Does Gluten Intolerance Exist?
Hey folks, just a quicky here on the recent news pieces talking about research indicating gluten intolerance may not exist. I’m earlobe deep in City Zero stuff so this will not be a long breakdown but it should help put some of this into context.
First, what is gluten intolerance? Unlike Celiac which is an autoimmune condition triggered by the protein gluten (gliadan to be specific) non celiac gluten sensitivity (NCGS) has been hypothesized to be an innate immune response which causes GI distress and inflammation. Recent research (please DO read that whole paper) suggests that gluten may in fact not be the culprit here, but rather FODMAPS.
Real Clear Science did a nice takedown on this but with some interesting commentary. First RCS pulls a quote from the original research:
“Reduction of FODMAPs in their diets uniformly reduced gastrointestinal symptoms and fatigue in the run-in period, after which they were minimally symptomatic.”
Followed by some (good) opinion by RCS:
Coincidentally, some of the largest dietary sources of FODMAPs — specifically bread products — are removed when adopting a gluten-free diet, which could explain why the millions of people worldwide who swear by gluten-free diets feel better after going gluten-free.
Can’t argue with this AND it might also be part of the reason why folks who consume lots of gluten-free products still have problems. The next bit of opinion is…well, just kinda wacky:
Indeed, the rise in non-celiac gluten sensitivity seems predominantly driven by consumers and commercial interests, not quality scientific research.
Only to be followed with what appears to be some correspondence with the lead researcher of the paper:
Biesiekierski recognizes that gluten may very well be the stomach irritant we’ve been looking for. “There is definitely something going on,” she told RCS, “but true NCGS may only affect a very small number of people and may affect more extraintestinal symptoms than first thought. This will only be confirmed with an understanding of its mechanism.”
So, “millions of people world-wide” feel better from a gluten free diet, the lead researcher is pretty sure “something is going on,” these effects may extend well beyond intestinal issues…but we are all goofy for tinkering with this stuff and it has ONLY been driven by a profit motive? newsFlash for RCS: That this research occurs AT ALL is due to the volume of people playing with this topic. Might it be mainly FODMAPS and not NCGS? The study that Biesiekierski put together is VERY good and quite compelling. You need to let the data speak for itself but it’s ironic that the problematic foods (let’s say bread in this case) is still, well, a problem.
Here are some thoughts/questions in no particular order:
-Why was celiac prevalence at one point written in stone as about 1/1,000 and is now in the 1/140 range?
-Is it a terrible thing to suggest a gluten free (and low FODMAP) diet to the scores of people who suffer GI problems?
-If people have a health problem, should they wait until “all the research” is in?
I have a couple dozen blog post in que and I’ll get to at some point. One of them is this paper looking at cardiovascular disease and vascular wellness. What’s interesting about that paper is it points out that yes, we know a lot more about CVD, yes we have some great treatment interventions that save lives, but the current model is so expensive it will likely bankrupt westernized countries (I think some folks have said something akin to this at some point). Check out the closing thoughts from that article:
Fortunately, healthcare providers do not need to wait for a national directive. In the arena of arterial disease, which is so costly from a humanitarian and financial standpoint, healthcare providers may choose, as the authors have, to enter this new era of arterial disease care now. It is exciting to practice medicine in an era where we possess clinical tools and knowledge allowing us to migrate to a more superior platform of healthcare. The platform that focuses on managing end-stage arterial disease is too expensive and devastating to an individual’s wellness. We now have the opportunity to shift to a platform designed to prevent disease, or at minimum treating it before it is evident. We do not need to wait for huge randomized double blind prospective outcome studies to prove such a platform will be superior. We have no choice. We have proven that the current platform leads to insolvency. It is possible with a personalized, comprehensive, and holistic approach to determine the causes of the arterial disease in each patient. There are effective therapies for all the inflammatory conditions and adequate biomarkers to judge the effectiveness of the treatment. Arterial inflammation can be extinguished. The new era of CV healthcare can guarantee arterial wellness.
Bolded emphasis is mine.
Ironically, the lead author of that paper, Bradley Field Bale, was one of the early influencers of the risk assessment program in Reno.
I’d argue that we could take “arterial wellness” from above and substitute anything from neurodegenerative disease to GI problems and have much the same story. we have the outcome based medicine potential of solving a lot of these issues, with neigh aRCT to support any of the clinical interventions.
Is NCGS a dead hypothesis, with FODMAPS being the real issue? Maybe. Time will tell. For now, how about practicing medicine using the best mechanism we have, and evaluating based on outcomes? The news reporting on this topic has been at best ignorant as it seems to gloss over the fact folks DO benefit from a gluten free (reduced FODMAP?) diet. Our understanding of the minutiae may have taken a giant leap forward with this research, how we tackle these issues on a personal or clinical basis may not have changed at all.