Peter H.R. Green

Okay, I have mixed feelings about this one, which is pretty much what I expected. I fit squarely into one of the main categories of people they are discussing – people who have not been diagnosed with celiac disease but who have quit eating wheat (and other grains) in order to relieve various symptoms, and who also, frequently, are avoiding other categories of food due to additional food intolerances. As the authors insightfully note, this sort of very restrictive diet can be problematic. Old Navy's size 0 pants become baggy, and then what does one do? I will admit that, as a physician and a science writer, the authors are only being responsible when they advise their readers to visit their doctors and have their ailments properly diagnosed. It's dangerous to self-diagnose, subsisting on a very limited diet, when what ails a person may actually be something entirely un-food related. Still, I found their lack of real appreciation of the obstacles which finances can place between people and extensive medical testing to be a serious shortcoming in this book.

The authors do identify various reasons why people may Not visit their doctors for diagnosis, and one of those is a lack of health insurance. Guilty. Turns out, though, that that really isn't a problem! As they very helpfully explain, if financial reasons are keeping you from having your symptoms seen to by a doctor, “you should seek out a clinic or practice that will accommodate your needs, before an underlying condition sends you to the emergency room.” Sage advice. Honestly, their advice would seem perfectly reasonable (aside from the fact that, obviously, neither of them has ever been without insurance and possessing of only modest funds), but as an endlessly repeated refrain it becomes increasingly irksome. Each symptom one suffers and each dietary change one considers seems to call for another visit to the doctor for more tests.

”If you feel that your diet does not contain sufficient amounts of everything your body needs, have your doctor run blood tests for essential vitamins and minerals.” (The authors advise that people should not take vitamin and mineral supplements without medical guidance.)

My thought on reading this was that it would almost be amusing to visit the county health department and introduce myself as a person of limited means and no insurance who would appreciate it if they would kindly run a battery of tests on me so that I might determine which, if any, vitamin supplements I should take. I imagine that the look of astonishment and dismay on the receptionist's face would be memorable. Still, despite the entertainment potential of taking my various symptoms in search of philanthropic medical practitioners, I've chosen instead to take a multivitamin and a few extra supplements, and to discontinue eating foods which cause me trouble (identified in as scientific a way as I can manage, because I'm not really an idiot) and to eat in a way that makes me feel very substantially, though not completely, better. It works pretty well, the price is right, and I'm saved the trouble of new symptoms resulting as side effects of prescription drugs.

From a scientific angle their dedication to tests is perfectly logical – the human body is a complex thing, and even if a dietary change seems to fix things, you don't know for sure if it's for the reasons you think, and whether something else dreadful, which you are unaware of because you are a slacker who won't go to the doctor, is an underlying problem which, going undiscovered, is going to lead to your downfall. Of course, as many dutiful patients have found, even going to the doctor and undergoing all the advised tests does not guarantee that the real issue will be identified. The bills are a sure thing, but the rest of it is a crapshoot. This book, though, is all about a scientific approach to nutrition, and pragmatic issues need not apply.

Still, despite these complaints, which were really no more than I expected given the “serious mainstream medicine” marketing for this book, these is a lot here that made it worth reading. The issues with vitamin K (with Factor V Leiden, I'm not keen to increase my blood clotting abilities, and it turns out that about all the foods I can still eat are high in vitamin K. The universe is sometimes a cruel place.), the potential risks of too much rice, tuna, etc. Lots of valuable cautions here which were new to me and potentially quite helpful.

Also, I found the detailed exploration of the digestive system, and of the various current studies of brain/gut relationships to be very interesting. I learned a lot. The descriptions of the various disorders which most commonly lead people to avoid gluten, such as celiac disease, nonceliac gluten sensitivity, IBS, IBD, neuropathy, etc, were also very helpful. I think I do have a better handle on what's gone wrong with my digestion (they point out the nonceliac gluten sensitivity is frequently linked to lactose and fructose intolerance, which supports my experience), and what's not (the descriptions of IBS and IBD reminded me to count my blessings). Given the wide range of disorders descussed, including fibromyalgia, chronic fatigue syndrome, autism, diabetes, etc., there will be fair chunks of the book which many readers will skip or skim due to lack of personal relevance, but the majority of the book will likely be of interest to readers avoiding gluten due to health problems.

Like much of the book, Chapter 30, “Nondietary Therapies – the Drug Pipeline,” tends toward the speculative. Various drugs are being studied, grains are being genetically modified, therapies are being tested which may, some day, allow people felled by gluten and other troublesome proteins to consume them with impunity. I thought it was rather a nice touch to include, near the end of the book, this optimistic chapter. Perhaps before I die I will again enjoy a thick slice of deep dish pizza, slathered with tomato sauce (there will be a pill for this), rich with cheese (Lacaid will be improved by then), and topped with onions, peppers, pineapple, and bacon (pills for all these too). Given the number of pills which will accompany it, I'm sure one slice will fill me, and I will enjoy every delicious bite. Hey, Science is one the case, and it could happen!

I'd recommend this to readers who are avoiding gluten or considering doing so, who understand going in that the authors believe many people are avoiding gluten without good cause. There are repeated admonitions to visit one's doctor and have symptoms checked out before attempting to effect a cure through dietary change. Readers who have found relief from their symptoms after removing gluten from their diets may find Green's and Jones's skepticism irritating, but, given the improbably large spectrum of disorders which it is currently credited with causing, their cautions are probably well warranted and a useful addition to the conversation.… (meer)