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Gluten-free skin and beauty products: Extracting cash from the gullible

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Even though yesterday was Easter, and, as unreligious as I am, I was still thinking of taking it easy, there was one target that popped up that I just couldn’t resist. My wife and I were sitting around yesterday reading the Sunday papers and perusing the Internet (as is frequently our wont on Sunday mornings), when I heard a contemptuous harrumph coming from her direction. She then pointed me to an article in our local newspaper entitled Gluten-free beauty products in demand among some customers. Now, I must admit that I haven’t been keeping up with the gluten-free trend, other than how easily it fits within the niche of “autism biomed” quackery, where, apparently, nearly every “biomed” protocol for autistic children demands that gluten be stripped completely from their diets, lest the evil molecule continue to infect them with the dreaded autism. I’ve kept an eye the literature, but haven’t really written about gluten. That’s why I could immediately tell why my wife had called my attention to the article:

Amy Soergel’s lip gloss was making her sick. The problem, she realized, was gluten — hydrologized wheat protein, to be exact. Then she went to the hairdresser who used a shampoo that made her neck burn. Again, it contained gluten.

“There’s hidden gluten in many places you may not consider,” including stamp and envelope glues, toothpaste and lip balms, said Soergel, who has a store, Naturally Soergel’s, near Pittsburgh that caters to people with allergies. Indeed, for people with celiac disease, a bit of gluten that might get swallowed from a lipstick or a stream of shampoo in the shower can be enough to cause illness.

A slew of gluten-free skin care products have come on the market, including items from well-known companies such as Murad, Dr. Hauschka, EO, MyChelle, Suntegrity, Acure and derma-e. Many are sold in Whole Foods and other health food stores. If they’ve been certified by a third-party agency, an icon usually appears on the packaging.

Whole Foods. Of course, it had to be Whole Foods (among others). Let’s take a look at the whole gluten-free movement and then at the end I’ll revisit the question of gluten-free cosmetics and skin products.

Gluten, of course, is nothing more than proteins found in wheat endosperm (a type of tissue produced in seeds and that is ground to produce flour) and can also be found in barley and rye. It consists of two proteins, gliadin (a prolamin protein) and glutenin (a glutelin protein). Gluten cannot be consumed by sufferers of celiac disease (CD), whose main manifestation is inflammation of the bowel lining when gluten is eaten. The end result of this chronic inflammatory process can be gastrointestinal scarring and atrophy of the villi (the finger-like protrusions of the lining of the bowel responsible for nutrient absorption, among other things). The most common symptoms are, of course, gastrointestinal, including diarrhea, nausea, abdominal pain, and bloating, but CD can also manifest itself in a number of other symptoms, including skin rashes, weight loss and fatigue, oral ulcers, joint pain, anemia, and depression. CD (or gluten-sensitive enteropathy) is not caused by gluten, but rather a genetic predisposition. If you’re unlucky enough to have this predisposition, gluten can do bad things to you.

There is no doubt that CD can cause real problems in the people who have true gluten sensitivity. Indeed, as this New York Times article describes, in the 1990s the general medical consensus was that in the US the prevalence of CD was around 1 in 10,000. More recent studies, such as this one from 2012, report a prevalence of around 1 in 100. Worse, the majority of CD goes undiagnosed. In actuality, what is happening appears to be a combination of more intensive screening due to better awareness of celiac disease as a potential cause of puzzling symptom constellations, plus what is arguably a real increase in prevalence since 1950, estimated by Mayo Clinic researchers to be approximately four-fold and continuing to increase over the last decade.

The definitive diagnosis of CD is made by:

  • Detection of anti-gluten antibodies in the blood (specifically, as Scott Gavura described, IgA antiendomysial antibody (EMA) and the IgA tTGA), a test that is 90-95% sensitive and 95% specific. This is suggestive of gluten-sensitive enteropathy but not fully diagnostic.
  • The gold standard test: Distal duodenal biopsy specimens demonstrating characteristic histologic changes in the small intestinal mucosa, changes that include: a spectrum from total to partial villous atrophy and crypt lengthening with an increase in lamina propria and intraepithelial lymphocytes. It is also important to take at least six biopsies, because changes can be patchy.

It’s also noted in multiple sources that these tests should in general be done before the patient is placed on a gluten-free diet, because otherwise the tests often produce a false-negative result. There is also a controversial condition known as “non-celiac gluten sensitivity” (NCGS). As both Steve Novella and Scott Gavura note, these are patients without definitive diagnostic criteria for CD who believe that gluten causes symptoms of bloating, fatigue, and irritable bowel syndrome, but do not have antibodies to gliadin. Indeed, Scott quite correctly speculated over whether non-celiac gluten sensitivity is becoming the new Candida; i.e., an all-purpose bogeyman responsible for all sorts of vague, chronic health complaints and thus a nice foundation upon which quacks can base all sorts of dubious therapies related to removing gluten from the diets of anyone with vague complaints but no evidence of CD on testing.

Scott also noted the dearth of good studies on NCGS, and a review of PubMed just yesterday found that, although there are about 27 more articles out there in PubMed than there were when Scott last wrote about NCGS, the quality of evidence supporting the existence of the entity of NCGS remains poor. For example, in 2013, Biesiekierski et al. reported a placebo-controlled, cross-over rechallenge study of 37 subjects, in which they found no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed on diets low in fermentable, oligo-, di-, monosaccharides, and polyols (FODMAPs) in order to control other potential triggers of gut symptoms. No markers of intestinal injury were noted in any of the groups, although a high nocebo response was noted. It’s not surprising that a recent review article characterized NCGS as “an entity awaiting validation, better diagnostic criteria, and, if it does exist, pathogenic mechanisms.” It was also noted that the “reluctance to acknowledge other components of wheat, such as fructans, non-gluten proteins and WGA, as potential pathogenic factors has often hampered good interpretation of clinical observations.” In other words, people are so fixated on gluten that they ignore other potential components of wheat and grains that might be the real cause of symptoms noted. The authors of the review article even go so far as to propose reasonable rules for future rigorous clinical trials on the subject:

Essential rules for future studies should include the following. First, celiac disease has to be seriously excluded by HLA studies and/or strict histological and immunological criteria. The inclusion of patients with intraepithelial lymphocytosis will always raise the issue of whether they really have celiac disease with a milder intestinal lesion. Secondly, the use of blinded placebo-controlled food re-challenge methodology to prove gluten sensitivity is present is not reliable, especially in patients who believe they have NCGS. Perhaps the selection of patients for study should be those with IBS naïve to a GFD. Thirdly, the trap of assuming that response to a GFD or exacerbation of symptoms due to a gluten-containing diet reflects specific effects of gluten should be outlawed and credence be given to the other wheat-related food constituents that can also cause gastrointestinal symptoms. Perhaps if these rules were followed, we would now be a lot closer to defining mechanisms by which gluten might act, might have developed biomarkers to identify patients who truly do have NCGS and perhaps, most importantly, answered the question of whether NCGS does really exist. On current evidence the existence of the entity of NCGS remains unsubstantiated.

So, in other words, CD is a real entity that is more common that diagnosed, but it is not even clear whether NCGS is a distinct clinical entity, despite the number of people who believe themselves to have it, the number of companies that cater to the belief that this entity exists, and the number of practitioners, particularly “integrative” practitioners and alternative practitioners, who have come up with all sorts of exclusionary diets and “biomedical” interventions to treat it. As yet, we do not have convincing, reproducible clinical evidence that the condition exists, which makes it premature to be speculating about mechanisms, no matter how much advocates of gluten-free diets as a cure-all for everything might “draw a line in the sand” and try to dismiss skeptics who don’t cite the biomarker studies they like as they promote dubious “paleo” diets. Does any of this mean that NCGS doesn’t exist or is bogus? No, not necessarily. What it means is that evidence is inconclusive and contradictory. Worse, because of relentless messaging in popular culture that gluten is bad for you, that many—who knows how many?—people have undiagnosed gluten sensitivities, and that most people would be better off without gluten in their diets, there’s a substantial nocebo effect. Meanwhile, confirmation bias, nocebo and placebo effects, regression to the mean, and the usual confounders that make individual experience so unreliable when determining if an intervention is effective in an individual explain the vast majority of glowing “testimonials” of people who “go gluten-free” and believe it made them so much healthier. Here’s a perfect example of An Open Letter to Gluten-Free Skeptics:

I gave up gluten in 2010. At the time I had no symptoms of gluten sensitivity – no digestive issues, no overt symptoms of problems. No diagnosis of celiac. I was, however, obese (and have been for most of my life), and prone to uncontrollable binge eating. I gave it up as an experiment – not sure that it would help me, just hoping.

