Talk:Gluten-free diet

Why is this diet trendy or popular?

I read this article because I wanted to find out why so many people are adopting this diet. However, it doesn't really say. Surely they don't all have chronic diarreah, wheat allergies or fear autism? It wold be helpful to read the common reasons, and fin out what science has to say about them.

Because the reasons are complete nonsense and not backed up by science. That's why. This article would be full of pseudoscience. The only people who should avoid gluten are people who are allergic are have coeliac disease. Dr. Morbius (talk) 18:03, 4 July 2012 (UTC)

I think the root of the problem is that the symptoms of celiac disease are so general and can be caused by many other things as well; and because the symptoms differ from person to person, there is no easy way to dismiss it as a possibility without an actual test (which is also one reason why it often goes undiagnosed.) Lots of people are going to suffer from low energy, say. This led to many people reading about celiac symptoms and trying a gluten-free diet after self-diagnosing themselves with it; and some of those people inevitably felt better afterwards (because they actually had undiagnosed celiac or gluten sensitivity, or because of placebo effects, or because an unrelated issue resolved itself.) Word of mouth from this, combined with confirmation bias, inevitably led to more and more people seeing gluten-free diets as a panacea for all of the symptoms of celiac regardless of whether they had it or not, especially since that list of symptoms almost precisely covers some of the most common things people want to improve about themselves in general -- the thought that you might be able to fix such common ailments with a simple dietary change is seductive, and anything that can credibly claim to have a chance of improving such a broad range of common issues (even if just in a subset of the population) is going to get attention. This eventually led to popular authors claiming increasingly broad powers for gluten-free diets, building on that increasingly popular mythos and eventually (in the more extreme cases) moving away from its connection to celiac or gluten sensitivity entirely and giving the implication that it was a miracle diet that could help anyone. Also, equally importantly, 'gluten' is a really ugly word. It sounds like 'glutes'. --Aquillion (talk) 13:26, 5 March 2014 (UTC)

I also came here to find out why "gluten free" is so popular now, but there wasn't any such information. Suddenly everybody's allergic to gluten? I've been eating extra gluten just to keep the gluten industry alive. At night I worry about the poor gluten producers. --67.165.140.73 (talk) 02:45, 13 September 2012 (UTC)

"Dr Morbius" you are wrong. Studies have shown that avoiding gluten prevents or reverses hypothyroidism in untreated coeliacs AND noncoeliacs. Wikipedia is supposed to be unbiased, so this article needs people to contribute who know the subject and are not just pedalling their point of view. I refer you to three peer-reviewed clinical studies: 1.Sategna-Guidetti C, Volta U, Ciacci C, Usai P, Carlino A, De Franceschi L, Camera A, Pelli A, Brossa C. "Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study". 2. Counsell CE, Taha A, Ruddell WSJ. "Coeliac disease, and autoimmune thyroid disease". Gut 1994;35:844–6. 3.Sategna-Guidetti C, Bruno M, Mazza E, et al. Autoimmune thyroid disease, and coeliac disease. Eur J Gastroenterol Hepatol 1998;10:927–31. — Preceding unsigned comment added by 78.146.73.107 (talk) 01:19, 30 January 2013 (UTC)

All those studies were about people who had either coeliac disease, hypothyroidism or both so those studies are irrelevant because his question was about why normal healthy disease free people eat gluten free diets. My response stands. Normal healthy people have no reason to avoid gluten. Dr. Morbius (talk) 17:41, 30 January 2013 (UTC)

You are wrong, the studies show that 'normal healthy disease free people' can prevent thyroid issues. — Preceding unsigned comment added by 78.146.48.79 (talk) 23:23, 31 January 2013 (UTC)

Opinions don't matter. Just give us a good reference and we'll happily include it Bhny (talk) 00:01, 1 February 2013 (UTC)

Cross-contamination.

That section doesn't address the topic except for a brief mention in the final paragraph re buffet-style restaurants.77Mike77 (talk) 19:08, 6 January 2013 (UTC)

Criticism of Wheat Belly

In a few places Davis either makes some very careless interpretations of the studies he cites or he deliberately misrepresents them. Only 39% of the celiac patients in the 215 patient study were overweight but he claims over 50%. Only 25 of the 215 lost weight on a GF diet while 91 actually gained weight. His major premise of the book is that a GF diet will cause most people to lose weight: that is just not what the cited studies state in their results. Over 2 years 81% of the patients gained weight including 82% of patients that were already overweight at the beginning. [1] When 19% of people on a GF diet lose weight after 2 years you can not make the claim it is a weight loss diet.

