Gluten, Revisited: The Latest Facts on a Popular Culprit

COMMENTARY

Gluten, Revisited: The Latest Facts on a Popular Culprit

William F. Balistreri, MD

Disclosures

February 26, 2020

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A quick look at your grocery store shelves or the menus of your favorite restaurants shows that "going gluten-free" is a defining dietary trend that is here to stay. And with over 100 million Americans consuming gluten-free products, it may just be time to revisit what we do and don't know about the gluten-free diet (GFD).

Who Really Benefits?

Two rationales are generally behind the adoption of a GFD. For those with the autoimmune-mediated disorder celiac disease or an immunoglobulin E–mediated wheat allergy, this diet isn't a choice so much as it is a mandatory prescription. However, many people elect to follow a GFD because of presumed non-celiac gluten sensitivity. They do so in hopes of relieving gastrointestinal (GI) symptoms such as abdominal pain, bloating, and gastroesophageal reflux disease, as well as a variety of non-GI ailments. They may also hope that adhering to a GFD will help them meet health goals like losing weight, attaining "stronger immune systems," or enhancing athletic or overall performance.[1,2,3] Studies suggest, however, that any perceived post-GFD clinical improvement in this group may not be directly attributable to the removal of gluten.[1,4]Instead, it is probably due to a placebo effect, collateral elimination of the non-gluten components of wheat, or reactivity to "modern wheat," which has been described by some as the source of the rising incidence in both celiac disease and non-celiac gluten sensitivity.

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