And it did.

I’ve been leaner, and generally healthier, during the past 3 years than at any prior time in my life. And this hasn’t been an easy 3 years – it’s been very stressful (for reasons having nothing to do with food), yet despite lots of travel and lots of serious life changes, I’ve been able to lose most of my excess fat and keep it off, without very much effort.

This was not my first attempt at leaning out – I’ve tried many different eating strategies, from low fat to low carb to vegetarianism to intermittent fasting – over the years. None of them “stuck” until I went gluten free.

He continues:

Even if I DON”T have dozens of double blind studies published in peer reviewed journals showing that a GF intervention reduces inflammation, improves digestion, and leads to weight loss, I DO have evidence that it vastly improved MY life and health.

And:

But as much as YOUR argument that I don’t have science proving gluten is bad for everybody – nobody has any science showing that NOBODY benefits from a GF diet.

Let me reiterate: NOBODY has ever done even a single study that shows in any sense that NOBODY benefits from eliminating gluten from their diet.

None of which demonstrates that a gluten-free diet did anything for this man. These are, in fact, the same sorts of arguments, confusing correlation with causation riddled with confirmation bias that antivaccinationists use to “prove” that vaccines cause autism, that “autism biomed” can “recover” autistic children, and even that Stanislaw Burzynski or Robert O. Young cured their cancers. They prove little or nothing. Unfortunately, given the panoply of vague symptoms attributed to NCGS, it’s a condition, if it exists, that’s seemingly custom-made for all the confounders that make demonstrating the efficacy of a treatment so difficult. That’s why the rules suggested in the review article I cited above are so critical to future studies. Unfortunately, it’s also why gluten is likely to continue to be demonized beyond its health effects on people who have true CD.

Which brings us back to why on earth anyone thinks gluten-free cosmetics and beauty products are of any value. The answer is: They aren’t, with possibly one exception. The reason, of course, is that the gluten protein is too large to be absorbed through the skin. Now, it is known that it only takes a relatively small amount of gluten ingestion to result in gastrointestinal problems, as little as 50 mg (present in 1/80th of a slice of wheat bread) can cause damage to the intestinal villi. Consequently, there is a rationale for “going gluten-free” for any product that goes on the lips or in the mouth, such as lip balm, toothpaste, or lipstick, at least for people with severe CD. For people who think they have NCGS, where it hasn’t even been convincingly demonstrated that gluten is actually the component in wheat that causes symptoms, gluten-free cosmetics is nothing but marketing hype feeding into the same marketing hype behind the gluten-free products that are only really needed by people who have true CD and only debatably helpful to others. Remember, as I’ve seen pointed out, 93% of consumers purchasing gluten-free products are not diagnosed with CD, but rather do so because of an interest in “health and wellness,” ascetic-based practices of self-improvement, or the “flavor of the month” diet trend.

But what about gluten-free skin products? In general, these are an even bigger waste of money, again because gluten isn’t absorbed through the skin. Most of the reports, like this one, in which people attribute skin issues to gluten, do not constitute decent evidence that topical gluten causes their symptoms. The reason is simple. Those with CD not-infrequently suffer from dermatitis herpetiformis, a type of skin rash, as part of their symptoms, that is not caused by contact with gluten (indeed, a gluten skin patch test is notoriously poor in sensitivity for diagnosing CD) but by ingesting gluten. When they remove gluten from their diet, their dermatitis herpetiformis resolves with the rest of their symptoms. Such people, once they are made aware that they have CD, start wondering if gluten in skin products can be the cause. Not surprisingly, they switch to gluten-free skin products at the same time they are removing gluten from their diet, and, as usually happens, their skin symptoms recede along with their gastrointestinal symptoms.

But what about the rest, who do not have CD but buy gluten-free skin products in order to avoid rashes? In my estimation, they’re wasting their money if they’re paying a premium for such products. If they’re not paying a premium, than it’s how well the product works for them that matters, not whether it has gluten in it or not. Again, there are many compounds and substances in skin products that can cause allergic reactions or simply contact dermatitis in some people, particularly fragrances. Because of all the publicity about gluten, it’s not surprising that so many people, whether they have CD or not, are quick to assume that a rash after using a skin product is due to gluten in the product. Without careful patch testing, assuming a reaction is due to gluten in a skin product is a leap.

It’s become clear that, up until the last decade or so, CD was severely underdiagnosed in the US. To some extent, it still is, although increased awareness and better-defined diagnostic criteria have alleviated that problem. Unfortunately, it is also a condition that appears to be increasing in prevalence, both due to an apparent increase due to greater awareness and, thus, diagnosis and, likely, to an increase in the actual frequency, as evidenced by studies suggesting that the prevalence of seropositivity for the appropriate IgA antibody in the population. In general, increased awareness is a good thing, as it allows for the appropriate diagnosis and treatment of a greater fraction of people with CD. So is the increased availability of gluten-free options for the approximately 1% of the population with CD, which allows them to alter their diet without suffering as grievous a hit to their quality of life.

Unfortunately, the known deleterious health effects of gluten in people with CD have been extrapolated into a much vaguer, as-yet scientifically unvalidated, clinical entity that supposedly a much larger percentage of the population suffers from. This has led to the unjustified demonization of gluten (which is really only harmful in a small minority of the population), overblown claims for “going gluten-free,” and ridiculous products such as gluten-free skin care products, deodorants, and shampoos.

Posted in: Basic Science, Clinical Trials, Nutrition

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125 thoughts on “Gluten-free skin and beauty products: Extracting cash from the gullible

  1. chris hickie says:

    I keep seeing more parents who have “gluten-freed” their child and then want me to test them for celiac. When I tell them they can’t be gluten free for the testing to have any meaning, they are almost always crestfallen. I then tell them that if their child is doing well on his g-f-free diet, they could just continue it (at least, assuming no one is lying in their labeling of foods) it is easy to find g-f foods. Then I get a look like “why would I want to continue him gluten-free?”. No one can fix celiac is you have it, so I have to wonder how much they’ve read about this new boogey-man gluten when they don’t know these parts of the equation.

  2. Guy Chapman says:

    I have coeliac. I am genuinely sensitive to gluten. I have never experienced any reaction to gluten in soap, shampoo or anything else I didn’t eat. But then, unlike these fad gluten sensitivity self-diagnoses, I have a genuine medically diagnosed condition, rather than neurosis and hypochondria.

    1. ConspicuousCarl says:

      Have you had any trouble with supposedly “gluten-free” foods still containing some of it?

      1. Melita Godden says:

        Yes, I do 20 ppm, is not gluten free. I keep away from them.

    2. Melita Godden says:

      You are lucky you know what your disease is until that happens you hunt for anything which makes you feel better thus appearing to be neurotic or a hypochondriac. autoimmune diseases are very difficult to diagnose.

  3. Jennifer says:

    I have gluten ataxia. It damages my nervous system and causes me to have MS type symptoms. My doctor showed me a study that concluded that gluten is the leading cause of neurological disorders. Not everybody needs to be gluten free, but those that do only need to eliminate gluten if they want to live a life free of disability. And that means all gluten. Just because you don’t have an issue with gluten doesn’t mean the problem doesn’t exist. In fact, if you read the paper I linked to, you will see that the incidence of gluten intolerance is much higher than previously thought. And previously, they thought it was 1 in 100 people.