Lastly he makes the claim from the naloxone study that after administration the binge eaters ate 28% less wheat based products. The study says very clearly that they actually ate 40% more bread sticks. Odd for a doctorate's reading comprehension to be this poor. 97.85.168.22 (talk) 17:09, 12 January 2013 (UTC)

Not sure wheat belly diet is relevant since it's not specifically gluten free. It's not mentioned in this article at all Bhny (talk) 17:47, 12 January 2013 (UTC)

The whole book is about removing gliadin from the diet and how wheat is become a poisonous and addictive grain since the introduction of dwarf strains. 97.85.168.22 (talk) 16:27, 13 January 2013 (UTC)

Strong opinions and NPOV

It is apparent that there are several editors with very strongly held opinions watching this page, who appear to be here to "right wrongs" and set people straight to convince them to stop eating gluten-free diets. This is not the appropriate place to conduct that campaign. It is a place to describe, with good references from both sides, the various reasons for the gluten-free diet. It is not the case the reason people are adopting gluten-free diets is "Because the reasons are complete nonsense and not backed up by science" (quoting Dr. Morbius above). For one thing, if you live in a household with a person who has celiac disease, it may be helpful for them for you to adopt it as well, greatly increasing its prevalence. For another, the prevalence of celiac disease has increased and diagnosis is costly and time-consuming. The first study finding increased prevalence was Rubio-Tapia et al 2009 followed by Catassi et al 2010 ("Natural history of celiac disease autoimmunity in a USA cohort followed since 1974"). The hypothesis which I see most often floated is changes in gliadin due to breeding of wheat - for example, it is mentioned by Joseph Murrary, an investigator in Rubio-Tapia et al 2009. It is not, as described by Bhny above, "nonsense". Saying such things just seems a little silly. I'm not even going to get into Sapone et al 2010's recent finding on gluten-sensitive people (who apparently cannot be diagnosed through traditional methods) right now, which is discussed in recent NYTimes ("medical experts largely agree that there is a condition related to gluten other than celiac")and CBS 20120 news articles. As a mainstream and prominent line of research, it deserves some coverage in this article - but I have to go right now. II | (t - c) 03:55, 1 May 2013 (UTC)

"breeding wheat with higher protein" is nonsense. What does it mean? It also wasn't in the reference which was the main reason I removed it. Bhny (talk) 16:07, 1 May 2013 (UTC)

The source discussed Murray's hypothesis that it may be due to changes made to wheat, but I may have accidentally channeled a little of my background knowledge. Higher protein means exactly that. Gluten is a protein, and wheat has been bred to have more of it. II | (t - c) 00:51, 8 July 2013 (UTC)

When I said it was nonsense, I meant grammatically or logically. "Higher" doesn't mean "more", maybe it meant "higher percentage" but as it stood it seemed to say the protein was now near the top of the plant. Anyway I couldn't see what it might mean in the reference. Bhny (talk) 16:10, 8 July 2013 (UTC)

Largely agree with ImprefectlyInformed, there is apparently a new condition that is being recognized now (non-celiac gluten sensitivity) and this should be covered in this article as well as the gluten sensitivity article. For the WP:MEDRS inclined, this review would be a good place to start as a recent review in a very high impact medical journal. Yobol (talk) 13:00, 1 May 2013 (UTC)

non-celiac gluten sensitivity is already in the article Bhny (talk) 16:17, 2 May 2013 (UTC)

The article cited here says, "“People might think I had a bias, but I couldn’t find any published literature on the health benefits of gluten-free diets for people without celiac disease, gluten sensitivity or autoimmune disorders. There should be some studies, but there are none." Suggesting that there are studies to indicate benefits for people in all three of those categories. The text in the article here left out the gluten sensitive and those with autoimmune disorders. Leaving out those large groups of people invalidates the point whoever wrote this article is trying to make about the popularity of gluten free diets

I don't know that much about the subject, but whoever wrote this article seems to have a bias against possible benefits. A more even-handed approach is needed.

