Celiac.com 03/06/2012 - I was disappointed to read the opinion article by Dr. Di Sabatino and Dr. Corazza published in February 2012 by Annals of Internal Medicine (1). The article itself is mostly reasonable and thoughtful. However, they implicitly assert gluten to be a healthy food by stating that they wish to prevent "a gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population" (1). In that single statement they are making dietary recommendations in the absence of evidence; the very situation they claim to want to rectify.
Their published opinion has spawned a number of articles online and in the popular press which seem to ignore all of the concessions to non-celiac gluten sensitivity in the source article. Some of these spin-off commentaries even use the original article to support their suggestions that a gluten free diet is inappropriate even for those with symptoms that are relieved by the diet. This definitely contravenes the opinions expressed by Di Sabatino and Corazza. For instance, one of them states "That hasn’t stopped many people from declaring they are gluten sensitive, even though they may not be." (2)
Doctors Di Sabatino and Corazza not only acknowledge non-celiac gluten sensitivity as a cause for symptoms very similar to those of celiac disease, they call for further research to develop and codify diagnostic protocols that will help clinicians better recognize and treat this newly recognized ailment. They go on to acknowledge that conditions including "headache, lethargy, attention-deficit/hyperactivity disorder, ataxia, or recurrent oral ulceration" in the absence of celiac disease often improve or resolve on a gluten free diet. Their unfortunate denial of gluten as toxic seems to have invited much of the spin-off conjecture under such titles as "Gluten-free diets not always necessary, study suggests" (3). Even the characterization of this opinion article as a study is misleading in the extreme.
Di Sabatino and Corazza focus mostly on gastrointestinal symptoms when discussing non-celiac gluten sensitivity. It is clear that their focus does not extend far beyond such symptoms. What is also clear is that many cases of non-celiac gluten sensitivity, just like celiac disease, manifest with a wide range of signs and symptoms including neurological illnesses. Dr. Marios Hadjivassiliou, chief neurologist at the Royal Hallamshire Hospital in Sheffield, U.K. has repeatedly demonstrated that a majority of his patients with neurological disease of unknown origin show evidence of gluten sensitivity, the majority of whom do not have celiac disease (4).
My disappointment stems not so much from doctors Di Sabatini and Corazza's article and their assertion that gluten grains are not toxic to the general population, as from the spin-off claims that the gluten free diet is being excessively followed in the belief that it is more healthful. A rapidly growing body of evidence is showing that increasing numbers of ailments among increasing numbers of people are driven by this ubiquitous food. Gluten may well be toxic for most of the population. We don't know. We can't know that without more research.
The growing numbers of people who are willing to accept the inconvenience and expense of a gluten free diet because of the benefits they experience should be considered. Gluten may be toxic to many more people than are currently identifiable by available testing. Asserting one side or the other of this argument is at least premature. At most it could prove very harmful to those individuals who listen and obey the voices of experts, even when they err and when relayed inaccurately by the media.
For a more detailed account of this controversy please see the spring 2012 issue of the Journal of Gluten Sensitivity.
- Di Sabatino A, Corazza G. Nonceliac Gluten Sensitivity: Sense or Sensibility? Ann Intern Med. 2012;156:309-311.
- Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.