Is Avoiding Gluten in Foods Always Necessary?

TUESDAY, Feb. 21 (HealthDay News) — Gluten-free diets have
become a popular way to manage gluten sensitivity, but a new analysis
suggests that many people who stop eating gluten may not need to do
so.

Health experts have claimed that this special diet can ease digestive
ills in those who are sensitive to gluten, a substance found in wheat,
barley, rye and possibly oats. Some even think avoiding gluten might
reduce headaches, fatigue, hyperactivity and autism symptoms.

However, when comparing the number of mentions of gluten sensitivity on
Google to the number of scientific articles on the subject, Italian
researchers found that the Google mentions far outweighed mentions in the
medical literature, at a ratio of 4,598 to one.

“Clinically, we see a lot of suspicion that gluten reactions are
responsible for numerous health problems, and it’s difficult to counter
this belief. There are a lot of alternative practitioners out there that
blame gluten for everything, even though there’s not a lot of science
behind it,” said Dr. Joseph Levy, division director of pediatric
gastroenterology at New York University Langone Medical Center in New York
City.

In the article, published in the Feb. 21 issue of the Annals of
Internal Medicine
, the Italian researchers explain that gluten has
become “the new diet villain” in the United States. American marketers
claim that 15 percent to 25 percent of consumers want gluten-free foods,
and popular estimates suggest that as many as 17 million Americans are
gluten-sensitive. However, there’s no official data on the prevalence of
gluten sensitivity in people who don’t have celiac disease, according to
the study authors.

Celiac disease is an autoimmune condition that damages the lining of
the small intestine when gluten is eaten. This damage prevents the small
intestine from absorbing the nutrients in food, and people with celiac
disease slowly become malnourished. It’s essential that anyone with celiac
disease maintain a gluten-free diet; even occasional slips can cause
damage.

Levy said there’s no question that some people appear to have what the
researchers dubbed nonceliac gluten sensitivity. “Some people, when you
remove gluten, have less gas, belly aches and nausea,” he said.

But, he added that it might not be the gluten that’s the problem, and
could instead be something else in foods containing gluten.

Another digestive expert, Dr. David Greenwald, isn’t convinced yet.
“It’s very hard to tell if someone has nonceliac gluten sensitivity. I
have a healthy skepticism until there’s a scientific basis for the
diagnosis. It’s very easy to jump on the wave, but the authors here are
saying to wait for the scientific evidence that there is a sensitivity
that’s not based on celiac disease,” he explained. Greenwald is a
gastroenterologist at Montefiore Medical Center in New York City.

Greenwald said that a lot of people who try gluten-free diets do so
because they’re having symptoms that suggest irritable bowel syndrome
(IBS), such as abdominal pain, gas and bloating.

“Most of the people who come to the conclusion that they have nonceliac
gluten sensitivity have IBS symptoms, and they’ve heard that a gluten-free
diet might help them, and a number of them start feeling better when they
eliminate gluten,” said Greenwald. But, in clinical trials, people with
IBS often have high placebo success rates, sometimes more than 30 percent,
he said. So, for some, going on a gluten-free diet might induce a placebo
effect.

Levy agreed. “Physiological changes can occur with positive thinking.
If, for whatever reason, someone is convinced that removing gluten will
help, and it does, that’s fine,” he said.

The good news is that a gluten-free diet is generally considered safe.
It’s helpful to work with a nutritionist to ensure you’re getting all the
necessary vitamins and nutrients if you decide to undertake a gluten-free
diet. And, Levy advised reading ingredient lists on gluten-free products.
Some are made with beans, which could cause gas and bloating if eaten in
significant quantities.

The only significant downside to gluten-free diets is cost, since
gluten-free foods are significantly more expensive than foods that contain
gluten.

“If people are uncomfortable and want to put themselves on a
gluten-free diet and they don’t mind it, there’s no real harm to that if
they’re willing to bear the inconvenience and cost,” said Greenwald.

However, both experts cautioned that it’s important that a doctor rules
out celiac disease before anyone undertakes a gluten-free diet. Lowering
the amount of gluten in your diet can change the results of the blood
tests used to screen for celiac disease, and might mask the presence of
celiac disease. With celiac disease, it’s essential to avoid all gluten to
avoid complications.

More information

Learn more about food allergies and intolerance from the American Gastroenterological Association.

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