• Wikipedia articles that touch on scientific subjects (which includes describing whether or not a diet has any medically-acknowledged benefit) have to reflect verifiable scientific consensus; and the verifiable scientific consensus on Gluten-free diets (as the article provides copious citations for) is that there is no benefit whatsoever to it if you lack a specific condition that requires it. It's important to capture all the nuances of the topic, of course (which can be lost if editors get too invested in a point of view), but trying to avoid the appearance of bias by presenting 'both sides' equally without regard for the verifiable research behind each is not an encyclopedic approach to writing. --Aquillion (talk) 11:26, 4 March 2014 (UTC)

Adverse effects of the gluten-free diet?

Couple questions:

• Gaesser & Angandi et al 2012 does appear to be a review article, but it has no abstract (somewhat strange) and was financially supported by the Grain Foods Foundation. I don't have access to this paper. Please provide the quotes which support the evidence of adverse effects, including what sources are used. I'm not sure this is really an appropriate source but perhaps it has information which I'm not aware of.

The URL you posted has the full text. Sterling.M.Archer (talk) 23:28, 26 July 2013 (UTC)

• de Palma et al 2009 is a primary source of 10 subjects. Based on an online copy, it seems no details were provided on the diet. The reduction in polysaccharides is heavily dependent upon what one eats in a gluten-free diet. The language in the lead overstates the evidence and also the information does not appear to be fleshed out in the body as required. In reviewing papers citing it, I can't find anything which really makes this case. One 2011 review says "microbial communities of treated patients share some patterns with the known microbial communities of healthy adults, although the patterns in the unknown bacteria communities are dissimilar; something is still missing from the restoration of the 'normal bacteria microbiota'". This is inconsistent with the statement by the primary study, as these patients are on a long-term gluten-free diet but the reviewer does not conclude that their gluten-free diet is causing a significant change in the micriobota but rather that differences are attributable to prior damage. In any case, the effect of gut flora on health is a fairly speculative area of research at this point. II | (t - c) 02:44, 26 July 2013 (UTC)

This isn't a question. Sterling.M.Archer (talk) 23:28, 26 July 2013 (UTC)

I guess it wasn't clear. The source doesn't comply with WP:MEDRS. II | (t - c) 00:01, 27 July 2013 (UTC)

If your complaint is that it's a primary source, delete it. The Gaesser & Angandi source is sufficient for the statement anyway. Simply because it was funded by a grain group doesn't mean that it isn't valid. — Preceding unsigned comment added by Sterling.M.Archer (talk • contribs) 09:05, 27 July 2013 (UTC)

Actually, no don't delete it. It's far better than most of the sources in the article. After the references for things like CBS news have been cleaned up, then we should start nit-picking about which peer-reviewed articles are better. Sterling.M.Archer (talk) 09:09, 27 July 2013 (UTC)

Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human

A ref in the lead concludes "Thus, the GFD may constitute an environmental variable to be considered in treated CD patients for its possible effects on gut health.", i.e. GFD changes the gut microbiota (as many foods do). This is kind of interesting but it is a primary source and doesn't say anything about the value of GFD and I don't see what point it is supporting in the article. I'll remove it unless someone can justify it. Bhny (talk) 04:52, 19 August 2013 (UTC)

I don't follow what you're planning to remove. Sterling.M.Archer (talk) 08:15, 19 August 2013 (UTC)

reference 4 Gluten-free_diet#cite_note-De_Palma-4

Yeah, please do remove it. As I discuss in the thread above, this is very speculative (and likely later contradicted) research). II | (t - c) 02:27, 26 August 2013 (UTC)

Removed quotations from "unnecessarily turning to the diet as a food fad"

Quotations were unnecessary on this phrase. If this phrase was referencing a specific quote, it needs a citation. — Preceding unsigned comment added by 184.166.13.180 (talk) 19:36, 7 May 2014 (UTC)

