Mark HymanMD · family physician · functional medicine
Yes, most people are better off without it
What it rests onA mechanism argument: gluten triggers release of zonulin, which opens tight junctions in the gut lining, allowing particles into the bloodstream and provoking an immune response and systemic inflammation. He adds a clinical observation, that gluten is the most common food sensitivity he sees, and that normal coeliac and antibody tests do not rule out a severe reaction.
Food Science BabeBS chemical engineering · food scientist and food-industry engineer
No, unless you have coeliac disease or it demonstrably helps you
What it rests onAn outcomes argument: leaky gut is not an accepted diagnosis while increased intestinal permeability is; gluten significantly increases permeability in coeliac disease and in one IBS study, but other human studies found no change in non-coeliac gluten sensitivity or IBS, and in people without those conditions it appears not to increase permeability. Coeliac disease affects an estimated 1 percent of the US population.
Source: agdaily.com ↗
Hyman is describing a self-selected clinical population who came to a functional medicine practice with unexplained symptoms; his strongest observation is about people who already suspect a food problem. She is reasoning about the general population, and she concedes the IBS and fructan cases that overlap most of his. Neither is describing the other's patient.
Both accept that coeliac disease requires complete avoidance, that increased intestinal permeability is a real phenomenon, and that some people without coeliac disease genuinely feel better without wheat. They disagree about whether the mechanism generalises to people with no symptoms, and about whether a mechanism finding is a reason to act.
Controlled trials of gluten challenge in asymptomatic non-coeliac adults with permeability and clinical endpoints, which is precisely the study neither side cites. Failing that, replication of the zonulin mechanism at dietary rather than challenge doses.
You do, and your call is dated, kept, and yours to change. Follow the people you already trust and what they publish turns into a short daily practice.
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