Going Against the Grains: Gluten-Free Diets in Patients Without Celiac Disease-Worthwhile or Not?

Dig Dis Sci. 2019 Jul;64(7):1740-1747. doi: 10.1007/s10620-019-05663-x.

Abstract

While the gluten-free diet (GFD) is the only known effective therapy for celiac disease, in recent years it has become increasingly popular in the USA and worldwide, with many believing it to be more "healthful" and others claiming that it has beneficial effects for health conditions, many extraintestinal, other than celiac disease. This review examines the evidence for use of the GFD in patients without celiac disease who self-report intestinal and/or extraintestinal symptoms (non-celiac gluten sensitivity), as well as for enhancement of athletic performance and treatment of autism, rheumatoid arthritis, and psychiatric disorders. Overall, the evidence for use of GFDs in conditions other than celiac disease is poor. Though non-celiac gluten sensitivity may ultimately emerge as a biomarker-defined condition, a large proportion of patients with apparent non-celiac gluten sensitivity have, after careful investigation, an alternative diagnosis. In light of this, and coupled with the potential physical and psychological harms associated with the avoidance of gluten, initiating a GFD should not be encouraged for people who have these other conditions or are seeking physical/athletic enhancement.

Keywords: Autism; Gluten; Gluten-free diet; Non-celiac gluten sensitivity; Rheumatoid arthritis; Schizophrenia.

Publication types

  • Review

MeSH terms

  • Animals
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / diet therapy*
  • Arthritis, Rheumatoid / immunology
  • Athletic Performance
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy*
  • Celiac Disease / immunology
  • Diet, Gluten-Free* / adverse effects
  • Humans
  • Nervous System Diseases / diagnosis
  • Nervous System Diseases / diet therapy*
  • Nervous System Diseases / immunology
  • Nervous System Diseases / psychology
  • Patient Selection
  • Physical Conditioning, Human / adverse effects
  • Physical Conditioning, Human / methods*
  • Risk Factors
  • Treatment Outcome
  • Wheat Hypersensitivity / diagnosis
  • Wheat Hypersensitivity / diet therapy*
  • Wheat Hypersensitivity / immunology