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  • Jefferson Adams
    Jefferson Adams

    Characteristics of Patients Who Avoid Wheat and Gluten in the Absence of Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Celiac.com 02/11/2014 - More and more people are reporting gastrointestinal symptoms that improve when wheat and/or gluten are removed from the diet. There is a diverse group of people who avoid wheat and/or gluten (PWAWGs), and who predominantly self-diagnose prior to presenting for clinical evaluation for celiac disease.

    Photo: CC--mag3737A team of researchers recently set out to compare patients who avoid wheat and/or gluten against patients with celiac disease, and with healthy control subjects. The research team included A. Tavakkoli, S.K. Lewis, C.A. Tennyson, B. Lebwohl, and P.H. Green, all with the Department of Medicine of the Celiac Disease Center at Columbia University in New York, NY.

    The team set out to characterize PWAWGs who were receiving treatment at a tertiary care referral center and to compare them to patients with celiac disease, and with subjects from the National Health and Nutrition examination survey (NHANES). The team conducted a cross-sectional study to evaluate patients seen by four gastroenterologists at a celiac disease referral center. They compared baseline characteristics, laboratory values, and medical comorbidities for these patients against results for celiac disease patients who presented at the same center, as well as for subjects enrolled in NHANES.

    The team compared results for eighty-four PWAWGs against results for 585 celiac disease patients and 2,686 NHANES patients. The found that doctors made a total of thirty-two alternative diagnoses in 25 PWAWGs (30%). Diagnoses included small intestinal bacterial overgrowth and fructose/lactose intolerance.

    When compared to patients with celiac patients, PWAWGs had similar body mass index (BMI, 23.1 vs. 23.5, p = 0.54) and mean hemoglobin value (13.4 vs. 13.3, p = 0.6). When compared to male and female patients in NHANES, PWAWGS showed lower BMI, folate, and mean hemoglobin values, while both male and female PWAWGs had a lower prevalence of hypertension.

    While there are similarities between celiac disease patients and PWAWGs that could arise from shared HLA haplotypes or result from the gluten-free diet, alternative diagnoses are common in these patients. PWAWGs have a similar cardiovascular profile as celiac disease patients in terms of lower BMI and lower prevalence of hypertension.

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    Obviously the whole study is not presented, but the article leaves me asking some questions. The alternate diagnoses do not explain why the PWAWGs improved on a gluten-free diet. Were the confirmed celiac patients also tested for intestinal bacteria overgrowth and fructose/lactose intolerance? Without that data it is impossible to assess the significance. The article seems to suggest that having any of the alternative problems precludes having a problem with gluten intolerance. It is my understanding that the diagnosis of NCGI requires two stages (1) improvement on gluten-free diet and (2) a gluten challenge to see if symptoms return. Is this study saying that they dismissed NCGI purely on the basis of the presence of other possible diagnoses?

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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