    The following web page is not the same study that my doctor showed me, but it will educate you a little. It is thorough in explaining what gluten does to people who react to it.

    http://jnnp.bmj.com/content/72/5/560.full

    1. Jennifer says:

      Sorry, I skimmed over the article the first time while my son was talking to my husband. I got the wrong impression. Too distracted…

      So far, I have not had reactions to gluten on my skin but I choose to use gluten free products anyway. However, you don’t always have to pay a premium for it. Head and shoulders and Dove are both gluten free. It just takes a little foot work to find the companies that are gluten free but don’t market it.

    2. Harriet Hall says:

      “gluten is the leading cause of neurological disorders”

      Wow! I would really like to see that study. How did ONE study manage to reach a conclusion about all neurological disorders? Was the study ever replicated? Do other studies disagree? Please see if you can locate that study for us.

      1. Windriven says:

        Hmmm, she said: “My doctor …”

        I wonder if her doctor is a physician or an ND, homeopath, chiropractor or other wannabe?

        The paper linked is not a study but a rather idiosyncratic review.

        A search of Pubmed on ‘neurological damage gluten’ returned 11 hits with only one at first blush suggesting investigational rigor. This was an observational study published in Lancet that demonstrated nothing more than mildly interesting correlation (this based on the abstract as I was unwilling to scale the paywall).

        This does not, of course, mean that there is no causative relationship, but if there is good evidence of it, Jennifer ought to cite it.

      2. mouse says:

        Celiac can cause malabsorption which results in B12 defiency, which can lead to neurological problems – but looking at the paper I found I was quickly in the weeds. That’s not what they are talking about?

      3. Jennifer says:

        http://brain.oxfordjournals.org/content/126/3/685.full

        Found it in the oxford journal. And no, my doc is not a homeopath. He is a neurologist.

        1. Harriet Hall says:

          @Jennifer,

          You said,”My doctor showed me a study that concluded that gluten is the leading cause of neurological disorders.”

          Thanks for finding the article. That is NOT what it said. Read it again, please; then come back and tell us what it actually said.

          1. Jennifer says:

            “Our finding that gluten ataxia accounts for up to 41% of cases of sporadic idiopathic ataxia makes it the single most common cause of ataxia in this cohort of patients.”

            1. Michael Busch says:

              To make it abundantly clear: “sporadic ataxia” is not the same as “neurological disorders”.

              The incidence of sporadic ataxias is measured a bit less than 20 per per-hundred-thousand people (I found a study report from Japan: http://www.ncbi.nlm.nih.gov/pubmed/18418674 ).

              Neurological disorders have total incidences of a bit more than 15 per hundred people. Migraines are the most common, if I read the overview reports correctly. (e.g. http://www.ncbi.nlm.nih.gov/pubmed/17261678 ).

              Notice the factor of 1000 difference between those two numbers.

      4. Jennifer says:

        I posted it in another reply. However, I don’t know if it’s been replicated. I’m not a doctor or scientist and only follow this stuff to learn how it things pertain to my health and my situation. Here’s the link again in case you can’t find it below.

        http://brain.oxfordjournals.org/content/126/3/685.full

        1. Harriet Hall says:

          If it was replicated, that would only confirm that gluten sensitivity “may account for a large number of patients with sporadic idiopathic ataxia.” That is only “a large number” of patients with one rare kind of neurologic disease. I suspect you mis-heard or mis-remembered what your doctor said. Did you read the study again?

          1. Jennifer says:

            The point I was trying to make by bringing this up was that it is not only celiac and IBS that have people avoiding gluten. Gluten causes ataxia/neurological disorders too.

            I constantly hear from “experts” in articles that if you don’t have celiac you shouldn’t go gluten free. I want to make sure people understand that gluten causes more issues than just celiac. In fact, gluten ataxia is one of the diseases that many people have never heard of. However when I say that gluten causes me to have MS type symptoms, then they understand. The general public has heard of MS, but not many have heard of gluten ataxia. But if you have it and don’t know to refrain from gluten, it is debilitating.

          2. Jennifer says:

            You may be right. I may have heard neurological disorder and not sporadic ataxia, even though sporadic ataxia is a neurological disorder. In my mind, I must have clumped the two terms together. That might have been the confusion…but it is still an interesting conclusion. Thank you for clearing it up.

      5. stanmrak says:

        The gluten study referred to didn’t reach a conclusion for ALL neurological problems… it said that gluten was a leading cause. You really should relax – have a Xanax.

        1. Jennifer says:

          I never claimed it said all neurological disorders are caused by gluten. I said the study concluded that gluten is the leading cause of neurological disorders.

          Sounds like you have the same problem I had of reading while distracted. The only difference is I chose not to attack the person who I misunderstood. Let’s keep this discussion on the up and up and not insinuate that other people need medication just because you did not take the time to read comments correctly.

          1. Harriet Hall says:

            @Jennifer,

            The study did NOT conclude that gluten is the leading cause of neurological disorders. It found that “gluten ataxia accounts for up to 41% of cases of sporadic idiopathic ataxia” which “makes it the single most common cause of ataxia in this cohort of patients”

            Please identify the statement in the article that makes you think it concluded that “gluten is the leading cause of neurological disorders.” Hint: “ataxia” is not a synonym for “neurological disorders.”

          2. Windriven says:

            “I said the study concluded that gluten is the leading cause of neurological disorders.”

            And you are dead wrong. That IS NOT what the study said. The study said that gluten was the leading cause of sporadic idiopathic ataxia – a teeny tiny fraction of all neurological disorders.

            Now how the authors could make even that claim escapes me – but then I am not a research neurologist. There was a much higher incidence of antigliadin antibodies in the sporadic idiopathic group than in the control. But even in the sporadic idiopathic group antibodies were only found in 41%. That is not a majority. In my estimation all the authors can legitimately conclude is that there is a significant correlation between the presence of antigliadin antibodies and sporadic idiopathic ataxia.

            “The only difference is I chose not to attack the person who I misunderstood.”

            If you feel attacked it is because you are out of your depth and you make statements that are not supportable. If you have questions about the author’s conclusions or the data that informed them, ask in an intelligent and reasonably respectful manner. I asssure you that you will be treated respectfully and get loads of useful information.

            1. mouse says:

              windriven “If you feel attacked it is because you are out of your depth and you make statements that are not supportable. ”

              Did you miss the part where stanmrack told her to have a xanax? That appears to be what she is responding to and I would take that as an attack.

              It appears there is just a small confusion due to a misunderstanding of Jennifer’s neurologist’s statement. Jennifer is being reasonable. I am happy that she supplied the source for her statement, so that clarification could be reached.

              Don’t know what stanmrack’s problem is…he’s usually so logical ;)

              1. Windriven says:

                @mouse

                Point taken.

          3. mouse says:

            @Jennifer – don’t let stanmrack bug you, he’s a crank who sells some kind of alternative diet/supplement program and believes in all sorts of alien/conspiracy theory stuff.

            Glad you posted your comment. I had never heard of Gluten Ataxia.

            1. Jennifer says:

              Thanks Mouse :)

  4. goodnightirene says:

    You would not believe what my companion on a trip to Door County (a tourist mecca in Wisconsin) paid for a gluten-free cherry pie (Door County is known for its pie cherries) for her (ack!) medical student son.

    I have the vaguest hope that he will come to his senses as he moves through his training, but in today’s “integrative” world, I’m not so sure.

    As to the fellow claiming weight loss who says, “ I’ve tried many different eating strategies, from low fat to low carb to vegetarianism to intermittent fasting – over the years.”–one wonders if he ever tried reducing calories? One also would like to know how much he lost (I’m “leaner now” is a bit vague) and whether or not he has maintained it?

  5. ChristineRose says:

    The reaction to the lip gloss is most likely to have been to carmine (cochineal). I haven’t seen any hard statistics but it’s common. It doesn’t say if she swallowed her lip gloss and had gastrointestinal symptoms or if she had topical burning as with the shampoo.

    Salon hair treatments contain numerous products that are known to cause allergic reactions, such as dyes (including carmine), latex, and numerous out and out irritants like ammonia and formaldehyde.

