Gluten free diet is a cure not a poison!

In the April issue, GHFBB is publishing a number of papers that focuses on the clinical and immunohistochemical diagnosis of gluten-related disorders. Dietary intervention for example, has revolutionised the treatment of patients with disabling irritable bowel syndrome (IBS). Increasingly, we are discovering that a large proportion of diagnoses such as IBS present with food-related bowel symptoms which mask the treatable presentation of either transient or permanent gluten sensitivity (1). A gluten-free diet is used by wide numbers of people and has been increasingly prescribed by health professionals over recent years for patients with " non-coeliac gluten-related " disorders. In particular, the use of a gluten free diet (GFD) has been proved to be very effective in a large proportion of patients labelled IBS. It has more recently become a very competitive therapeutic approach to other dietary interventions, like the removal of fermentable carbohydrates (FODMAP) (2). Improvement in the symptoms with a GFD, and their re-occurrence following the reintroduction of gluten seems to show that a large proportion of these patients, also fulfilling the Rome III criteria, have unrecognised gluten-sensitivity (3). Intestinal symptoms with different aetiology (4) usually results in dysbiosis. Both fermentable carbohydrates such as those included in the term FODMAP, and a GFD, have some effect on intestinal microbiota (5, 6). FODMAP delivered to the colon have potential anti-carcinogenic and anti-inflammatory actions (7). The evidence shows that good pro-biotics, like Bifidobacteria spp, are reduced in those patients following a low FODMAP diet (8). Therefore, there is a need to be able to critically distinguish between gluten sensitivity and other carbohydrate sensitivities. Here, the start point in managing patients should be the Rome III criteria, since a reduction in FODMAPs delivered to colonic microbiota might have deleterious effects on the growth of bacteria which have potentially favourable health effects (9). Some recent studies have raised the concerns that GFDs might be a risk factor for metabolic syndrome (10, 11). This might be explained by improvements in intestinal absorption as well as the high content of sugar, fat and calorie in gluten-free products: indeed, the high calorie content of gluten free products may seriously affect Leptin. Leptin resistance is considered a risk factor for obesity. It has been hypothesized that dietary cereal grain protein could increase circulating Leptin levels by preventing it from binding to Leptin receptors (12). But before jumping to conclusions, it shouldn't be forgotten that the prevalence of …