Misconceptions about gluten may lead many to cut it out unnecessarily.
Novak Djokovic called him ”the great doctor” – a Sarajevo-trained GP with expertise in Chinese medicine and acupuncture; a graduate of the Indian Institute of Magnetotherapy in New Delhi, lately specialising in the use of a Budapest-designed biofeedback machine.
More than anyone else, Igor Cetojevic is the man credited with revolutionising the world No. 1′s tennis game. He is the man who told Djokovic he was gluten intolerant.
”He’s done a great job in changing my diet after we established I am allergic to some food ingredients, like gluten,” Djokovic said of the diagnosis that turned around his career two years ago. ”It means I can’t eat stuff like pizza, pasta and bread. I have lost some weight but it’s only helped me because my movement is much sharper now and I feel great physically.”
The improvements to Djokovic’s form are not in contention. But the explanation for the Serbian’s success is based on one of the most vexed areas of dietary science.
”There are a whole lot of people who believe they are gluten intolerant, who don’t have coeliac disease,” says Professor Peter Gibson, professor of gastroenterology at the Alfred Hospital in Melbourne. ”This is very controversial because there is a quite big percentage – even up to 10 per cent – of people who are avoiding gluten because they think gluten is their problem. Naturopaths have put them on a diet, or they have done it themselves after reading the internet or speaking to a friend.”
As yet unpublished research from Monash University, co-written by Professor Gibson, found only 14 per cent of people on gluten-free diets were put on the regime by a doctor. Almost half had simply decided to cut wheat and grains from their diet because they assumed they were intolerant. More than 60 per cent had not been tested conclusively for coeliac disease.
”It’s a very emotive area,” Gibson said. ”Fortunately, now there is a lot of work going on around the world trying to define this and how we can identify people who are truly gluten intolerant.”
The issue is a question of medical distinction: coeliac disease is an immunological complaint in which gluten interferes with the body’s ability to absorb nutrients, identifiable by a blood test; gluten intolerance has no diagnostic test or biological mechanism by which to explain it.
Improvements to a person’s health without gluten can be explained several ways, by placebo effect or by the fact a gluten-free diet removes other agents from the body – most importantly the poorly absorbed carbohydrates known as fructans, which may cause illness or discomfit.
An Australian study published last year in the American Journal of Gastroenterology showed for the first time that gluten could trigger symptoms of fatigue in people without coeliac disease – making the argument for what doctors call non-coeliac gluten intolerance. But the mechanism remained unexplained.
”Gluten intolerance in individuals without coeliac disease is a controversial issue and has recently been described as the ‘no man’s land of gluten sensitivity’,” the authors wrote. ”The evidence base for such claims is unfortunately very thin, with no randomised controlled trials demonstrating that the entity does actually exist.”
Finland has done more than any other nation to identify its coeliacs. It has the most reliable data on increased prevalence: a doubling, from 1 per cent to 2 per cent between 1979 and 2000. Fins have been eating gluten free burgers at McDonald’s for two decades.
It is accepted that coeliac disease affects about one in every 100 Australians – although there is no local research to confirm the Finnish findings. Some academics argue perceived increases in coeliac disease are heightened by increased testing, but it is generally agreed that prevalence has increased.
The increase in people identifying with non-coeliac gluten intolerance is more conflicted. An editorial in the Medical Journal of Australia last year noted the distinction: ”The popularity of the ‘fad’ gluten-free diet might be peaking, but the medical need for gluten-free diets continues to rise.”
Penny Dellsperger, a dietitian at Coeliac NSW, said there were significant medical risks to people adopting gluten free diets without first ascertaining whether they suffered coeliac disease. She said the symptoms could easily relate to other illnesses.
”Obviously there are a lot of people on gluten free diets who don’t need to be and who haven’t had the proper tests. We have to be careful gluten doesn’t get a bad wrap,” she said.
”I don’t understand why you would [maintain a gluten free diet] if you didn’t need to. It’s been marketed a lot and gluten has been promoted as an evil thing when it’s actually not.”
Read more: http://www.smh.com.au/lifestyle/diets-based-on-a-grain-of-truth-20120127-1qlc1.html#ixzz1khW3IofT