    Personally I have issues with carmine and chromium (mostly in the hexavalent forms, but I avoid the trivalents simply out of common sense) and both of these are usually celebrated as “safe” cosmetic ingredients. My net takeaway is that they put all sorts of horrors into cosmetics but the manufacturers are happy to leave out the benign and easily substituted gluten and tout their products as “healthy.”

    1. Epiphyllum says:

      I have a friend who makes cosmetics for sale at the local Farmers’ Markets and we have discovered that I am ridiculously sensitive to the comfrey that she puts in the lip balms and some of the salves. Leaves my skin looking and feeling like I have chemical burns. Needless to say I now check products for comfrey before applying.

      1. n brownlee says:

        Sensitivity to comfrey is not at all unusual- every herb gardener knows it, or should. A considerable percentage of people who handle the leaves will wind up looking like they have picked poison ivy. Small sets of the plant often have a little warning sticker. And anyone who’s making herbal products should make themselves familiar with ALL the properties of the herbs they’re using.

  6. Michael Finfer, MD says:

    One question I have about this topic is has celiac disease REALLY been under diagnosed in the past or has the way some people read the biopsies changed?

    My experience in looking at many thousands of duodenal biopsies during my career is that cases that look like classic celiac disease or that have intraepithelial lymphocytosis, defined as at least two lymphocytes for each epithelial cell nucleus, is fairly uncommon and have remained so for the almost 30 years that I have been doing this. Remember that there will always be SOME intraepithelial lymphocytes because that is how the immune system gains access to the gut contents.

    It could be that my clinicians have been biopsying patients inappropriately, diluting the abnormal cases so that they only seem less common, but it might also be that some pathologists have liberalized their criteria for intraepithelial lymphocytosis. I really do not have a feel for this issue, but I have to wonder what is really going on here.

    1. David Gorski says:

      Interesting thought. Not being a pathologist or a gastroenterologist who sees a lot of celiac disease, I don’t know that I can comment, other than by searching PubMed to see if there’s any evidence that what you speculate could be true.

    2. StellaB says:

      I tested a lot of people for antibodies. Over the years I saw one person with “IBS” who had florid CD and a couple of people with borderline antibodies and a whole lot of people who were antibody free.

  7. Angel says:

    Saw gluten-free DOG FOOD this weekend at PetSmart. Why do our dogs need to be gluten free exactly?

    1. David Gorski says:

      Hmmm. Odd that I never saw that one. I wonder what the prevalence of celiac disease is in dogs. :-)

      1. simba says:

        Irish setters can get it.

        There’s a big thing in the dog world at the moment against grain, soya, and ordinary meats like chicken or beef (like Lily’s Kitchen in the UK). It has to be venison, salmon, beaver, grain-free, meal-free- I even saw a tin recently in the pet shop which boasted it was 100% chicken breast, absolutely no nasty organ meats or leg meat (Applaws.) Why?

          1. simba says:

            Yeah, a brand called Canine Caviar does holistic tinned beaver. I suppose it’d be a godsend if you were looking to see if the dog had allergies to the food you were currently feeding.

        1. Frederick says:

          Since dog are not strict carnivorous, I don’t think cereal is bad, On the other hand cats are strict carnivorous, a lot more than dogs. But I give my cats high quality food from the vet and it does have cereal in it between all the meat, and i don,t care, they like it, and they are very healthy. Cats eat grass and other plant to “clean”, seem like cats need to puke once in a while lol.

          1. Jax says:

            Even the strictest carnivores (Hypercarnivores) are mostly only around 70% meat in their diet, the rest is vegetable / inorganic like ash/clay. It is not that they can only digest meat but that they can not synthesis some proteins/nutrients from vegetables so need meat for those items.

            They get most of this non-meat via eating the stomach contents of their kills but they also eat vegetable matter directly.
            Cats don’t generally eat grass to ‘clean out’ they do it for the nutrients. It was misunderstood for years because the grass stood out in vomit so it was a bad causation/correlation link. People didn’t see all the time cats eat grass and don’t vomit. There is some evidence of animals picking specific plants to induce vomiting, but this is a separate behavioural action.

            I had one cat owner say their cat was allergic to wheat, I have no idea if it was true, but suspect it wasn’t.

            (as a silly side not the Polar Bear has the most meat heavy diet at 90%)

        2. LovleAnjel says:

          But organs have all the nutrients! It’s what carnivores eat first in larger prey. That’s just dumb.

    2. stanmrak says:

      The same reason that they need pet cemeteries. Ask a dog owner.

  8. thor hauff says:

    Often the treatment cannot come with a definitive diagnosis due to testing cost. I work with many low, or even worse for insurance, just above low income families. They will refuse to be tested for CD due to the cost and do the next best thing when assessing for an allergic reaction to something, just stop the offending substance. If they improve with no other actions taken then tah dah that was what it was. After the fact, they are diagnosed with CD but yet never really tested for it. It makes it hard for the bean counters who are following ICD9 (soon to be 10) codes when they see a diagnoses of CD with no testing.

    1. Harriet Hall says:

      How does the cost of testing compare to the cost of gluten-free foods over a lifetime?

      1. Windriven says:

        “How does the cost of testing compare to the cost of gluten-free foods over a lifetime?”

        A question of academic interest but beside the point for many lower income people. For many in that circumstance it is easier to come up with an additional few dollars each week for gluten free bread – or simply to stop eating bread – than to come up with $200 all at once.

        It is criminal that people in this country cannot afford important diagnostic tests without having to have the power cut off or running late on the rent. I helped one of my employees who earns about $11 per hour select health care insurance off the WA exchange. There were no good choices, only a selection of less poor ones. If single payer isn’t the answer, I wish to hell someone would tell me what is.

        1. Frederick says:

          “It is criminal that people in this country cannot afford important diagnostic tests without having to have the power cut off or running late on the rent.”

          I could not agree more. As a Canadian, I’m always dumbstruck by the lack of universal health in a country as rich as the US. I mean, With all the money wasted on military, just cut like a small percentage of this ( of course NOT the percentage that goes to NASA of course), and US could have the best universal health care in the world. The money is right there.
          any that’s of topic.

          1. Republicus says:

            The irony there is that if they cut anything from defense, our health care is usually the first thing the generals seem to put up on the chopping block.

            That said, while some sort of single payer insurance is getting harder and harder for me to oppose, the few run ins with healthcare in Canada (and even one in the UK) has somewhat soured me on the nationalization of the healthcare itself–although I do worry that you can’t keep costs down without it.

            1. Windriven says:

              I too have been dragged kicking and screaming into support of a single payer system. And I harbor no illusion that it will be a panacea. The problems are vast and multifaceted. Moving to single payer would be only one step in cutting the problem down to manageable proportions.

              1. Republicus says:

                The tipping point for me has been the preventative value of being able to treat problems before they grow to be large ones. When one of our daughters gets a rash or I cut myself (like i did at thanksgiving), our first thought is which hospital to go to, not whether we’re should go at all. Without Tricare, though, I doubt we’d be that proactive, being far from wealthy otherwise.

                However, I do show more restraint when I’m being seen on base, because my experiences with military medicine inspire rather less confidence in me than private providers have.

                No offense to Dr. Hall, of course.

        2. Calli Arcale says:

          In one of the Discworld books (I don’t remember which one at the moment, but it might have been Men at Arms), Commander Vimes is wearing the fancy new boots his wealthy beloved has bought for him. Vimes grew up absolutely dirt poor, so he’s used to wearing boots with cardboard soles, boots that you can feel the cobblestones through. With the expensive leather boots, he can’t feel the cobblestones anymore and feels a bit lost. And he starts reflecting on how much the good boots cost. It was about ten times what the cheap boots cost, but the good boots will last twenty times as long. And that means that the poor actually spend more on boots than the rich do, and have absolutely no choice in the matter because they never have enough cash to buy the good boots that will last them years.

          So it’s like that. You can go gluten free in hopes that will solve your problems, which will cost you a bit more in groceries, or you can have an expensive test done to see if you really have celiac disease. If you don’t have the cash for the latter, well, the elimination diet is really your only option. Well, other than just ignoring the problem and hoping it goes away, which is of course also very popular among the low income, for obvious reasons.

