Nonceliac Gluten Sensitivity (Intolerance) (cont.)

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Is nonceliac gluten sensitivity real?

I suspect that a common reason for self-diagnosing gluten sensitivity is the placebo effect. The placebo effect is much greater for subjective symptoms (such as those of patients with self-diagnosed gluten sensitivity) than is appreciated. It is seen in 20% to 40% individuals. That is, of patients who report an improvement in symptoms by eliminating gluten, 20% to 40% are NOT improved. They THINK they are improved. (Purists may argue that it doesn't matter if they really are improved as long as they think they are improved.) It also is possible that some of the placebo response is real and due to psychological reasons. For some patients, the placebo effect is enough, and they don't mind the dietary restrictions of a gluten-free diet. I don't see those patients in my practice.

Of the patients that I do see who report that their symptoms have improved on a gluten-free diet, almost all have had their symptoms return or continue with reduced severity despite continuing the diet. There are two potential explanations for recurrent or continuing problems; either the placebo effect is wearing off or something other than gluten sensitivity is going on in addition to gluten sensitivity. What else might be occurring?

What other diseases mimic celiac disease?

There are numerous gastrointestinal diseases that could be causing symptoms similar to celiac disease. The intestine has a limited repertoire of symptoms with which to respond to disease, so it is not surprising that symptoms of many intestinal diseases can mimic those of food intolerances like gluten sensitivity. That's why it is important for individuals to be evaluated by their physicians to exclude intestinal diseases even if they think the problem is food intolerance. A gluten-free diet not only reduces the intake of gluten, it also alters the intake of other nutrients. It is possible that the alterations of these other nutrients and not the reduction in gluten affects the symptoms of other intestinal diseases, for example, inflammatory intestinal diseases such as inflammatory bowel disease.

Medically Reviewed by a Doctor on 3/19/2014

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