Practice A Patient’s Journey

Non-coeliac gluten sensitivity

BMJ 2012; 345 doi: (Published 30 November 2012) Cite this as: BMJ 2012;345:e7982

Re: Non-coeliac gluten sensitivity

Fascinating. A peruasive tale but a total lack of plausible explanatory mechanism for the many disparate symptoms. Who knows how this will all turn out? As always in medicine, it pays to be simultaneously open-minded and sceptical.
But we can say for sure that the patient can be relieved of one major symptom without recourse to a gluten-free diet. "The most important issue with my weight is that it can easily rise 4-7lb overnight if I accidentally eat gluten, as I fill up with fluid....". It is only possible to fill up with fluid by literally filling up with fluid, i.e. drinking lots, and so we can only assume this patient is in the habit of consuming 2 to 3 litres of fluid (and a bit more) overnight.
This can be effectively addressed by simple modest fluid restriction - possibly the only intervention in this tale which can be guaranteed to work every single time.

Competing interests: No competing interests

24 December 2012
John Main
James Cook University Hospital
Middlesbrough, TS4 3BW