliva, blood or stool testing. However, these tests have not been validated and are therefore not Universally accepted. Although they can give an indication, they are just not specific or sensitive enough to be used as diagnostic measures. Due to the lack of biomarkers,  it is difficult to differentiate between gluten sensitivity and conditions that are not gluten related (2).

Currently, the only widely medically accepted way to diagnose this condition is by elimination. One must be tested for coeliac disease and wheat allergy. If tests are negative for coeliac disease and wheat allergy, gluten can be eliminated for a few weeks and then re-introduced to observe the response under a doctor or dietitian’s guidance. If symptoms disappear then recur on introduction of gluten, non coeliac gluten sensitivity is diagnosed. Dr Alessio Fasano and his team of scientists are currently working on developing a biomarker to diagnose this condition.

 

Continuum of disease.

Dr Dempster claims that there is a continuum of disease, from mild gluten sensitivity to ”full-blown Coeliac disease”. Coeliac disease is coeliac disease. It is not a severe form of NCGS. It is an auto-immune condition that is triggered off by ingesting gluten, leading to damage to the intestinal wall and resulting in many conditions and complications if left undiagnosed.  Conversely, NCGS is a different condition. It is not mild coeliac disease. It is what was previously known as gluten intolerance and it is not auto-immune. Although symptoms are similar to coeliac there does not appear to be any long term damage when gluten in ingested.

 

My final note.

The point I am trying to make is this. It is so easy to access information over the internet. Sometimes it can be hard to know what is true and what is not. It can be reather daunting having to check the references of everything that pops up on your screen. I urge everybody to join an association or coeliac group, and if in doubt, ask questions. We are all here to help and support each other.

 

 

References:

1. Ash, M. “Coeliac Disease and Its Many Complications.” NutriLink Ltd Clinical Education RSS. N.p., 4 Jan. 20. Web. 19 Apr. 2014. <http://www.nleducation.co.uk/resources/reviews/coeliac-disease-and-its-many-complications/&gt;

2. Carlo, C., Bai, J.C., Bonaz, B.,  Bouma,G., Calabrò, A., Carroccio, A.,….Fasano, A. (2013)Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders. Nutrients. National Center for Biotechnology Information. Web. 07 Apr. 2014.

3. Molina Infante, J., S. Santolaria, M. Montoro, M. Esteve, & M. Fernandez Banares. Non-celiac Gluten Sensitivity: A Critical Review of Current Evidence. (2014) Unbound MEDLINE. N.p., Web. 07 Apr. 2014.
 

 

 

 

 

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4 thoughts on “Is gluten really that bad for you? A review of an article.

  1. Some people are getting advice from nutritionists to eliminate gluten without telling them to visit their doctor. They are concluding that their clients are gluten intolerant without having any tests! Isn’t this dangerous too?

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    • Hi Mary Anne. As health care professionals, registered dieticians know that they should refer to a doctor to get tested before eliminating gluten. I know of two brilliant dietitians here in Malta who really know what they are talking about, and I am sure there are others. I only know one registered nutritionist but there are many others also, One must be careful though because there are some people who are not registered nutritionists but still call themselves nutritionists. They either completed a short course in nutrition or are self taught. It happens in every profession and it is up to the client to check if they are registered as health professionals. These people would not have the medical background necessary to advise people. That being said, a nutritionist posted on The Coeliac Hub that a gluten elimination diet is too slow to diagnose NCGS and advised people to contact him privately for a blood test. These blood tests are not always accurate so are not advised.They can either fail to pick up a significant allergy or can over-diagnose multiple allergies I also know that these tests are being done regularly in Malta and people are being diagnosed with a long list of allergies and intolerances. I suggest that if anybody thinks they might be intolerant to gluten they should speak to a dietitian or gastroenterologist, and not to a nutritionist. Dieticians are qualified health professionals. They can assess, diagnose and treat diet and nutrition problems.

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  2. Yes! You have the exact same frustrations as me. Especially when someone tells me they have coeliac disease, but don’t even know what an endoscopy is! At the New England Celiac Conference they had a scale from low to high on one slide by Dr. Fasano (I believe, it could have been another keynote speaker), where they showed where various institutions think the prevalence of NCGS is. MGH and Columbia were both in the “low category,” below the 5-10% category. The crazy Wheat Belly and Grain Brain were up in high. And the U Chicago Celiac Center was slightly higher than MGH/Columbia. It’s so interesting how much information/misinformation is being spread about a topic we admit to knowing so little about. Know that you’re not alone, and educating (without being overwhelming- some people are a lost cause) is key!

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