Abstract
Background
There has been a marked increase in the adoption of the gluten-free (GF) diet.
Aims
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.
Methods
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.
Results
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).
Conclusions
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.
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Abbreviations
- CD:
-
Celiac disease
- FDA:
-
Food and drug administration
- GMO:
-
Genetically modified food
- NCGS:
-
Non-celiac gluten sensitivity
References
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. https://doi.org/10.1038/ajg.2012.219. (quiz 1537, 1545).
Lebwohl B, Ludvigsson JF, Green PH. Celiac disease and non-celiac gluten sensitivity. Bmj. 2015;351:h4347. https://doi.org/10.1136/bmj.h4347.
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. https://doi.org/10.1016/j.mayocp.2016.10.012.
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. https://doi.org/10.1007/s10620-013-2981-6.
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. https://doi.org/10.3109/00365521.2013.809598.
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. https://doi.org/10.1097/01.meg.0000435546.87251.f7.
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. https://doi.org/10.1111/jhn.12375.
Ludvigsson JF, et al. Increasing incidence of celiac disease in a North American population. Am J Gastroenterol. 2013;108:818–824. https://doi.org/10.1038/ajg.2013.60.
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. https://doi.org/10.1053/jcgh.2003.50004.
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. https://doi.org/10.1001/jamainternmed.2016.5254.
Thompson, T. Gluten-Free Cheerios: Updated Position Statement. https://www.glutenfreewatchdog.org/news/gluten-free-cheerios-updated-position-statement.
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. https://doi.org/10.1038/ejcn.2014.211.
Brottveit M, et al. Absence of somatization in non-coeliac gluten sensitivity. Scand J Gastroenterol. 2012;47:770–777. https://doi.org/10.3109/00365521.2012.679685.
US Food and Drug Administration. Accessed at http://www.federalregister.gov/documents/2013/08/05/2013-18813/food-labeling-gluten-free-labeling-of-foods.
US Food and Drug Administration. Accessed at http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm106108.htm.
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. https://doi.org/10.1016/j.jada.2010.03.014.
Lee AR, Ng DL, Zivin J, Green PH. Economic burden of a gluten-free diet. J Hum Nutr Diet. 2007;20:423–430. https://doi.org/10.1111/j.1365-277X.2007.00763.x.
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. https://doi.org/10.1136/postgradmedj-2015-133395.
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. https://doi.org/10.1177/1756283x16637532.
Zylberberg HM, Yates S, Borsoi C, Green PHR, Lebwohl B. Regional and national variations in reasons for gluten avoidance. J Clin Gastroenterol. 2017. https://doi.org/10.1097/mcg.0000000000000912.
Laszkowska M, et al. Socioeconomic vs health related factors associated with google searches for gluten-free diet. Clin Gastroenterol Hepatol. 2017. https://doi.org/10.1016/j.cgh.2017.07.042.
Centers for Disease Control. Vaccine Excipient and Media Summary. 2015. https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/b/excipient-table-2.pdf.
Crowe JP, Falini NP. Gluten in pharmaceutical products. Am J Health Syst Pharm. 2001;58:396–401.
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. https://doi.org/10.1331/JAPhA.2011.10137.
Brogan, K. Where do Vaccines Fit into a Paleo Lifestyle? http://kellybroganmd.com/vaccines-fit-paleo-lifestyle.
Kresser, C. RHR: CoQ10, Vaccination, and Natural Treatment for Migraines. https://chriskresser.com/coq10-vaccination-and-natural-treatment-for-migraines (2012).
Reich JA. Neoliberal mothering and vaccine refusal. Gender Soc. 2014;28:679–704. https://doi.org/10.1177/0891243214532711.
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. https://doi.org/10.1586/14760584.2015.964212.
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. https://doi.org/10.1001/archpedi.159.5.470.
McNutt LA, et al. Affluence as a predictor of vaccine refusal and underimmunization in California private kindergartens. Vaccine. 2016;34:1733–1738. https://doi.org/10.1016/j.vaccine.2015.11.063.
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. https://doi.org/10.1038/ajg.2010.352.
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Rabinowitz, L.G., Zylberberg, H.M., Levinovitz, A. et al. Skepticism Regarding Vaccine and Gluten-Free Food Safety Among Patients with Celiac Disease and Non-celiac Gluten Sensitivity. Dig Dis Sci 63, 1158–1164 (2018). https://doi.org/10.1007/s10620-017-4879-1
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DOI: https://doi.org/10.1007/s10620-017-4879-1