REAL DIETITIANS NEEDED

December 1, 2015 in New Sprue Review

I was contemplating a problem with Refractory Sprue the other day when I ran across an article that brought the problem of correct diet into sharper focus. The problem is that doctors that actually know something about the spectrum of gluten problems have been trying for some time to find dietitians that are knowledgeable in the gluten free diet, and they haven’t found any. Without these qualified dietitians, it is very difficult to provide effective treatment to Celiacs in general and those with Refractory CD in particular.

The article, titled “5 ‘Healthy’ Foods That May Fool You” was written by Katherine Brooking, MS, RD, and published on WebMD (linked, of course, by the Wheat Gluten Council.) Sure enough, the very first thing she mentions is “Gluten-Free Foods.”

I was tempted at first to blow her off as just another half-wit who thinks she knows something about Celiacs, Celiacs Disease, Gluten Sensitivity, Refractory CD, Non-Celiac Gluten Sensitivity, Gluten Psychosis (could this apply to her?) or any of the host of other often dire consequences that are brought on by the consumption of gluten. Then I realized that, when she said in her article “With…nutrition misinformation all over the internet, it’s easy to be duped”, she was talking about her own article.

How’s That? Lets look at and evaluate her performance as a Registered Dietitian as if our lives depend on it. Which, of course, they do.

The first study she refers to and what she says about it: “Yet another study found that nearly 90% of those who think they are “sensitive” to gluten actually have no problem digesting it at all.”

Really. Look at the facts. Everyone, regardless of Celiac status, has a “problem” digesting gluten. EVERYONE! This is a fact that is so well known that it’s very difficult to believe a dietitian wrote that sentence. Many of the gluten peptides are so indigestible that the detection in human stool of the relatively toxic 33 MER peptide may one day be used to monitor compliance with the Gluten-free diet, in an effort to reduce the incidence of Type 2 Refractory CD and enteropathy-associated T-cell lymphoma.

I actually met a woman a couple of years ago that survived Refractory CD. She had to be fed intravenously for a year. Bet she could have used a qualified dietitian.

And note that word “toxic.” The problems associated with gluten consumption do not stem from “digesting” it, which you cannot, but from trying to digest it in the first place.

Since I am familiar with this study, I will point out something else about it that Ms. Brooking conveniently didn’t mention: THE STUDY WAS ABOUT SOME SPECIFIC EFFECTS OF GLUTEN AFTER DIETARY REDUCTION OF FODMAPS IN NON-CELIAC GLUTEN SENSITIVITY, not about who could or could not “digest” gluten.

(For those of you who are unfamiliar with FODMAPS, they are essentially the carbohydrate portion of many foods that are poorly digested in the small intestine. When these carbohydrates make it to the large intestine, the bacteria there ferments them, causing all kinds of grief with gas, bloating, abdominal pain and so forth. This is known as Irritable Bowel Syndrome, and has nothing to do with the damage caused by gluten. Gluten containing grains are excluded on the FODMAP diet for the carbs, not the gluten itself.)

We’ll go on to the next study after reviewing what the researchers actually said in their conclusion of the first study. The italics are those things that an actual dietitian should have clearly seen, had she read it:

“These data suggest that Non-Celiac Gluten Sensitivity, as currently defined, might not be a discrete entity or that this entity might be confounded by FODMAP restriction, and that, at least in this highly selected cohort, gluten might not be a specific trigger of functional gut symptoms once dietary FODMAPS are reduced.”

How does Ms. Brooking get from that to “90% of those that think they are sensitive to gluten actually have no problem digesting it at all ?”

The next internet nutritional misinformation (remember, those are her words, not mine,) is in the very next study Ms. Brooking sites:

“A study published in the Journal of Human Nutrition and Dietetics found that people following a gluten-free diet are often lacking in several nutrients including B-vitamins, magnesium, calcium, iron and zinc.”

YES! TRUE! COMPLETELY SO!

But why did she leave out the very next sentence from the study abstract: “Inadequate intake did not relate to the nutrient density of the GFD (Gluten Free Diet.)

Could this omission be due to some kind of effort on her part to woo the Gluten Industry? Maybe get on Good Morning America or the Dr. Oz show again?

I’ll leave you with part of the conclusion from this study. Again, the italics are the items that a QUALIFIED dietitian should pick up: “Dietary inadequacies are common and may relate to habitual poor food choices in addition to inherent deficiencies (thiamine and vitamin A) in the GFD. Dietary education should also address the achievement of adequate micronutrient intake.”

It seems to me that this dietary education is the very thing that a Registered Dietitian should be doing. Especially one that has supposedly earned a MASTERS DEGREE in nutrition education from Columbia University. Unfortunately, at least in Ms. Brooking’s case, it is easier to just dupe people with “internet nutritional misinformation.”