Trend towards a gluten-free diet requires more tolerance from clinicians

IBS

8 Sep 2016

Evidence that the increasing popularity of gluten-free diets is not driven by rates of coeliac disease creates a challenge for clinicians – how to respond to the hype around gluten intolerance.

But Professor Katie Allen, director of the Centre for Food and Allergy Research at the Murdoch Childrens Research Institute, said it was not helpful for health professionals to be dismissive of community concerns.

“It is our responsibility to examine these unresolved concerns especially as a perceived intolerance to gluten is equally, if not more, common than coeliac disease,” she told the limbic.

She said there was a mismatch between patient expectations and what the medical profession was currently delivering.

“Training regarding food allergies and intolerances has not kept up with their incidence in the community. There isn’t sufficient research and we don’t have good diagnostic tests. People will vote with their feet.”

Professor Allen was commenting on a US study published this week in JAMA Internal Medicine that found the number of people choosing gluten-free diets without a diagnosis of coeliac disease had trebled between 2009 and 2014.

Yet rates of coeliac disease in the NHANES cohort study of over 22,000 adults and children had remained stable at about 0.7%.

The researchers suggested public perception that gluten-free diets were healthier, wider availability of gluten-free products, and self-diagnosis of gluten sensitivities were combining to drive the trend.

Professor Allen said the study showed Caucasian women aged 20-39 were most likely to adopt a gluten-free diet for health or lifestyle reasons.

“These people have undifferentiated conditions that we need to understand. Some will be seeing naturopaths or alternative health practitioners and may be recommended a gluten-free diet without the rigour of elimination and re-challenge diets or tests for other conditions.”

She added that fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) were another dietary explanation for gastrointestinal discomfort in some individuals.

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