Digestive Diseases and Sciences

, Volume 63, Issue 5, pp 1158–1164 | Cite as

Skepticism Regarding Vaccine and Gluten-Free Food Safety Among Patients with Celiac Disease and Non-celiac Gluten Sensitivity

  • Loren G. Rabinowitz
  • Haley M. Zylberberg
  • Alan Levinovitz
  • Melissa S. Stockwell
  • Peter H. R. Green
  • Benjamin LebwohlEmail author
Original Article



There has been a marked increase in the adoption of the gluten-free (GF) diet.


To query individuals with celiac disease (CD) and non-celiac gluten sensitivity (NCGS) on their beliefs toward the health effects of gluten, and safety of vaccines and GF food products.


We distributed a Web-based survey to individuals with CD and NCGS on a CD center e-mail list. We used univariate and multivariate analysis to compare responses of respondents with CD and NCGS.


The overall response rate was 27% (NCGS n = 217, CD n = 1291). Subjects with NCGS were more likely than those with CD to disagree with the statement that “vaccines are safe for people with celiac disease” (NCGS 41.3% vs. CD 26.4% (p < 0.0001), and were more likely to decline vaccination when offered (30.9 vs. 24.2%, p = 0.007). After adjusting for age and gender, NCGS subjects were more likely than CD subjects to avoid genetically modified (GMO) foods (aOR 2.30; 95% CI 1.71–3.10), eat only organic products (aOR 2.87; 95% CI 2.04–4.03), believe that the FDA is an unreliable source of information (aOR 1.82, 95% CI 1.26–2.64), and believe a GF diet improves energy and concentration (aOR 2.52; 95% CI 1.86–3.43).


Subjects with NCGS were more likely than those with CD to have doubts about vaccine safety and believe in the value of non-GMO and organic foods. Our findings suggest that the lack of reliable information on gluten and its content in food and medications may reinforce beliefs that result in a detriment to public health.


Celiac disease Non-celiac gluten sensitivity Gluten Vaccines 



Celiac disease


Food and drug administration


Genetically modified food


Non-celiac gluten sensitivity


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest and nothing to declare.


