The Gluten Effect: A Book Review

Celiac.com 06/27/2020 - A new book on gluten and health called The Gluten Effect by doctors Vikki and Richard Petersen, has just hit the market.  The Gluten Effect is an excellent primer for those who want to learn the basics of gluten sensitivity and celiac disease, otherwise known as the ‘gluten syndrome’.  Doctors Petersen offer excellent graphics, a detailed explanation of regulatory T cells, and a good description of the dynamics of oral tolerance for the lay reader.  

The doctors Petersen surprised me with some startling statistics.  For instance, I was not aware that 80% of lymphoma patients are gluten sensitive.  This is an enormously important assertion and I will be reading their source materials diligently and reporting further on this finding in the summer issue of ScottFree newsletter.  

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On the other hand, I was not surprised to learn that 69% of Americans have digestive problems.  Extensive and expensive advertising for a wide range of over-the-counter and prescription medications to relieve heartburn, indigestion, constipation, and diarrhea leave little doubt that there is a huge market for these products.  This specific frequency of digestive problems offers a sharp, contrasting backdrop against which we can evaluate estimates of the prevalence of gluten sensitivity and its celiac disease subset.  

I was also pleased to read these authors’ discussion of the current allopathic focus on “objective” laboratory results while almost ignoring symptoms during the diagnostic process.  Then they examine the prevalent practice of treating symptoms.  They offer an excellent metaphor that illustrates their position:  A patient’s foot is painfully pinned by a large boulder.  They ask if it makes more sense to administer pain medications or to remove the boulder.  The self-evident answer is a powerful critique of much current medical practice.  Doctors Petersen offer a number of such illustrative examples, making their arguments considerably more powerful and persuasive.  They go on to question the common allopathic practice of chronically suppressing the immune system with drugs, especially systemic steroids.  They acknowledge the therapeutic importance of such drugs while raising some very valid concerns about the sometimes inappropriate use of these chemical agents.  

They also offer a good discussion of current antibody tests of serum, feces, and saliva, along with a brief discussion of scopes and biopsies.  This survey of current tests and diagnostic procedures, along with an overview of the strengths and weaknesses of each, is particularly empowering to those who are exploring the possibility that gluten may be a contributing factor in their health concerns.  

They go on to limit their own prospective reading audience saying that those who have a diagnosis of celiac disease from their doctors are unlikely to be reading their book.  I couldn’t disagree more.  It is a book that offers insight into the disease process, awareness of connections with other forms of autoimmunity, and important suggestions for maintaining and improving one’s health in the context of all forms of gluten sensitivity.  I was particularly pleased to see their assertion that 16% of those with autoimmune hepatitis are gluten sensitive.  This is a connection that has long been recognized in the medical literature, but is usually ignored or neglected in medical practice.  

Obesity, in association with gluten, is another frequently neglected area that the Petersens cover in some depth.  As some readers will know, my mother experienced effortless but substantial weight loss after beginning a gluten-free diet for her gluten sensitivity and arthritis.  The Petersens also discuss and explain some connections between gluten sensitivity and heart disease, dementia, hormonal imbalances, osteoporosis, autism, ADD/ADHD, memory loss, depression, skin disorders, and IBS.  Almost every important point they make is supported by carefully selected case histories that both illustrate the impact of a gluten-free diet, and the limitations to quality-of-life for those who continue to follow a regular diet.  
 
Their detailed discussion of bone density in relation to gluten sensitivity was also most gratifying to read.  Although they recommend magnesium supplementation, they do not discuss its value for re-mineralizing bones.  However, they report a very high rate of gluten sensitivity among those with early osteoporosis and even report childhood calcium deficiency and reduced bone density among children with celiac disease.  

The doctors Petersen also offer some detailed instructions and guidance regarding a gluten-free lifestyle and their advice comes from living our lifestyle.  This is a rarity among practitioners and the invaluable insights gained from this practical experience show through in their comprehensive chapter on this issue.  

Unfortunately, very early in the introduction, the authors provide an outdated statistic claiming a 1 in 250 incidence of celiac disease in the US.  They cite a 1999 publication by S.  Helms rather than providing the newer information from the following year, published by Fasano et.  al.  that suggests a US incidence of 1 in 133.  Please do not let this unfortunate choice dissuade you from reading this very valuable book.  Later in the book, they cite a U.S.  incidence of celiac disease of more than 2%, based on Dr. A.Vodjani’s work, thus offering something of a balanced view on this issue.

In closing, I would like to point out that there are several issues raised by the Petersens where I disagree with their stated or implied biases.  For instance, they depict immune reactions against gluten as suggestive of a defective immune system while I see the adoption of cereal grain consumption as the underlying problem.  In my view, gluten grains are simply not a healthful food.  We certainly did not evolve eating grains.  The vast majority of the world’s population has not had sufficient time to adapt genetically to this food that is better suited for ruminants.  Most human exposure to these foods ranges from less than 20 generations.  Many people of European descent have had much longer exposure to these grains, but even that is quite variable and is often depicted as a contentious claim.  However, there can be little doubt that it is only with the advent of modern technology and economies of scale that grains have formed such an enormous portion of human diets.   

In all, The Gluten Effect is a valuable contribution to the gluten-free community, offering new information on a solid platform of insight and understanding of gluten-induced illness and the gluten-free lifestyle.  While each of us has differing tastes in writing styles, The Gluten Effect is rife with awkwardness and contains a substantial number of mechanical errors.  I found those errors to be a jarring distraction from an otherwise impressive book.  Nonetheless, I highly recommend this book to everyone with gluten sensitivity, celiac disease, or chronic health problems.  It offers valuable insights and important strategies for recovering and/or maintaining good health.