Are gluten free products a waste for those without celiac disease?
Eating gluten-free has become a hot nutrition trend, but many of those who spend extra to buy gluten-free products may be wasting their money, according to an opinion paper published yesterday in the Annals of Internal Medicine.
Those with celiac disease — an autoimmune condition where gluten triggers severe inflammation in the small intestine — must avoid gluten, but many others without celiac, including actress Gwyneth Paltrow, have embraced gluten free diets as more nutritious or in the belief that they’ll clear up chronic digestive symptoms such as abdominal pain, gas, and diarrhea, or garden variety headaches or fatigue.
In fact, many of these patients may be told by their doctors that they have gluten sensitivity or non-celiac gluten intolerance, newish disorders that are frequently made after celiac has been ruled out. The trouble is, according to the authors of the paper, experts don’t agree on a standard definition for this sort of condition, and there’s no reliable way to test for it, outside of a research setting.
Gluten is a component of the more complex protein mixture contained in wheat flour. As a consequence, it cannot be considered the sole agent responsible for functional symptoms in persons who eat bread and pasta, and other [starchy] proteins, wrote the paper authors, who are affiliated with the Universita`di Pavia in Italy. Thus, switching to gluten-free breads, cereal, and pastas may not do much to help symptoms.
While the authors say gluten sensitivity may, in fact, exist in some people without celiac disease, a better diagnostic test is needed to make more accurate diagnoses. The gold-standard test is a double-blind oral challenge where patients are given drinks with and without gluten and then asked to rate their symptoms. Neither the patient nor the doctor knows whether the gluten free or gluten filled drink was given, so symptoms can be objectively evaluated, but the method is time consuming and costly.
Until a better, cheaper test is available, the study authors say doctors can rely on single-blind challenge tests — where patients don’t know whether they’re given a gluten or gluten free drink — to determine whether subjective symptoms such as abdominal pain, nausea, fatigue, or headaches get worse with gluten. They can do an open challenge test — where a gluten drink is administered with a patient’s knowledge — in those who have easy to measure symptoms such as diarrhea, vomiting or a rash thought to be triggered by gluten.
Deborah Kotz can be reached at [email protected]. Follow her on Twitter @debkotz2.Gluten free Recipes with Bill & Sheila
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