Recognition of Gluten Sensitivity
The first step is to agree that gluten sensitivity is emerging as a serious problem. Creating criteria for the condition is the next step, followed by research to determine its prevalence, and adding gluten sensitivity to the medical insurance list of coded conditions.
Treatment of Gluten Sensitivity
The current problem of ruling out celiac disease and not recommending a gluten-free diet for gluten-sensitive individuals needs to be corrected. Perhaps patients who are sure that certain foods trigger their symptoms, but are not sure of the causative factor(s), may be best served by providing them a test elimination diet. Most importantly, the question yet to be answered by researchers is whether or not gluten-sensitive individuals are at risk for the same potentially serious side effects known to affect untreated celiac disease patients. Some researchers suggest that gluten sensitivity can also be associated with neurological symptoms in patients, and coin the term 'gluten syndrome'; however, the research appears limited. Box 2 lists the possible consequences in patients with celiac disease who do not adhere to a gluten-free diet. These include, but are not limited to, autoimmune conditions, intestinal cancer and neurological problems that start with foggy mind, memory and concentration difficulties with possible escalation to cerebellar atrophy and calcification of the brain. These serious ramifications dictate that individuals at risk for celiac disease need to be screened. In addition, celiac disease patients need to be made aware of these side-effects so that they understand that this is not just a 'diet' in which gastrointestinal problems are the only consequence of consuming gluten. Currently, this is not the case in medical practice. In the best interest of these patients, referrals to registered dietitians are recommended. Gluten is not only found in wheat products, but in many hidden locations in the diet that are not easily communicated in a short office visit.
Expert Rev Gastroenterol Hepatol. 2012;6(1):43-55. © 2012 Expert Reviews Ltd.