All Hype? Gluten-Free Diets May Not Help Many

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Gluten-free products are all the rage these days, but many health-conscious eaters who buy them may be wasting their money, the authors of a new commentary in Annals of Internal Medicine suggest.

Going gluten-free is necessary for people with celiac disease, an autoimmune condition triggered by gluten, which is found in wheat, barley and rye. The disease causes inflammation in the small intestine and can lead to malnutrition.

Yet many others without celiac disease have also adopted gluten-free lifestyles — no doubt inspired in part by athletes and celebrities like Gwyneth Paltrow and Victoria Beckham — in hopes of losing weight, boosting energy and resolving any number of potentially gluten-related symptoms like diarrhea, bloating, gas, headache, ADHD and mouth sores.

Many such adopters have been diagnosed by their doctors with “nonceliac gluten sensitivity,” a condition that by some estimates affects as many as 18 million Americans. But the authors of the commentary, celiac researchers Dr. Antonio Di Sabatino and Dr. Gino Roberto Corazza of Italy’s University of Pavia, question that figure, noting that there’s no official data on the prevalence of nonceliac gluten sensitivity, nor is there any consensus among doctors about how to diagnose it. Unlike with celiac disease, which can be identified through blood tests and bowel biopsies, there’s no good test to determine gluten sensitivity.

What there is, however, is a lot of hype surrounding the supposed benefits of gluten-free eating. Such claims “seem to increase daily, with no adequate scientific support to back them up,” the authors write. “This clamor has increased and moved from the Internet to the popular press, where gluten has become ‘the new diet villain.'”

It’s possible that people who have bad reactions to common gluten-containing foods — pasta, breads, baked goods and breakfast cereal — may actually be sensitive to something else in wheat flour or to other ingredients in the foods, the authors suggest. It’s also possible that some people develop gastrointestinal or other symptoms simply because they believe they’re food-sensitive.

That’s not to say that nonceliac gluten sensitivity doesn’t exist. But the authors say that more clinical research is needed to help define it and to prevent a “gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population.”

In the meantime, until researchers figure out the best way to diagnose gluten sensitivity, the authors discourage people from cutting out gluten entirely, which could lead to a diet that’s lacking in fiber — and put serious dent in your wallet — and suggest that doctors use an “oral challenge,” a test in which a patient drinks a gluten beverage to see if symptoms arise, to help identify likely cases of sensitivity.