COMMENTARY

Going Gluten-Free: Value Beyond Celiac Disease?

David A. Johnson, MD

Disclosures

March 04, 2013

In This Article

Testing and Treatment

What should we do with these people? If you have a patient who has diarrhea, gas, and bloating, it's very reasonable to do serologic testing. I think celiac disease is still missed in many patients. If you have a celiac patient who is negative for the standard profile and still has symptoms, it's reasonable to do HLA typing and the DQ2 or DQ8 profile. It would certainly give you an idea of whether this patient may do better after withdrawal of gluten, particularly if you could combine it with another marker. If the patient is antigliadin positive and tTG positive, start to look at phenotypic markers as well.

In trying to make patients totally gluten-free, it is very challenging to tell them to be totally restrictive. In my practice, I refer them to a nutritionist. There is very strong evidence that when patients are left on their own, a variety of macro- and micronutrient deficiencies can develop. If you are a patient, talk to your doctor. As a physician, I refer these patients to a nutritionist.

I think that gluten-sensitive non-celiac disease is going to get considerably more attention. It has been estimated that the industry is shifting to meet this market with approximately $6 billion in gluten-free products. We know that gluten is not only in food products but in things like beer, cosmetics, and postage stamps. The industry is shifting to meet the need, and fanning the fire is the patient's recollection that he feels better without gluten.

The science is there. It is beginning to emerge. It does make sense, but not in everybody, so be aware of it. Talk to your patients and look hard at potentially finding markers for whether they are more likely to have a response.

These patients are no longer lacking the ability to go out and find gluten-free foods or products. If they are truly celiac, then they have to be a line reader. But for people with non-celiac gluten sensitivity, it remains to be seen how much of an antigenic response will be necessary to truly make the patient feel better. I think it's real. We need to pay attention, we need to be a little bit more pragmatic, and our patients will benefit from this as we learn.

I'm Dr. David Johnson. Thanks for listening.

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