  1. 1.
    Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107:1538–1544. (quiz 1537, 1545).CrossRefPubMedGoogle Scholar
  2. 2.
    Lebwohl B, Ludvigsson JF, Green PH. Celiac disease and non-celiac gluten sensitivity. Bmj. 2015;351:h4347. Scholar
  3. 3.
    Choung RS, et al. Less hidden celiac disease but increased gluten avoidance without a diagnosis in the United States: findings from the National Health and Nutrition Examination Surveys From 2009 to 2014. Mayo Clin Proc. 2016. Scholar
  4. 4.
    Tavakkoli A, Lewis SK, Tennyson CA, Lebwohl B, Green PH. Characteristics of patients who avoid wheat and/or gluten in the absence of Celiac disease. Dig Dis Sci. 2014;59:1255–1261. Scholar
  5. 5.
    DiGiacomo DV, Tennyson CA, Green PH, Demmer RT. Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009–2010. Scandinavian journal of gastroenterology. 2013;48:921–925. Scholar
  6. 6.
    Aziz I, et al. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroenterol Hepatol. 2014;26:33–39. Scholar
  7. 7.
    White LE, Bannerman E, Gillett PM. Coeliac disease and the gluten-free diet: a review of the burdens; factors associated with adherence and impact on health-related quality of life, with specific focus on adolescence. J Hum Nutr Diet. 2016;29:593–606. Scholar
  8. 8.
    Ludvigsson JF, et al. Increasing incidence of celiac disease in a North American population. Am J Gastroenterol. 2013;108:818–824. Scholar
  9. 9.
    Murray JA, et al. Trends in the identification and clinical features of celiac disease in a North American community, 1950–2001. Clin Gastroenterol Hepatol. 2003;1:19–27. Scholar
  10. 10.
    Kim HS, et al. Time trends in the prevalence of celiac disease and gluten-free diet in the US population: results from the National Health and Nutrition Examination Surveys 2009–2014. JAMA Intern Med. 2016;176:1716–1717. Scholar
  11. 11.
    Thompson, T. Gluten-Free Cheerios: Updated Position Statement.
  12. 12.
    Thompson T, Simpson S. A comparison of gluten levels in labeled gluten-free and certified gluten-free foods sold in the United States. Eur J Clin Nutr. 2015;69:143–146. Scholar
  13. 13.
    Brottveit M, et al. Absence of somatization in non-coeliac gluten sensitivity. Scand J Gastroenterol. 2012;47:770–777. Scholar
  14. 14.
  15. 15.
  16. 16.
    Thompson T, Lee AR, Grace T. Gluten contamination of grains, seeds, and flours in the United States: a pilot study. J Am Diet Assoc. 2010;110:937–940. Scholar
  17. 17.
    Lee AR, Ng DL, Zivin J, Green PH. Economic burden of a gluten-free diet. J Hum Nutr Diet. 2007;20:423–430. Scholar
  18. 18.
    Burden M, et al. Cost and availability of gluten-free food in the UK: in store and online. Postgrad Med J. 2015;91:622–626. Scholar
  19. 19.
    Roy A, et al. The association between socioeconomic status and the symptoms at diagnosis of celiac disease: a retrospective cohort study. Ther Adv Gastroenterol. 2016;9:495–502. Scholar
  20. 20.
    Zylberberg HM, Yates S, Borsoi C, Green PHR, Lebwohl B. Regional and national variations in reasons for gluten avoidance. J Clin Gastroenterol. 2017. Scholar
  21. 21.
    Laszkowska M, et al. Socioeconomic vs health related factors associated with google searches for gluten-free diet. Clin Gastroenterol Hepatol. 2017. Scholar
  22. 22.
    Centers for Disease Control. Vaccine Excipient and Media Summary. 2015.
  23. 23.
    Crowe JP, Falini NP. Gluten in pharmaceutical products. Am J Health Syst Pharm. 2001;58:396–401.PubMedGoogle Scholar
  24. 24.
    Mangione RA, Patel PN, Shin E, Fiebert J. Determining the gluten content of nonprescription drugs: information for patients with celiac disease. J Am Pharm Assoc. 2011;2003:734–737. Scholar
  25. 25.
    Brogan, K. Where do Vaccines Fit into a Paleo Lifestyle?
  26. 26.
    Kresser, C. RHR: CoQ10, Vaccination, and Natural Treatment for Migraines. (2012).
  27. 27.
    Reich JA. Neoliberal mothering and vaccine refusal. Gender Soc. 2014;28:679–704. Scholar
  28. 28.
    Dube E, Vivion M, MacDonald NE. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev Vaccines. 2015;14:99–117. Scholar
  29. 29.
    Salmon DA, et al. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Arch Pediatr Adolesc Med. 2005;159:470–476. Scholar
  30. 30.
    McNutt LA, et al. Affluence as a predictor of vaccine refusal and underimmunization in California private kindergartens. Vaccine. 2016;34:1733–1738. Scholar
  31. 31.
    Marild K, Fredlund H, Ludvigsson JF. Increased risk of hospital admission for influenza in patients with celiac disease: a nationwide cohort study in Sweden. Am J Gastroenterol. 2010;105:2465–2473. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Loren G. Rabinowitz
    • 1
    • 6
  • Haley M. Zylberberg
    • 1
    • 6
  • Alan Levinovitz
    • 2
  • Melissa S. Stockwell
    • 3
    • 4
  • Peter H. R. Green
    • 1
    • 6
  • Benjamin Lebwohl
    • 1
    • 5
    • 6
    Email author
  1. 1.Department of Medicine, Celiac Disease CenterColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Department of Philosophy and ReligionJames Madison UniversityHarrisonburgUSA
  3. 3.Department of PediatricsColumbia University College of Physicians and SurgeonsNew YorkUSA
  4. 4.Department of Population and Family Health, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  5. 5.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  6. 6.The Celiac Disease Center at Columbia UniversityNew YorkUSA

Personalised recommendations