          1. Simba says:

            Ahhh, the Sam Vimes ‘boots’ theory of economics. And the poor will still have wet feet.

      2. thor hauff says:

        Unfortunatley those that are in the need of testing do not see things in the light of long term costs vs short term. If they did I would see many more patients for preventative or health maintenance visits. I would much rather spend any hour educating a patient on healthy life style before seeing him or her for 4x15min acute care appointments due to the fact they are now ill with something that could have been prevented.

      3. stanmrak says:

        The real cost of eating cheap food is in the medical bills you get later on. The gluten issue doesn’t need to be proven. Just try going off it for 30 days and you will know one way or the other. Too many positive reports to ignore, IMO.

      4. Li says:

        My husband has celiac disease and our food costs haven’t gone up. You don’t need to buy special products if you do your own baking and eat from cuisines that aren’t gluten heavy (e.g. Mexican, Cuban, Indian, etc.).

      5. Lee says:

        You don’t have to get any special foods that are gluten free — just stop eating things with gluten in them. Just like you wouldn’t have to buy any special foods if you were allergic to peanuts, or chocolate, or alcohol. You don’t need grains — it is not an essential food group.

        1. WilliamLawrenceUtridge says:

          But mmmm, soooo delicious!

          Not to mention many processed foods, restaurant meals and even condiments have gluten in them. Soy sauce for instance. It can be hard to go gluten-free, which is why labelling is important.

    2. RFM says:

      It might be interesting to compare CD, etc. rates in the Untied States, before medical insurance was generally available; more recently, as people there begin to get used to not having to pay immediately for most medicine; and in other places (Canada, Europe, etc.) where medical care has not been liimited to a fortunate minority.

  9. Windriven says:

    @WLU

    Semi-apropos to today’s blog, I tried the 80% hydration bread recipe you suggested some weeks ago and found it quite good. I will likely play with the recipe using a Kitchenaid mixer as the every 45 minute folding pattern is difficult when good weather beckons.. But both crumb and crust were quite good. I would note that the amount of salt needs a kick. That will help flavor and would reinforce an already good crust.

    Baked at 475F with a cup or so of boiling water poured over a baking sheet with river stones for steam generation. Killed the oven at 15 minutes and cracked the door at 22. Removed bread when just still warm.

  10. Stella B says:

    If you give up gluten, you eliminate a vast range of junk food. It’s not surprising that this results in weight loss.

    My husband and I were chuckling over “gluten free” ham in the grocery store when we turned the corner and found an entire display of “gluten free” jam, but our favorite of all was “gluten free” flourless chocolate cake.

    1. Windriven says:

      I wonder which is cheaper, a gluten-free flourless chocolate cake or a chocolate hazelnut torte? ;-)

      1. Michael Busch says:

        I combine the two: flourless Nutella brownies.

    2. thor hauff says:

      I have found bottles of water that will label themselves as “fat and gluten free” in large bold letters.

      1. David Gorski says:

        Yeah, I’ve seen that too. It’s hilarious and shows what contempt some companies have for the intelligence of their customers.

        1. harriet huestis says:

          I chuckled aloud at the grocery store there was a sign for gluten free chicken.

          1. Toby says:

            In the major supermarkets in Australia (Coles and Woolworths) they have a freezer section labelled “Gluten Free” which is predominantly stocked with fake meats, most of which contain gluten and a few, like saitan, are almost entirely made of gluten (saitan is usually like 70-80% solid gluten). I laughed at the irony and then almost cried at the stupidity.

      2. Renate says:

        And I suppose you had to pay top dollars for those bottles, compared to water without that claim.

        1. TwistBarbie says:

          Gluten free water? That’s up there with “organic” sea salt.

      3. Frederick says:

        Huum i wonder if i could find so gluten free compressed air, LOL you know like in spaceballs

    3. Tay says:

      I have confirmed celiac disease. When I was diagnosed I was surprised to learn that a lot of foods we don’t think of as being wheat products do contain gluten. Pre-cooked meats are sometimes dusted in flour, or brined in broth that can contain small amounts of gluten. A marinade for a cooked meat might also contain soy sauce which generally contains gluten. A traditional “flourless” chocolate cake actually contains about a tablespoon of flour. I would be the last person to endorse avoiding chocolate cake, because it’s delicious, but that allergen labeling is actually meaningful to me and other celiacs.

    4. Li says:

      There are hams cured with soy sauce, which is not gluten free, hence the need for the label.

  11. Mike says:

    I’ve run into at least half a dozen people in the last few months who aren’t celiac but who have inexplicably given up gluten.

    Much of the junk food in the American diet contains gluten (or at least is not certified gluten-free). Consequently, a side effect of going gluten free may be weight loss associated with the reduced calories in the restricted diet.

    But as Gorski notes, the reduction in gluten itself is unlikely to cause weight loss.

    A more common symptom of celiac disease is weight loss, not weight gain. Thus, a celiac who finally eliminates gluten may be more likely to gain weight.

    1. stanmrak says:

      It’s not inexplicable. After you’ve heard enough reports from others about how much better they feel since giving up gluten and how life-long health issues disappeared after they did so, you get curious enough to try it yourself, unless your a hard-headed skeptic.

      1. Windriven says:

        “After you’ve heard enough reports from others about how much better they feel since giving up gluten”

        That’s our stan – if somebody believes it, it must be true!

        Space aliens
        Ghosts
        Astrology
        Morgellon’s
        Faked moon landing
        CIA created HIV
        US executed 9/11 atack

        The world’s full of crazies, stan. You’re kind of our poster child.

  12. Newcoaster says:

    I suspect many of the NCGS patients, typically self-diagnosed following a diet elimination, or dubious test from an alternative practitioner, really just have old fashioned Irritable Bowel Syndrome.

    And of course you will lose weight on a gluten free diet, it is eliminating a large volume of carbohydrates which are now thought to be more contributory to obesity than the previous bogeyman, fats.

    For people who actually have coeliac disease, this is a good time to be alive, as there is huge variety of GF products, and menu options at restaurants. My concern is what happens in 2-3 years, when the food faddists have moved on to the next big thing, and there is no longer much profit to be made from providing all the GF foods.
    The CD patients will be back where they were 5-10 years ago, limited options at their grocery stores, and probably no options at restaurants.

    1. Susan says:

      My 10 yo nephew is on a gluten free diet and he doesn’t have CD. I just got off of the phone with him and he asked me to try to get my sister to let him eat gluten again. Some integrative medicine practitioner is the one who recommeded it for issues that are unrelated to CD. I wish I could talk her out of it, but she buys into stuff that is not SBM, so it’s unlikely. If any of you have any ideas for talking her out of it, my nephew would be forever grateful.

      1. Michael Busch says:

        Is the kid at least getting all necessary nutrients from what he is eating?

  13. Hillary says:

    I buy gluten free body wash, but it’s because it smells good and doesn’t have those stupid plastic exfoliants in it.

    I do know a couple people with celiac disease who appreciate the extra labeling that companies do these days. I’m probably not the only one who’s managed to get body was in my mouth because I wasn’t awake when I took a shower.

  14. John Johnson says:

    This nonsense is exacerbated by the fact that the Disney Channel has commercials saying gluten free is a “healthy lifestyle choice.”

  15. mho says:

    Costco sells a brand of baby-wipes that are gluten and nut free.

    1. Windriven says:

      “Costco sells a brand of baby-wipes that are gluten and nut free.”

      They can only be used on girls?

      1. Frederick says:

        I saw what you did there… LOL you are a funny man Windriven

  16. David Lear says:

    “nocebo”? Huh?

    1. Sean Duggan says:

      nocebo definition

      Short summary, you know how a placebo can make you feel better even though it’s inert because you think it will make you feel better? Nocebo substances go the other way. People think it’s harmful, so they feel worse. As with the placebo effect, it really only works on subjective effects such as pain or nausea, or abilities that we already know can be affected by biofeedback, such as temporary changes in heart-rate and temperature.

