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Food avoidance: some answers, more questions

Sinead Golley, Philip Mohr and David Topping
Med J Aust 2015; 203 (8): 314-315. || doi: 10.5694/mja15.00965
Published online: 19 October 2015

The growing number of consumer foods and ingredients branded as “gluten-free” and/or “lactose-free” suggests that avoidance of specific dietary factors is common. CSIRO (Commonwealth Scientific and Industrial Research Organisation) survey data indicate that this behaviour is a real phenomenon, with one in seven adult Australian respondents not diagnosed with coeliac disease reporting avoidance of wheat or dairy foods. The behaviour is largely self-initiated, occurring predominantly without a formal medical diagnosis and is driven principally by adverse reactions attributed to those foods. Mostly, these comprise gastrointestinal symptoms that include bloating and cramps, commonly associated with irritable bowel syndrome. Wheat contains gluten, which provokes an immune reaction in susceptible individuals. However, the pattern of survey responses regarding symptoms does not suggest an allergenic or autoimmune cause; wheat avoiders do not seem to be undiagnosed coeliacs (Public Health Nutr 2014; 18: 490-499).

Our results raise several causes for concern. Translation of the data to the general population suggests that a significant proportion of adult Australians are at risk of nutritional imbalance. Wheat- and dairy-based foods are important sources of essential nutrients, so their exclusion could lead to dietary deficiencies (eg, of fibre, calcium) or, of equal concern, dietary imbalances caused by consumer overcompensation for perceived deficiencies. Clinically, self-diagnosis of symptoms of intolerance also carries the risk of delays in the identification and treatment of potentially serious medical conditions (BMJ 1988; 297: 719-720). For the majority of avoiders, the actual causes of symptoms and their mechanisms need to be established to improve condition diagnosis and management. Complicating matters is the issue of poly-avoidance, with more than 50% of wheat avoiders also avoiding dairy foods, and we need to establish whether the behaviours share a common aetiology. We also need to clarify whether consumers are making other self-prescribed dietary changes, either in response to their symptoms or in the belief that they are improving their personal health.

  • Sinead Golley
  • Philip Mohr
  • David Topping

  • 1 CSIRO Food and Nutrition Flagship
  • 2 University of Adelaide
  • 3 CSIRO Food and Nutrition Flagship

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access_time 05:03, 19 October 2015
Heather Schubert

I am a gluten and diary avoider after being diagnosed with gluten sensitivity via genetic testing, and diary intolerant via blood tests. Each of these tests was self requested after years of ongoing GI problems and limited assistance from medical professionals. There are valid reasons for avoiding these foods in those who are not diagnosed celiac.

Competing Interests: No relevant disclosures

Mrs Heather Schubert
RECC

access_time 05:45, 19 October 2015
JOHN MCEWEN

The CSIRO item ignores those with allergy to wheat. At 70 year of age, I inexplicably developed a severe allergy to wheat confirmed by a specialist clinical immunologist. Initial mild episodes (blistering of tongue after eating toast) worsened following a surgery-associated septicaemia. The allergy manifests as a severe blistering urticaria (photo available). Onset is provoked more readily by exercise following intake of a wheat-containing food such as white bread. Other gluten containing products do not provoke the allergy. For people who have wheat allergy but not coeliac disease the availability of gluten-free foods is an invaluable means for avoiding wheat.

Competing Interests: No relevant disclosures

Dr JOHN MCEWEN
no institution

access_time 03:27, 20 October 2015
Margaret Rose Cihocki

Sorry, but wheat and other grains do not have any "essential" nutrients. "Essential" means we need to eat them because the body can't make them. There are no such nutrients in grains. Dairy, yes, grains, no. Humans can survive very well without grains (and did for millions of years before agriculture) so worrying about nutritional deficiencies from not eating grains is ludicrous. We can easily get all the nutrients in grains in much greater quantities from leafy greans and other non starchy vegetables. Not that we need them at all. There are many cultures that do quite well without eating much or even any plant food at all.

Competing Interests: No relevant disclosures

Mrs Margaret Rose Cihocki
Retired

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