Is going gluten-free always necessary?

Given the growing amount of gluten-free foods available at the grocery store, it seems a number of people have trouble digesting the stuff. But are they truly gluten-intolerant, and is there a clear diagnosis for that?

Gluten sensitivity is the topic of a paper published recently in the Annals of Internal Medicine in which researchers acknowledged the seriousness of celiac disease, but also said part of the population could have nonceliac gluten sensitivity. That’s characterized by having distinct symptoms such as diarrhea, abdominal pain, gas, bloating or headaches after eating foods containing gluten.

Celiac disease, also triggered by eating foods with gluten, can cause damage to the lining of the small intestine. Among gastrointestinal symptoms are nausea, diarrhea, abdominal discomfort, and sufferers can also be lactose intolerant. Vitamin and nutrient absorption can also be an issue. A blood test can determine if someone has the disease.

The authors sited a 1981 study in the journal Gastroenterology that found six out of eight people with chronic diarrhea and abdominal pain had a gluten sensitivity but did not have celiac disease. But since then, they added, not much more has been done because testing for nonceliac gluten sensitivity is difficult.

That hasn’t stopped many people from declaring they are gluten sensitive, even though they may not be. Cutting out wheat products — especially simple carbs such as white bread, cookies and pastries — often makes people feel better, so they assume they can’t tolerate gluten.

Claims of being gluten-sensitive, the authors write, “seem to increase daily, with no adequate scientific support to back them up. ... This clamor has increased and moved from the Internet to the popular press, where gluten has become ‘the new diet villain.’ ”

Opting for a gluten-free diet isn’t necessarily any healthier than a diet with gluten, and products are sometimes costly. If gluten intolerance is not truly an issue, there may be no advantages to cutting out wheat and other foods, because some substitute grains contain little fiber.

The researchers argue that more research should be done on nonceliac gluten-sensitivity, “and that ‘sense’ should prevail over ‘sensibility’ to prevent a gluten preoccupation from evolving into the conviction that gluten is toxic for most of the population. We must prevent a possible health problem from becoming a social health problem.”