      A common example that I’ve seen is that classic kid’s joke of telling someone you spat in their burger after they finished eating it. Logically, they know that your spit isn’t going to poison them, and that it didn’t taste any different, but they develop nausea. More extensive cases can lead to people developing hives and rashes because they’re convinced they’ve been exposed to an allergen. You could probably take it a step further and argue that hysterical blindness might come from the same source.

  17. Nutrition prof says:

    When my husband had GI symptoms for several months after taking antibiotics prior to a prostate biopsy(negative, phew)-we tried low fodmap, and his symptoms cleared up. I don’t know if low fodmap is the new fad, or I just got tired of his complaining (I’m a good wife, honest…but it was like taking my work home with me!), but while I’m waiting for the data, this seems to help. As an RD, the idea of it makes sense…the RDs writing about it seem reputable. After following you folks for a number of years, I’m still skeptical -but there appears to be a mechanism for this-and he can still drink beer.

    1. Iorek says:

      We did low FODMAP for a month or so in pursuit of a cure for my daughter’s tummy trouble last year. Unfortunately lots of people who are on it never get past the exclusion stage, which leaves them exposed to nutrition deficiencies down the track. We did the exclusion for a month and she felt no better/worse for it, though we developed a taste for spelt pasta and spelt sourdough bread which we continue to enjoy.

      Low FODMAP is pretty respectable and unless taken to extremes ie not moving on to the re-introduction phase, it’s a useful tool in the ‘sore/upset tummy’ toolbox.

  18. NotADoc says:

    The local food co-op carries, alongside the $7.99/lb strawberries and the non-fat water, packages of gluten-free . . . PAPER PLATES!

  19. Ruth Jones says:

    This is the study that is usually quoted to support the increased prevalence of celiac. It is based on serum samples, not biopsies.

    http://www.gastrojournal.org/article/S0016-5085(09)00523-X/abstract

    As to dog food, some people with celiac are afraid that if their dog licks them after eating dog food that contains gluten, that they will ingest enough gluten to have a reaction. (Probably the same people who assume every time they get an intestinal upset it was due to gluten contamination in something they ate).

  20. Sharon Hill says:

    Costco’s Kirkland brand shampoo is gluten free. Sent me for a loop, I tell ya…

    http://doubtfulnews.com/2013/03/gluten-free-shampoo-is-this-really-necessary/

  21. KillCurve says:

    My daughter is a celiac, so recently my wife and I attended a “Gluten-free expo” at a local convention center. I anticipated there would be lots of woo mixed in at the expo, but it was even worse than I had predicted. There was a ridiculous autism-anti-vaccine booth there, and a number of chiropractors, with their usual spinal totems on display, had booths setup along multiple aisles. There was also a booth touting “neuro emotional technique” or some similar nonsense.

    I’ll be honest, though–my family benefits by piggybacking on this gluten free fad, regardless of how ill conceived it is. The variety and accessibility of gluten free products, even compared with just a few years ago, is truly a boon to us.

    1. Frederick says:

      I know a women, She the best friend of my wife and medical doctor, with celiac, And as much as she dislike woo and pseudo-science, she admitted that she somehow liked that g-f woo, just because she can eat a lot more stuff now. My wife, she also happy because the brand El peto make really good gluten free chocolate cake, ( it is not as good as the real stuff, but still pretty good) so she can cook a cake at her best friend birthday now!
      my local groceries Store, part of Loblaws, they have tons of G-F product, from cookies to bread etc.

  22. My doctor recommended a gluten free diet and it did not help me at all. I can’t imagine how it would be worth paying a premium for gluten-free hair and skin products unless you had allergies. My friend’s son has celiac disease but he is the only one I know who truly cannot have gluten.

  23. Trish says:

    Have none of you ever licked your finger to unstick a page in a book? If lotion is on your hands, you can gluten yourself. When you are washing your hair and you accidentally get it in your mouth, that can also gluten you. While many doctors might not like to acknowledge that these products can help or prevent a random glutening, doesn’t mean that they aren’t of any value. My doctors didn’t even consider wheat to be my problem for years on end. Why do you always assume the doctor is right?! It primarily depends on how sensitive you are. Just like some people can get away with eating products that were done in a factory wheat and others can’t. Gullible? In many cases, I consider these people extremely mindful because they’ve learned from experience.

    1. LovleAnjel says:

      I did not know gluten was a verb.

      1. Jennifer says:

        I like to use glutenized as my verb, but many people use glutened when they have accidentally ingested gluten. In the world of gf dieters, gluten is a verb as well as a noun.

        1. Doug says:

          These comments don’t help to clear up a fairly complicated subject. The main article could have used a few edits too. It was fairly hard to follow the logic, but I’ll try. Basically you are saying that CD either is or isn’t under-reported and that the benefits of going gluten-free can or cannot be proven so therefore, punt! Or at least don’t pay more for GF stuff and don’t believe the hype.

          Then the comments follow: GF worked for me so it must be true or I tried it and it didn’t so therefore false marketing gobbledygook.

          Sticking with it and making it to the end (not sure why) but it never reconciled itself. There seriously wasn’t one thing that was resolved other than gluten isn’t the cause of most neurologic disorders. There was a bread recipe in there oh yeah and the usual diatribe about the US healthcare system single payer blah blah (remember one person’s cost is another’s revenue as as long as our government is bought and paid for by the corporations and not the people, it’s won’t happen so please stop discussing it as an option until we have reformed the government to allow it)

          I been gluten-free for a bit and now I try to avoid it (wheat and most other grain based carbohydrates) but am not a zealot. I like pizza and beer and cake. I feel better and have more energy when I am off gluten but that may just be that by focusing on that, I make better overall dietary choices (ie salads rather than sandwiches).

          All this leads me to a couple questions:
          1. does gluten (or any part of wheat or grains) cause a small amount of inflammation in everyone or is it just those with sensitivities? Or is the sensitivity that the inflammation in much greater in those with the CD or other GI problems and causes issues that interfere with other systems?

          2. Is GMO wheat introducing a higher level of gluten per pound (or however you would measure it) than wheat we have developed an evolutionary tolerance for?

          3. (ok 3 is more than a couple) Why are MDs given much more credibility than “integrative” or “functional” docs? Aren’t MDs the ones that have been shills for the pharma industry basically serving as vehicles to ply the population with drugs they don’t need for conditions they don’t have to put them on the path to dependance to make sure they remain a ripe revenue source for the healthcare machine (doctors, insurance companies, pharma, hospitals included) hippocratic oath be damned? (other than this is a blog developed by an MD?)

          1. Michael Busch says:

            1. No, people without gluten sensitivity do not have any measurable changes to their health on a gluten-free diet as compared to off it, assuming all dietary requirements are being met in both cases. And since most people who go gluten-free don’t actually have any measurable benefit from doing so, we can say that they do not need to.

            2. No, it is not. No genetically-modified (as opposed to conventionally hybridized) wheat strain has yet been approved for release anywhere in the world. This is trivial for you to check with access to the internet.

            3. Cut the science-denying nonsense. As amply discussed here and elsewhere, “integrative medicine” and “functional medicine” are not medicine – they are ways for pseudoscience to be given a veneer of respectability. Most MDs have credibility because they at least have been educated in programs that provide an appropriate knowledge of chemistry, biology, and how to actually practice effective medicine.

            You are wrongly attributing to the MDs and “Big Pharma” the wrongs of the quacks and the “dietary supplement” industry. And when MDs or pharmaceutical companies misbehave particularly badly, the writers here will tend to call them on their bad behavior.

            1. doug says:

              So if someone does go gluten free and feels better, what is the possible reason for this? Undiagnosed sensitivity? Whoey? Psychosomatic?

              Most doctor’s I have visited have never even bothered to ask me about my diet. They ask if I do drugs, drink, smoke but will look for pharmacological treatments way before ruling out things that may be in our food.

              Also, I am not attributing anything to the MDs that they don’t rightly deserve. The dietary supplement industry has more than their fare share of blame for the current health (or lack there of) of our global population. For that matter, the food industry probably gets most of the blame. But the over prescription of drugs by doctors is part of the problem. You’re sick, don’t worry I have a pill for that. And it’s backed by a bunch of scientific research.

