Sunday, February 26, 2012

The Logic of Going Gluten-Free

At last, consensus is consolidating in the murky waters of gluten-related-illness.

Fifteen international-celiac-doctors have put forward a consensus statement on the “new nomenclature and classification of gluten-related-illness”.
I have previously named this set of illnesses “The Gluten Syndrome”.

Here are the 3 steps in my gluten logic:

Step ONE
a) If, gluten sensitivity is common: perhaps affecting over 10% of the population);

b) If, gluten-related illnesses are varied and have multiple symptoms: a quote from the consensus paper emphasises this “The symptoms in GS may resemble those associated with celiac disease (CD) but with a prevalence of extra-intestinal symptoms, such as behavioral changes, bone or joint pain, muscle cramps, leg numbness, weight loss and chronic fatigue. Their symptoms include abdominal pain (68%); eczema and/or rash (40%); headache (35%); ‘foggy mind’ (34%); fatigue (33%); diarrhea (33%); depression (22%); anemia (20%); numbness in the legs, arms or fingers 20%; and joint pain (11%)”;

c) If, there is no definitive diagnostic test for gluten sensitivity: the Consensus paper goes on to say “However, currently there are no laboratory biomarkers specific for GS. Usually the diagnosis is based on exclusion criteria; an elimination diet of gluten-containing foods followed by an open challenge is most often used to evaluate whether health improves with the elimination or reduction of gluten from the patient's diet;

d) And if there is no harm from going on a gluten-free diet; gluten-free is healthy.

Step TWO
Then the logical conclusion is that anyone, with any symptoms that are chronic and unexplained (that is they do not have a definite diagnosis) should be put onto a gluten-free diet for a clinical trial for three months or more.

Whatever the test results and whatever the symptoms, a response to a gluten-free diet suggests that their illness is gluten related (some people might demand a double blind food challenge).

Up until now, most gluten/celiac doctors have dismissed non-celiac patients as having a placebo response to a gluten-free diet.  This is clearly not the case.

The above logic means that all people with undiagnosed illnesses should be given a trial of gluten-free.  This is likely to have huge health benefits and wide ramifications on the management of ill health.

Already 10% of Australians are adopting a gluten-free diet.
It is my prediction that in another generation most people who wish to remain well will also adopt a gluten-free diet.

Look forward to comment
Dr Rodney Ford

1 comment:

  1. In reference to this post and the one before it about being tested or not: My then-13 year old daughter presented an illness last April with symptoms of stomach discomfort (cramps, bloating, nausea), low energy, low appetite, and eventually weight loss (6 lbs in 4 weeks). Our small town of 2300 does not have a GI specialist, so she was seen by a nurse practitioner in a clinic. Lab work was done to check thyroid, white count, hemoglobin, and UA. All labs were normal, and again normal 2 weeks later. The NP did not mention anything about testing for CD, but after another visit, suggested a gluten-free diet. Not having any other information about the need for gluten in her diet during the tests, my daughter started a gluten-free diet and had almost immediate good results. She even did a challenge after a week, and felt sick again. We have continued her gf diet since then, and have seen great improvements in her health. One thing that greatly bothers me, however, is that the NP suggested the gf diet, but gave us no information about getting tested. In all the books and articles I've read in the last few months, there is always a line at the end that says something like "get tested before starting a gluten-free diet." It seems a little backwards that I have to read books and articles about eating gluten-free so I can help my daughter feel better, and only then do I hear about getting tested first. I brought this to my NP's attention at a later visit, in order to help other patients in the future. What I am extremely happy about is that my daughter is feeling SO much better eating gf. I do not want to re-introduce gluten, just to have her get tested. (If anyone disagrees, I will have her live with you during that time. Not a happy kid.) So, because we don't know for sure that she has CD, we refer to it as a gluten intolerance. The diet will not change.

    I look forward to your comments.