Re: Where’s the evidence for gluten sensitivity?
As a carer, I welcome this discussion of gluten sensitivity in the BMJ and the marketing/financial interests that are involved. In the UK, a diagnosis of coeliac disease, which allows the patient subsidised access to potentially expensive gluten-free foods on prescription, can rely on invasive testing that carries its own risks of harm. Furthermore, negative test results can exclude patients from such prescriptions, which could otherwise provide great benefit and alleviate symptoms. I would challenge the assumption that "a gluten-free diet itself reduces quality of life" and query the evidence behind it. In our experience, a gluten-free diet can significantly improve quality of life. In the case of my family, we are fortunate enough to be able to afford gluten-free products and substitutes without prescription, and to put in the effort to source or make these foods, investments we decided to make following N of 1 trials. My concern is for more deprived non-coeliac but 'gluten sensitive' patients whose symptoms and quality of life could benefit from a gluten-free diet but who cannot afford or access such products without prescription. Perhaps the possibility of a diagnosis of non-coeliac gluten sensitivity could help to address inequality in this area of health.
Competing interests: Family members without a coeliac diagnosis who have responded positively to a gluten-free diet