              No where in my rant does it say of hint that i am a science denier. Quite the contrary actually but I think that is just as big of a mistake to say – you can’t explain this through science to therefore it must be untrue. Or of no benefit to anyone. I like to consider my environmental and other issues one of those being diet and where my food comes from. Also my functional doctor is a MD. Is he practicing medicine?

              1. Michael Busch says:

                “So if someone does go gluten free and feels better, what is the possible reason for this?”

                Possible reasons include undiagnosed sensitivity, placebo, or making better eating choices that did not actually require gluten avoidance.

                “Most doctors I have visited have never even bothered to ask me about my diet. ”

                Mine have. N = 1 personal experience is not a good judge of actual clinical practice.

                “Also my functional doctor is a MD. Is he practicing medicine?”

                Given that “functional medicine” can mean just about anything, as described by the experts here before (e.g. http://www.sciencebasedmedicine.org/?s=functional+medicine ), I cannot say what the practitioner you’re dealing with does. But the things that distinguish functional medicine from actual medicine are unsupported and sometimes quite dangerous pseudoscience.

                I am done.

              2. Doug says:

                Yep me too. My original point was that everyone was using the n=1 justification for why it is good/not. I wandered in here looking for some proof points to tell my friend who is being brainwashed by the Isagenix stuff to try to talk him off the cliff.

                I am feeling pretty good doing what I’m doing and as a 46 yr old dude who has never been in better shape or health, I think I’ll just carry on with my method of mixing science with good honest intuition and listening to my body.

          2. Dave says:

            Want to elaborate a little on conditions people don’t have for which they take medications they don’t need? The following are the most commonly prescribed drugs last year according to medscape:

            Hypothyroid medication levothyroxine (Synthroid, AbbVie) was the nation’s most prescribed drug in 2013

            Following levothyroxine as most prescribed were the cholesterol-lowering drug rosuvastatin (Crestor, AstraZeneca), the proton-pump inhibitor esomeprazole (Nexium, AstraZeneca), and the antidepressant duloxetine (Cymbalta, Eli Lilly).

            Rounding out the top 10 most prescribed drugs in 2013 (in order) were the asthma drugs albuterol (Ventolin, HFA) and fluticasone propionate/salmeterol (Advair Diskus, GlaxoSmithKline), the antihypertensive valsartan (Diovan, Novartis), the attention deficit drug lisdexamfetamine dimesylate (Vyvanse, Shire), the antiepileptic pregabalin (Lyrica, Pfizer), and the chronic obstructive pulmonary disease drug tiotropium bromide (Spiriva, Boehringer Ingelheim).

            I’m now a hospitalist but spent many years in primary care medicine. The bread and butter internal medicine practice sees a lot of acute problems such as acute upper respiratory ailments, urinary tract infections, acute sprains, acute headaches and vertigo, etc. The bulk of an internal medicine practice are chronic diseases which are hardly imaginary – diabetes, hypertension, coronary artery disease, peripheral vascular disease probably lead the list, followed by gastroesophageal reflux, osteoarthritis and the inflammatory arthritides, chronic pulmonary diseases (of which there are several), anemias, inflammatory bowel diseases, Parkison’s disease and other chronic neurologic conditions such as multiple sclerosis, seizure disorders, peripheral neuropathies, and various dementing disorders. There will be some patients with various cancers. There are a lot of people who have depression and anxiety, often presenting as physical symptoms. If you could elaborate on what spurious diseases and what unneeded medication you are concerned about your post might be better addressed. It’s also good in this website if you can present actual data, such as the number of prescriptions ordered for diseases people don’t have, rather than just making a statement like that.

            And PLEASE don’t bring up statins. That issue has been beaten to death in this website.

      2. David Gorski says:

        Neither did I. That’s the first time I’ve ever seen it used that way.

      3. ina says:

        it can become a verb. why not.

        1. mouse says:

          Clearly, we should never turn a noun or proper noun into a verb. Don’t believe me? You can use Google to research the information. (If only there was a shorter way to say that.)

          1. Simba says:

            Verbing weirds language, as Bill Watterson said.

    2. Michael Busch says:

      This is not a question of if doctors are always right or not, nor was Dr. Gorski making that false assumption.

      The problem is that something is being marketed as “gluten-free” to people who do not actually need to avoid gluten. If the apparent mindfulness is actually just a cover for lax regulations and a warning label being appropriated as a marketing fad, we have a problem.

      I personally benefit from increased availability of gluten-free food, but when I see tea being marketed as gluten-free I get annoyed – the labeling has been diluted to the point of being meaningless. Likewise with some of the other examples people have given here – “gluten-free water”, seriously?

      It’s also a question of dosage. Sensitivity limits do vary from one person to another, but you’re not going to give yourself a meaningful dose of gluten from licking a fingertip that was covered by 5 milligrams of lotion that was in turn a couple of percent wheat protein by mass. That’s 50 micrograms of gluten, or 200 times or so less than the daily ingestion limit at which challenge studies show any detectable changes in cohorts of people with celiac.

      That that level of transfer does not cause meaningful contamination is a very good thing. Policing my food for gluten is annoying enough without having to treat it all like fugu.

      And none of this applies to the particular case that Dr. Gorski has described. Gluten intolerance does not manifest with with any short-term reactions – celiac is a slowly-moving disease. Anyone who claims otherwise has a very heavy burden of proof to deal with.

      Non-gluten wheat allergies operate differently, but there using the “gluten-free” labeling is a mistake too.

      1. Calli Arcale says:

        Actually, a really severe case can present very suddenly and dramatically. My cousin is like that. She developed a high fever and an ileus at the age of six months when she had her first exposure to wheat cereal. At first, the doctors thought she had meningitis, but when they realized her gut had shut down, ordered a colonoscopy, and that’s when they saw the characteristics of celiac disease. This was before it was fashionable, BTW. I think she was an unusually severe case, though.

        1. Michael Busch says:

          I should have been more specific:

          Challenge studies show that celiac in adults presents with detectable reactions only after 10 days or so of gluten exposure above 10-100 milligrams per day with the threshold varying by that factor of ten or so from one person to another, given a previous diagnosis of celiac and at least a year of previous gluten-avoidance to establish a baseline (e.g. http://www.ncbi.nlm.nih.gov/pubmed/16480395 ).

          Numbers for childhood onset would be harder to quantify precisely, since an appropriately-controlled challenge study would likely not be possible and would also not be ethical.

  24. JenJen says:

    I went gluten-free for several months back in 2008. I wanted to see if it would help my IBS symptoms. It did not. I did lose the weight I was trying to lose, but that was because I was also following a healthier diet with lower sugars and fewer calories and no “junk food”. Then all this GF food (including GF junk food) started flooding the stores. I don’t get the whole “eating GF is a healthy lifestyle”. I mean if you actually have celiac or your kid has it, then definitely avoid gluten. If you want to see if it affects you, do your own temporary gluten-free diet.
    It kind of amuses me when people think they will lose weight from just going gluten-free. Not if you buy gluten-free desserts and keep eating the same amount of calories as before.
    Side note: my IBS is much much better now that I eat fewer processed foods, hardly ever eat “fast food”, don’t eat too many fruits and veg, and don’t eat “whole wheat” bread or things with lots of wheat bran. Also, I include cultured dairy products such as high quality yogurts with no added sweeteners, and kefir, etc. in moderation.
    I am also amused as some of you folks were above in the comments, by all the labeling of foods as gluten free, when there is naturally no wheat or barley or rye in it in the first place, such as a flourless cake, or fruit juice, and on and on.

  25. Doug says:

    Wow! Which part of my comment made it deletable?

    1. Doug says:

      sorry must have been in the moderation queue. withdrawn

  26. Elizabeth says:

    My brother has been anaphylactic to gluten (and other things) since infancy. He is 25 years old, and has managed to effectively avoid gluten, nuts, and fish for all of those 25 years, with the rare exception that resulted in hospitalization. He has certainly benefitted from the gluten free fad, as he is now able to eat in restaurants, and people seem to have a bit of a better understanding of food restrictions (we still emphasize that it could kill him, though).

