Re: Gluten elimination diets: Drs Cadenhead and Sweeny respond

Ms Hammond has made some good points about the emerging literature regarding non-celiac gluten sensitivity. Our COHP column was directed to primary care physicians to briefly give an overview of diagnosis of celiac disease and information to counteract “the misinformation and marketing in the public realm.” The issue of non-celiac gluten sensitivity was beyond the scope of our article with an im­posed maximum of 700 words. 

Ms Hammond claims that the article by Sapone was a consensus document recommending that non-celiac gluten sensitivity be recognized alongside celiac disease and wheat allergy as one of three gluten-induced conditions. We found Sapone’s article to a very good review article; however, it was not an international consensus document. There continues to be significant debate in the academic community about gluten intolerance or non-celiac gluten sensitivity. 

The article did make reference to the fact that there is an association between gluten and irritable bowel syndrome and certainly did not intend to discount patients’ experiences. Trial elimination diets with food and symptom diaries followed by reintroduction food challenges are an option. However, elimination diets are complicated by the fact that it is very difficult to fully eliminate gluten without consulting a professional dietitian, and there is always a placebo effect with the reintroduction food challenge method.

Ms Hammond points out that physicians need to bear in mind when communicating with patients that what is dogma today may be called into question by new evidence tomorrow. This is certainly a point that most physicians are well aware of with ever-changing evidence-based recom­mendations and guidelines. The current evidence on non-celiac gluten sensitivity is under debate. The overwhelming majority of patients adopting gluten-free diets do not need to be so restrictive. Patients with significant symptomatology need to be tested for celiac disease prior to adopting a gluten-free diet. If they remain symptomatic they need further investigation and possible referral to a gastro­enterologist.
— Kathleen Cadenhead, MD
—Margo Sweeny, MD
Council on Health Promotion Nutrition Committee

Kathleen Cadenhead, MD, Margo Sweeny, MD,. Re: Gluten elimination diets: Drs Cadenhead and Sweeny respond. BCMJ, Vol. 55, No. 6, July, August, 2013, Page(s) 272-273 - Letters.

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