Who Should Follow a Gluten Free Diet?
Let’s make sure that we separate fact from myth.
Is gluten really Public Enemy #1? Many seem to regard it as a toxic agent that causes a variety of symptoms. Restaurants and supermarkets offer a wide variety of gluten-free foods. Years ago, physicians advised a gluten-free diet only for individuals who had celiac disease (CD), which is an autoimmune disease that largely affects the small intestine. If a celiac patient wades back into gluten territory, then his or her intestine will revolt. I care for a few of these folks, but they are but a slim fraction of my patients who are shunning gluten.
Gluten are proteins contained in wheat and other grains. Many adherents of a gluten-free diet believe that avoiding gluten is a more healthful dietary choice. There is no actual test to confirm gluten intolerance, but many patients feel better on this diet. . Why should it matter if an individual chooses to avoid gluten? After all, there’s no risk here? In fact, avoiding gluten can lead to vitamin deficiencies and increased exposure to arsenic and mercury. I’m not suggesting that glutenphobes are at risk of poisoning themselves, but they should make sure that they remain nutritionally sound.
There are 3 conditions with scientific support for avoiding gluten.
Celiac Disease: Without question, gluten is the enemy.
Gluten Intolerance (GI): A murkier condition that likely exists but may be over-diagnosed. The relationship between gluten and the symptoms attributed to GI, such as abdominal pain, brain fog, bloating, fatigue, headaches and bowel irregularity, is tenuous. Many other medical conditions beyond gluten exposure might be responsible. There is no accurate test for GI.
Wheat Allergy: This is a food allergy. True food allergies (not intolerances) are very rare, although many patients mistakenly believe they are suffering from them.. Allergic features include hives, wheezing, itching and difficulty breathing.
Most gluten avoiders do not fall within the above categories. They avoid gluten because they feel better on the diet or believe that it is serving their health interests. We all do stuff that we believe benefits us, even if there is no scientific support. If you feel better avoiding a food item, then of course you should do so.
We are a free country and we have the right to be gluten-free. But, let’s make sure that we separate fact from myth, or put another way, separate the wheat from the chaff.
Thank you. It's a huge frustration to see gluten free lumped into IBS diets, and confused with FODMAPS, and just so hyped but poorly understood.
Directed here from Reddit.
I guess I don’t see this adding anything new or novel to the “to gluten or not to gluten” debate. In fact, I think it just adds another layer of expert opinion “evidence” that judgmental laypeople utilize to fuel their judgement and criticism of people who are trying anything and everything to feel better.
If you are truly concerned about the health of those who are avoiding gluten without a diagnosis (i.e., because of potential vitamin deficiencies, etc.), I think it would be constructive to provide specific education on how to mitigate those risks within their lifestyle choices with supplements and the like, even partnering with a registered dietitian who can co-author educational articles with you.
I say this because I struggled for years trying to manage multiple symptoms by adhering to a gluten-free diet, and the judgement, ignorance, and disregard I got from folks in real life was degrading and made me doubt my own experience (To be clear, the worst judgement I got was from laypeople reading articles like yours. My providers were always supportive).
I figured, why do I do this without a diagnosis when it’s so expensive, difficult, and people are so freaking rude about it? So I started a gluten challenge under the supervision of a provider at MNGI. Imagine my chagrin yet relief when my first serology on my gluten challenge was negative! Everyone was right. Never mind that my GI symptoms persisted. I have a history of PTSD. It was all in my head!
…then The Migraine. The photophobia. The phonophobia. The nauseating hyperosmia that lasted for weeks. The steroid burst required to break the status migraine and the neurologist who wanted to prescribe three other medications to manage my migraines the day she met me.
The second serology that was positive. The Marsh Type 3 changes on biopsy.
It was hell. I put myself through hell to get a diagnosis largely because of social pressure from laypeople who read articles like yours and figured a doctor must know more about what gluten does to people’s bodies than I know about what it does to my own.
I think writing like this is more likely to do harm than to help.