Is gluten intolerance bullsh*t? (Ronald Hoffman, MD)

by Ronald Hoffman, MD
“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”
Arthur Schopenhauer, German philosopher (1788 – 1860)
To this we might add, in this era of click-bait journalism, a fourth stage: “Then it is ridiculed again.”
Such is the case with gluten intolerance, a real phenomenon that is suddenly taking a shellacking in certain less-enlightened segments of the media.
Articles with lurid titles like these are appearing with greater frequency:
“Does it Even Matter if Gluten Sensitivity is Bogus?” –PLOSblogs
“Gluten Intolerance is Apparently Bullsh*t” –Jezebel
“Your Gluten Allergy is Fake and I Hate You” –Redditt
“Being Gluten-free is Dumb—And Gluten Intolerance May Not Even Exist” –Muscle-for-life
“Calling Bullsh*t on a Fake Gluten Allergy” –LocalBizComedy
“Why a Gluten-Free Diet is Unnecessary and Even Unhealthy” –XoJane
If you haven’t heard of many of these pop culture outlets, don’t worry. The stories aren’t written by health professionals who’ve ever seen a patient. Their snarky, sensationalistic style typifies a new genre of health reporting that’s been unleashed by the democratization of the Internet and social media. The name of the game is to garner the most “clicks” – he who trends most wins.
It’s not surprising that a recent survey showed that only 6% of the population has a “high degree of trust” in the media.
Even Presidential contender Ted Cruz took a swipe at gluten correctness: He pledged not to provide gluten-free MREs to military personnel, signaling his disdain for effete, “PC” liberalism. (Cruz needn’t worry—the military already takes a dim view of gluten intolerance, and provides no special accommodation for soldiers who claim the affliction)
I get that “gluten-free” has become a fashion statement in certain pretentious precincts, and it’s spawned a growth industry for opportunistic food manufacturers who offer a plethora of (often not very nutritious) products. Many people who claim a gluten “allergy” do so with no objective evidence. They’ve never undergone testing, but claim to feel subjectively “better” when they skip wheat and related grains. Undoubtedly, some of the benefits they experience are due to the placebo effect.
So let’s drill down on the scientific study that has all the gluten skeptics exulting. The trial was published in the August 2013 edition of Gastroenterology. It involved 37 subjects with irritable bowel syndrome, all of whom were given a preliminary “FODMAPs” diet for 2 weeks. None of them had tested positive for celiac disease, the uncontroversial “classic” form of gluten intolerance.
The FODMAPs diet is designed to reduce intestinal bloating and gas by eliminating fermentable carbohydrates (fructans, oligosaccharides, disaccharides, monosaccharides, and polyols). That means no grains, no milk products, no sugars, and elimination of certain fruits, nuts and vegetables. While highly restrictive, this diet often yields superb results in sufferers of IBS.
No surprise: The subjects felt much improved. Then they were challenged with either a high-gluten, low-gluten, or no-gluten meal plan and the effects were assessed.
All 3 diets—whether or not they included gluten—produced identical symptoms in the testers: they reported feeling worse.
 
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