Sunday, October 24, 2010

Doctor Versus Doctor And Lame Journalists

A colleague sent me this article:

"Q. Other than celiac disease, is there any reason to avoid gluten in the diet?

"A. 'Though the hype continues on gluten-free diets being the panacea for all ills, science still lags behind in concrete evidence supporting this belief,' said Dr. Vandana Nehra, a gastroenterologist who specializes in celiac disease at the Mayo Clinic in Rochester, Minn.

Dr. Nehra said it was 'unclear if the benefit of a strict gluten-free diet in conditions other than celiac sprue may be related to the avoidance of carbohydrates and thus eventually to weight control' or was 'merely a placebo effect as individuals feel better eating a healthier diet.'

Gluten, a protein in cereal grains like wheat, barley and rye, has been blamed by some individuals for everything from indigestion to arthritis to depression. However, these people often do not have any allergic sensitivity to gluten, nor do they have celiac sprue, an autoimmune disease that damages the small intestine and interferes with food absorption. Gluten is known to aggravate intestinal irritation in the disease."

There are so many issues with just this part of the article it's tought to know where to start. First, the "if your symptoms don't match our diagnostic framework you must be crazy" approach to medicine drives me nuts. It's not scientific, for starters. Dismissing evidence contrary to your hypothesis is pretty much the definition of unscientific, in fact.  Second, I've never heard a single person claim that a gluten-free diet is "the panacea for all ills", so that's a straw-man argument.  Third, if it's 'unclear' to Dr. Nehra if it's only a placebo effect, she should consult with Dr. Fasano:

"'In your medical practice, how do you determine if a patient has non-celiac gluten sensitivity?'

“'Because gluten sensitivity is not a food allergy (like wheat allergy), or an autoimmune process secondary to exposure to gluten (like celiac disease), the diagnosis is based on exclusion criteria. In other words, people that experience symptoms that are suspected as being related to gluten exposure will be tested for wheat allergy and celiac disease. If they are negative for both, gluten sensitivity is considered. The diagnosis will be confirmed if symptoms resolve following the embracement of a gluten free diet.'"
Fasano is one of the leading researchers on celiac.

I don't mean to pit Drs. Nehra and Fasano against each other, however.  I'd wager that 90% of any difference in opinion between the two of them is the result of the journalist at the Times doing a bad job of asking questions of Dr. Nehra, and of conveying the answers, never mind trying to get more than one source.

Celiac and wheat sensitivity are difficult, complicated issues, and there's a lot more going on than what is conveyed in this New York Times article.