    With this, he has had to be very careful with the ingredients in everything that touches his body. His allergy is severe enough that baking (and having flour in the air) has resulted in hospital trips in the past. I remember accidentally scratching him with my fingernails once, and his skin swelled and blistered. I had just eaten a sandwich, so my fingers were covered in wheat. Gluten in shampoo has resulted in blisters covering his scalp.

    I am the first to explain to people in my social group why the gluten-free fad is dangerous and ridiculous, but I do have to admit that clearer labelling of skin care products, etc. will help my brother’s life. (Though I doubt anyone in my family will ever rely on a label and ignore the ingredients list).

    1. Michael Busch says:

      “My brother has been anaphylactic to gluten”

      I do not know the medical history of your brother, but as Dr. Gorski has described, gluten reactions do not generally produce anaphylaxis, nor give a surface contact reaction. What you describe sounds much more like a very severe wheat allergy, which is not the same thing.

      This matters. While gluten is present in wheat, rye, and barley (and products contaminated with them), the various other compounds in wheat that may be provoking a severe allergic reaction are present in different combinations of other plants – i.e. avoiding gluten-containing-foods may be excessive, or not enough. And the threshold for exposure is likely to be quite different than the FDA “gluten-free” labeling requirements, which are based on those of us with celiac.

      It’s good that it’s your brother is apparently doing well now. But it’s important to not confuse the cause.

      1. Elizabeth says:

        You bring up a good point, and I did check with my brother. Interestingly enough, on all of the testing he comes up as allergic (severely) to all fish, all nuts, wheat, barley, rye AND gluten (he is anaphylactic to all of these). He is extremely careful with more than just gluten and, as I said before, will never rely on a label saying “gluten free” when the ingredients lists are easily accessible and more extensive. It is nice to have that search narrowed down a bit with the labeling, though.

        I know this thread is pretty old now, but I figured I would respond with a clearer explanation.

  27. Autism mum says:

    “…how easily it fits within the niche of “autism biomed” quackery”

    From Autism Speaks, Sept 2013: “In the largest study of its kind, researchers found no link between autism and celiac disease, a severe intestinal disorder triggered by an immune reaction to gluten. ****However, the study also confirmed a strong association between autism and the presence of antibodies to gluten. Such antibodies indicate a significant immune reaction to the protein, which is found most commonly in wheat.****

    The report, by researchers at Sweden’s Karolinska Institute, appears today in the journal JAMA Psychiatry.

    “In the past, we have had the believers and nonbelievers when it came to the role of gluten in autism,” comments gastroenterologist Alessio Fasano. “Hopefully this paper can clarify, once and for all, that a subset of those with autism has gluten sensitivity, a condition triggered by gluten but distinct from celiac disease.” Dr. Fasano is chief of pediatric gastroenterology at the MassGeneral Hospital for Children, home of the Lurie Center for Autism, an Autism Speaks Autism Treatment Network site.

  28. WhatPaleBlueDot says:

    My husband has celiac. As a result, our home is as close to gf as we can manage. I try to find face and skin products that are gf, as the primary cook, because I just don’t want to risk handling food or kissing ‘dirty’. I also won’t use leave-in hair products with gluten, because hair ends up in food. It’s just an additional precaution that doesn’t cost me anything. Our pets are on gf foods for similar cross contamination concerns. We’re less worried about the dog than the cats tracking everything they touch everywhere. Cats are filthy. The dog, however, does better on grain free anyway because boxers are broken. Luckily, gf is becoming common enough that none of these adjustments cost extra, unlike the changes to our diet. (I eat normally out of the house.) It’s a minor step that has at least made us feel better about the whole thing, and possibly has helped keep my husband’s antibody levels near zero since diagnosis.

    That said, I spend a lot of energy discouraging people from trying gf diets and correcting people on what is and isn’t based on solid science. I also mock people who claim to have been glutened walking past the bakery. STFU.

  29. Eyelash says:

    We could probably all argue about, and discuss this issue for the rest of our days. The main question to ask ourselves is: “Is there a sufficiently large proportion of the population who could (or do) suffer from gluten in skin and beauty products to justify making and marketing these as such?” The answer is probably no.

    1. mouse says:

      In an area with a reasonably high population density, you don’t need a large proportion of the population to demand a product. Even a small proportion of a large population may support profitability. That’s a niche market.

  30. WorriedGD says:

    I have Graves’ disease (GD) and thank you for writing this because trying to cure GD or for that matter any thyroid issue with diet is a growing concern specifically with the ‘Gluten Free Fad Diet’.

    For me I have chosen ATD therapy and I am happy with my decision. I belong to a number of thyroid groups (hyper and hypo), most of which I lurk around to only listen. Some I participate in trying to offer some advice. But one thing I haven’t touched on is diet, only because it is a touchy subject with many people. So I have frantically been searching for truth – perhaps to d-bunk this notion of diet can cure autoimmune diseases.

    There are many people who rely completely on diet alone and refuse meds usually at the advice of their NP. There are people with NO thyroid who refuse meds and swear by g-f.

    I hear statements daily such as, “I feel so much better and my doctor is lowering my ATD because of going g-f.”

    When I hear this it makes my skin crawl, I feel like jumping through my screen, grabbing their shoulders and saying, “Your meds ARE working, not the g-f!” But I just sit tight, patiently waiting for someone to write up a nice and simple study (not for my sake). I have actually opted out of a few sites because I just couldn’t take it.

    I have seen people go into thyroid storms, have heard of people dying all because they chose the new ‘Forth’ option in treating this disease.

    I fear for these people. So I find myself lurking in other autoimmune groups. I suppose out of curiosity to see if they too are talking about g-f, and of course they are. And don’t get me started on the Paleo diet. Add in Dr. Brownstein pushing iodine on these people claiming that too is a cure for thyroid issues.

    Many people have not only removed wheat, but dairy, corn, some remove meat. GD is notorious for vitamin D deficiency. So how are they getting it if they have removed all the foods which contain it? Perhaps some are supplementing but for most part a lot of people in this group never have had this tested, and never realized this is an issue.

    It seems to me our healthcare will be bursting at the seams with nutrition deficiency issues. And as you know levo is the highest prescribed drug calculated that in with the amount of people with autoimmune disease and we will end up with an epidemic on our hands if someone doesn’t speak up.

    So if anyone can offer suggestions, advice, studies that can help, I will be forever thankful.

  31. Christina says:

    I have ulcerative colitis rather than celiac. There are studies that suggest having UC or Celiac increases your chances of having the other disease and that some people with UC do better when they cut out gluten. My UC has been in remission from active flare for many years but I had a number of more irritable bowel type symptoms such as bloating, gas, and frequent bowel movements without diarrhea. I went gluten free to see if it would improve those symptoms and it did. The couple of times I have tried to eat something with gluten in it since I went gluten free brought on a fairly rapid and intense onset of abdominal pain and diarrhea so I am staying off gluten. My gastroenterologist agrees with my decision. I buy gluten free beauty products when I can find them at a reasonable cost to avoid the cross contamination issue as mentioned in an early comment. Gluten free is definitely a fad diet for a lot of people and I can understand the scientific complaint, but I hope it is a fad that lasts because the food labeling and alternatives that have come about due to the fad makes my life much easier.

  32. amy says:

    My sister in law and brother have their children on a gluten and dairy free diet and have been doing so for at least 3 years now. I have seen the young ones get cavities in their baby teeth, their teeth are very yellow, they’re growth seems minimal, one needs an Xray because it appears the bones in his shoulders are developing differently, and they are developing these pot bellies that you see in malnutritioned children in Africa.

    They eat healthy otherwise.. lots of fruits, vegies and not too much meat. But they are always starving, and they consume way much more sugar since all of the gluten free products contain sugar as a substitute and the sis in law bakes a whole lot of goodies without gluten.

    I am starting to get concerned for their health but I’m not sure if I am just seeing things and being anecdotal with my observations.

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