Thread by @trott_nick

So this is a very belated response to this article in the guardian a couple of weeks back. It feels ‘Un-Twitter Like’ to respond so late hey.. If we can have Slow Food and Fashion.. Why not... #SlowTwitter. 😁

Ever since watching All the Presidents Men I’ve kind of assumed all journalists want to inform, clarify and advocate.. I’m sure the author of this of this article intensions were the same. However I think the article fails in this regard...

The article purports to tell the ‘Truth About Gluten, & Non Coeliac Gluten Sensitivity" (NGCS). However it largely ignores the evidence base then relies on anecdote and superficial quotes from selected studies that serve its narrative...

Firstly and most crucially the article doesn’t emphasise the importance of getting a blood screen for coeliac disease (CD) when anyone has on-going gut or IBS type symptoms. This is vital as CD is 4x higher in the IBS vs general population.
bit.ly/2MptSqB

At the umm.. risk of repeating myself 😉... Only 1 in 4 people with coeliac disease have been diagnosed in the UK. If you have gut symptoms.. Do Not Change Your Diet.. Go to your GP and ask for Coeliac bloods to be done.. More here...
▶ bit.ly/1dh0i0H

The article also suggests the gender disparity in IBS/NCGS diagnosis means they’re ignored. Functional Gut Disorders are maligned but not by specialists working the area. Studies on the gendered experience of IBS suggest
its difficult for women & men. bit.ly/2wfwhJF

The NCGS population is quoted at 6% of the general public. The ‘truth’ is (pun intended!) we don’t know. The 6% figure is likely too high as it’s based on a study in a tertiary referral centre & liable to have an element of selection bias...
bit.ly/2PwSBay

Also the article ignores the studies that explore the % of people with self-reported NCGS that actually report GI symptoms to gluten when challenged in blinded placebo-controlled trials. Recent metaanalysis of 1684 pt showed about a 30% response to gluten. bit.ly/2MsBYyK

The reasons why some people’s symptoms improve on a GFD (beyond gluten avoidance) is still not fully clarified. FODMAPs, ATIs, WGAs & Placebo effects...? These are subject to a substantial research effort... This more or less completely ignored...
bit.ly/2MTqfc8

The Low FODMAP method is only briefly mentioned in reference to one anecdotal case. Which falsely suggests it’s an unachievable dietary approach...!🤦‍♂️

...None of the meta-analyses demonstrating up to 70% improvement in symptoms (short-term) or 60% (long-term) are discussed or highlighted..

bit.ly/2P62Xx5
bit.ly/2NgAx2M

Nor is the best way to undertake the Low FODMAP diet (with Dietetic support) discussed. A more interesting paper would have been as to whether people with IBS are able to gain access to a Dietitian for assistance with this approach...

bit.ly/2o86245

So what’s does the article suggest is causing NCGS? “Food Processing”... That’s a hypothesis that’s been proposed before.. (and I think it’s a reasonable one to consider). But what evidence does the author put forward to support this concept? Let’s have a look...🤔...

..Apart from a couple of anecdotal quotes. Not much. A paper on wheat allergy is cited. NCGS by is very definition (GI symptoms in the absence of CD or wheat allergy) has nothing to do with genuine wheat allergy! Which effects less then 1% of people! #Redherring ⬇️

Hasty generalisations are made about a 🐭 study on the effects of two emulsifiers (cellulose gum & polysorbate) low-grade inflammation, but the mice were given 250 times daily limits for human consumption! Again this study was nothing to do with NGCS! #AssociationFallacy

Then a paper from 2003 on mineral bioavailability from sourdough bread in 🐀 is mentioned? Why? The paper does not mention GI symptoms, IBS or NCGS anywhere?...

While sourdough techniques can be beneficial (bit.ly/2yZE8Py) the research is mixed, a recent pilot study comparing sourdough wheat bread to yeast fermented to breads showed no benefits to people with IBS/Wheat sensitivity..

bit.ly/2BNDeaZ

A narrative review of the use of different fibre types in IBS is selectively quoted. While it has been known for many years that insoluble fibre (specifically bran) can be detrimental, long chain soluble fibre can be helpful in IBS.
bit.ly/2wo9FH2
bit.ly/2AtZGjx

The article ends without offering any solutions to its unsubstantiated claims and appears to serve no purpose except precipitating unwarranted food worry.

I’ll agree for many people with gut symptoms finding a dietary pattern that helps can be challenging. But I think the solutions will be found in continued research & individualised support from health care professionals. Not in misinterpretations or extrapolations of the science.

Finally there has been some great science journalism on #NCGS.. Check out this fantastic article & video by bit.ly/2sbOXbc @KellyServick ⬇️..👍