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It’s Hard To Know Where Gluten Sensitivity Stops And The Placebo Effect Begins

Rating

4 Star

Tags

It’s Hard To Know Where Gluten Sensitivity Stops And The Placebo Effect Begins

Our Review Summary

“Non-celiac gluten sensitivity” (NCGS) is a condition in which people report gastrointestinal problems related to consuming gluten — even though they do not have either celiac disease or a wheat allergy. The story concludes that, at most, 1 in 30 of the people who have adopted a gluten-free diet to address NCGS actually suffer from it, with the remainder feeling better because of the placebo effect. The story is especially effective at explaining why NCGS is so difficult to study, and why research to date can’t tell us with certainty if the condition really exists.

 

Why This Matters

According to a 2013 survey cited in the story, more than 29 percent of people in the U.S. are trying to reduce or eliminate their gluten consumption, presumably due to concerns over NCGS. This can have a significant economic impact on consumers. A 2007 study on the cost of gluten-free foods reported that “every gluten-free product was more expensive than their wheat-based counterpart,” and that “bread and pasta was twice as expensive as their wheat-based counterparts.” A similar study in 2008 reported that “On average, gluten-free products were 242% more expensive than regular products.” In short, if 29 percent of Americans are avoiding gluten due to NCGS, millions of people may be paying significantly higher food prices for little (if any) health benefit.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

While the story does mention that there are now a broad range of gluten-free foods on the market, it does not discuss the increased costs associated with those products. One additional sentence would have made a really good story a little bit better.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story does a good job of addressing the symptoms associated with NCGS, which would presumably be eliminated by adopting a gluten-free diet. It also provides useful numbers on the size and duration of the studies mentioned and how big the effects observed were. Example: “The authors found that 40 percent of patients on the entirely gluten-free diet reported a continuation of symptoms, compared with 68 percent of those who had consumed gluten.”

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story doesn’t address the fact that adopting a gluten-free diet can pose nutritional risks. As a Harvard Medical School post notes, “cutting out [gluten-containing] products may mean you’re reducing your fiber intake from whole grains, or missing out on vitamins that you’d normally get from fortified foods.” For example, a 2000 study that compared the diets of a healthy control group with celiac disease patients who had gluten-free diets found that, among other things, “the diet of the [celiac] patients was unbalanced, with a higher percentage of energy as fat and a lower percentage of energy as carbohydrates.” Children would likely be most impacted by nutritional deficits from a restrictive gluten-free diet.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story does a good job of evaluating the literature on NCGS in regard to the potential benefits of a gluten-free diet. Even better, the story (which appears in an online-only publication) includes links to every study it mentions. The story also makes good use of common-sense examples — for example, lack of “blinding” when participants know they are eating bread — to explain important concepts of study design in randomized trials. It provides information that goes beyond the specific topic of NCGS to educate readers about how to understand the strengths and limits of studies.

Does the story commit disease-mongering?

Satisfactory

No disease-mongering here.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story offers an excellent overview of the literature on NCGS and gluten-free diets, but includes no input from sources other than the author — an economist who has done extensive work on the economics of health-related issues. We think the story stands up pretty well without that independent perspective, but it certainly couldn’t hurt, and would likely have helped, to hear from experts in related health fields, such as a nutritionist or gastroenterologist.

Does the story compare the new approach with existing alternatives?

Not Applicable

The main options here seem to be a diet with or without gluten. We’ll rate this not applicable.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story clearly notes the now-widespread availability of gluten-free foods.

Does the story establish the true novelty of the approach?

Satisfactory

The story notes the history of research into NCGS, which dates back to the 1970s.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story clearly goes beyond any news release.

Total Score: 6 of 9 Satisfactory

Comments (4)

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Catherine Poles

February 23, 2015 at 9:27 am

A good review of the literature seems to suggest that the story uses independent sources. Just because someone is not quoted saying “I agree with all this” doesn’t mean the journalist didn’t check with someone. Why would you quote an independent source unless they said something meaningfully different to all the other material gathered?

Reply

George

February 23, 2015 at 1:36 pm

“…but it certainly couldn’t hurt, and would likely have helped, to hear from experts in related health fields, such as a nutritionist or gastroenterologist.’

I’ve seen the title “nutritionist” used too many times in these reviews. The more appropriate person to speak to would be a registered dietician. An RD is a degreed professional licensed to practice. On the other hand, anybody can call themselves a nutritionist.

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