COMMENTARY

Going Gluten-Free: Value Beyond Celiac Disease?

David A. Johnson, MD

Disclosures

March 04, 2013

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In This Article

Hello. I'm Dr. David Johnson, Professor of Medicine and Chief of Gastroenterology at Eastern Virginia Medical School in Norfolk, Virginia.

Gluten-sensitive enteropathy is something that we probably need to think more about. Patients are all abuzz with this concept of gluten withdrawal, and they are saying, "I feel better. What can you tell me about this?"

I thought it would be helpful to review this topic. A recent article in the New York Times[1] caught my eye, and lo and behold, it was about an excellent article in the February issue of Gastroenterology and Hepatology by William Chey's group[2] at the University of Michigan. I thought it was time to take a look at the data and put some science behind what is currently a field that is running without much guidance.

What Is Gluten and What Is Celiac Disease?

First, let's talk about gluten. Gluten is a component of wheat and wheat-related grain products. When you start to talk about gluten withdrawal, is it really gluten withdrawal or is it wheat-product withdrawal or grain-product withdrawal? Grains are complex carbohydrates that have a number of fermentable sugars, which we would frequently remove from patients' diets because most of them are polyglycols -- fructans and galactans. We know from experience that when you withdraw fermentable sugar from patients, they frequently have improvement in symptoms such as bloating, gassy discomfort, and diarrhea.

Now let's focus on celiac disease. The prevalence of celiac disease has increased over the past several decades. Some inferential data suggest that some of it may be related to the hybridization of wheat and related grain products over the past several decades. We may actually be sensitizing more people, causing gluten-sensitive enteropathy or non-celiac gluten sensitivity, which we will discuss later.

We found that gluten-sensitive enteropathy is responsive to gluten withdrawal, but now we are seeing other patients who tell us that they feel better if they withdraw gluten. And they have found this out by going on the Internet or talking to friends and family who have had causal experience with this. Now we have patients out there doing a variety of things on their own accord and without a lot of medical judgment. That is not so good, particularly when you start talking about withdrawal and restrictive diets.

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