Gluten free diets may be unnecessary for many, suggest researchers

06-Mar-2012 - Last updated on 07-Mar-2012 at 17:58 GMT

Nonceliac gluten sensitivity has become an increasingly prevalent diagnosis in the United States, but many Americans may needlessly be limiting their diets as there is no accepted definition of the condition, according to a commentary published in the Annals of Internal Medicine.

The popularity of gluten free diets has soared in recent years, but not just for celiacs, who must avoid gluten to manage their symptoms. Market research organization Packaged Facts has found that the market for gluten free products has grown faster than expected, and valued the market at $2.64bn in 2010 – a compound annual growth rate (CAGR) of 30% from 2006 to 2010.

Celiac disease, an autoimmune disorder triggered by gluten – the protein in wheat, barley, rye and spelt – is estimated to affect about one in every 133 Americans. The only treatment currently available is complete gluten avoidance. But there is a growing number of Americans with intestinal and abdominal symptoms that may be eased or disappear when gluten is eliminated from the diet.

The authors of this latest commentary, Dr. Antonio Di Sabatino and Dr. Gino Roberto Corazza of Italy’s University of Pavia, question a widely cited figure claiming that as many as 17m Americans could be gluten-sensitive. They say that there is no official data on the prevalence of nonceliac gluten sensitivity and little consensus among medical professionals about how it should be diagnosed.

They urge open or single-blind challenge tests to determine nonceliac gluten sensitivity, after celiac disease has been ruled out, in order to avoid misdiagnosis and unnecessary dietary restrictions.

“Nonceliac gluten sensitivity should be the subject of more in-depth clinical research, and “sense” should prevail over “sensibility” to prevent a gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population,”they wrote.

“We must prevent a possible health problem from becoming a social health problem. Self-prescription of gluten withdrawal by a growing number of patients inevitably leads to a series of problems: subsequent inability to correctly diagnose or exclude celiac disease, deleterious health effects from the probably suboptimal adherence to a gluten-free diet in the case of patients with undiscovered celiac disease, and the high economic burden related to an unjustified gluten-free diet.”

Meanwhile, Packaged Facts predicts that the market for gluten free foods will continue to grow over the next several years, albeit at a slower rate, and now projects the US market for gluten free foods and beverages to approach $5.5bn by 2015.

Source:Annals of Internal Medicine

Vol. 156, No. 4, pp. 309-312

“Nonceliac Gluten Sensitivity: Sense or Sensibility?”

Authors: Antonio Di Sabatino and Gino Roberto Corazza