Many practitioners of alternative medicine in the United States, such as chiropractors, acupuncturists and naturopaths, make false or misleading claims about the diagnosis and treatment of celiac disease, according to a study recently published in the American Journal of Gastroenterology.
“This is of concern, given the popularity of complementary and alternative medicine (CAM) and the fact that misinformation on this topic can lead to misdiagnosis of celiac disease, unnecessarily restrictive (and possibly unhealthy) diets, and delays in diagnosis of other conditions that may be underlying the patient’s symptoms,” Dr. Benjamin Lebwohl, the study’s senior author and director of clinical research at the Celiac Disease Center at Columbia University, told Reuters reporter Lisa Rapaport.
About 1 percent of the U.S. population has celiac disease, an inherited autoimmune disorder that can damage the intestines and block absorption of nutrients. Eating gluten, a protein found in wheat, barley, rye and certain other grains, triggers the immune response. Symptoms include diarrhea, bloating and gas, abdominal pain, constipation, nausea and fatigue.
Celiac disease is diagnosed with a blood test that looks for elevated levels of certain antibody proteins. The condition is often further confirmed with a procedure called an endoscopy, which sends a tiny camera down the throat and into the small intestine to look for signs of damage. In some cases, a small tissue sample (biopsy) may be taken of the lining of the small intestine.
There is no cure for celiac disease. Most people, however, can successfully manage the condition by following a strict no-gluten diet.
Celiac disease is not the same as “gluten intolerance” or “gluten sensitivity” (sometimes referred to in the medical literature as nonceliac gluten sensitivity, or NCGS). Although some of the symptoms are the same, NCGS does not cause damage to the tissue of the small intestines.
Many people who believe they are insensitive to gluten are not, however. A 2015 study found, for example, that more than 80 percent of people who reported gluten-related symptoms did not have celiac disease, NCGS or a wheat allergy.
For their study, Lebwohl and his colleagues examined the websites of 500 alternative medicine practitioners in the 10 most populous metropolitan cities in the U.S. (Dallas, New York City, Washington, D.C., Atlanta, Chicago, Houston Boston, Los Angeles, Miami and Philadelphia). The selected websites were the first 10 Google results for each of five alternative medicine disciplines (chiropractor, naturopath, homeopath, acupuncture and integrative medicine) in each city’s metropolitan area. For integrated practices, only ones with a medical doctor (someone with an M.D. degree) on staff were counted.
The researchers analyzed the marketing claims made on these websites for any mention of celiac disease, NCGS or gluten sensitivity, including claims that the practitioners were able to diagnose and treat such conditions. They also looked for statements about the efficacy of alternative treatments for the conditions, such as “Homeopathy works for celiac disease,” or “We can treat celiac with chiropractic, which has been shown to work.”
Each claim was categorized as either “true or mostly true” or “unproven or false.” The categorizing was done by experts who have written review articles on the treatment of celiac disease and other gluten-related conditions for major international medical journals.
The study found that 178 (35.6 percent) of the 500 clinics made 238 separate claims regarding celiac disease, NCGS or a gluten-free diet. Of those claims, 138 (59.5 percent) were either false or unproven.
“The health claims made on clinic websites were diverse and ranged from speculation about the cause of the increased incidence of celiac disease and NCGS to [baseless] claims of over-the-counter digestive enzymes that would allow for normal digestive function for those with celiac disease and NCGS,” the study’s authors write.
Most of the claims were written by the clinics themselves, although a small proportion of the claims (3.4 percent) were made through patient testimonials.
Most likely an underestimation of the problem
The study has limitations. It looked only at English-language websites in the U.S. As a result, the websites examined in the study may not truly representative of all alternative medicine clinics across the country. In addition, the Google search did not involve the terms “wheat” and “allergy.” Including those two words might have turned up more references to celiac disease and NCGS on the websites examined.
Indeed, Lebwohl and his colleagues believe the true proportion of alternative medicine practitioners that offer services for celiac disease or NCGS is probably higher than what they discovered in the study, given that many websites for such practitioners offer little detail about any of their services.
The clear message from this study is “caveat emptor.”
“A substantial proportion of claims (40.5 percent) [made by the CAM practitioners] involving celiac disease and NCGS were deemed accurate, and it is possible that a patients seeking a CAM specialist can be identified as having possible celiac disease, leading to appropriate [blood tests] and referral for intestinal biopsy,” write the researchers. “However, it is particularly concerning that some clinics advertised treatments that pose potential harm.”
The claim that digestive enzymes will allow a person with celiac disease or NCGS to eat gluten safely was particularly concerning, as it could lead to serious health problems if the person does indeed consume gluten, Lebwohl and his colleagues point out.
“The significant percentage of clinic websites that made claims, many of which were false or unproven, suggest the need for increased regulation of CAM marketing to prevent medical misinformation that can lead to harmful consequences,” the researchers conclude. “Efforts are warranted to increase awareness of celiac disease and NCGS with a specific emphasis on countering widespread misinformation.”
FMI: You’ll find an abstract of the study on the website for the American Journal of Gastroenterology, but the full study is behind a paywall.