Comedy

Hello. "This does not seem like encyclopedia content" is a reference to the editor doing the reading, not to the content. Comedy is a legitimate activity. It was placed in the proper section. I didn't add a trivia section. I take the liberty of making a revert and placing this explanation here in hopes of avoiding an edit war. The source says 10 percent of people need to be on this diet (but my grocer is bringing in gluten-free items to beat the band). -SusanLesch (talk) 21:25, 9 May 2014 (UTC)

I don't know what you're talking about. Anyway, you put this trivial material in the middle of a paragraph where it makes no sense. I don't argue that comedy isn't a "legitimate activity", but I don't think a daily late night show is a prime example artistic commentary. There are many examples someone can find on the internet of a gluten-free diet as a "subject of comedy", and I don't think any of them are worthy sources for an encyclopedia. I'll revert again unless someone has an intelligent solution for this. Eflatmajor7th (talk) 08:48, 10 May 2014 (UTC)

The Boston Globe is a perfectly acceptable secondary reliable source. I have absolutely no allegiance to Jimmy Kimmel Live but there's no doubt his program was significant and it's in its third day on Google News. What other example can you provide? I'd be happy if you wish to reword or move the sentence if you don't like where it is. Please don't remove it entirely. Thanks. -SusanLesch (talk) 15:37, 10 May 2014 (UTC)

Also I'd like to thank you for trying. The lead of this article does explain that this diet is not for the general population. But we've reached a groundswell of how ludicrous nutrition books and dietetics can be. Perhaps it's better to highlight comedy than the tragedy of people following nutrition fads. -SusanLesch (talk) 17:35, 10 May 2014 (UTC)

My problem isn't with the Boston Globe as a source, it's with the actual mention of Jimmy Kimmel in an encyclopedia article about a diet. Even if the point belonged in the article, its current form is probably recentism. In the sentence you wrote, you lead the reader to believe that the "topic" Kimmel addressed was that a gluten-free diet apparently offers no benefits to about 90% of the population. But that's not what he did, he just made a few people look stupid, a pretty cheap and easy form of comedy if it's comedy at all. If anything at all, his "topic" was that a few people don't know what gluten is. And besides he could have interviewed another 10 people that did know what it was, and just not edited them in. My point is that the point you're trying to make with this sentence is already made in other places in the article with other references, unless the point you're trying to make is that some people like to make fun of gluten-free diets, in which case I don't think that's encyclopedia-worthy. Eflatmajor7th (talk) 01:25, 11 May 2014 (UTC)

Two quick clarifications. No intention on my part to make fun of gluten-free diets. Your article does a great service for those who must eat gluten-free (in that respect, it's amazingly good). Second, no that's not what this sentence would lead the reader to believe. The source does quote a doctor who thinks there's no benefit to 90% of the population, but the sentence itself is neutral about that point. -SusanLesch (talk) 15:46, 11 May 2014 (UTC)

You are right (and I knew it when I posted that this topic was three days on Google News) Jimmy Kimmel Live is recentism. But jokes on late night TV in the US stretch back more than three years (John Pinette, Jimmy Fallon, Erin Foley on Conan O'Brien). Perhaps we can arrive at a sentence we can agree on. I'm glad you like The Boston Globe (superior in my opinion to the Huffington Post, Los Angeles Times, TIME magazine etc. coverage of Kimmel's show). Simply adding the phrase "late-night talk show comedy" or "US television comedians" anywhere here would satisfy my requirements. What do you think? -SusanLesch (talk) 15:46, 11 May 2014 (UTC)

Let's call the claim "A gluten-free diet offers no benefits to 90% of the population" A. The reason why the sentence you wrote leads the reader to believe that Kimmel addressed A is the context the sentence is embedded in. The previous sentence basically says that the diet isn't beneficial to non-celiacs. Then your sentence says that "the topic" became the subject of comedy; the only reasonable way to interpret this is that Kimmel somehow addressed A through comedy. But he didn't. He made fun of four people, mostly through editing his video. To be clear, what I'm saying is that the only thing Kimmel addressed about gluten, in any form, is what it is, not anything about benefits or lack thereof of the diet. I don't really see that it even matters that you picked Boston Globe as a source, rather than HuffPost or something else, because the actual sentence in the encyclopedia article isn't about anything substantive in the piece, just Jimmy Kimmel. If you had put in some other stuff that the piece addressed regarding the lack of benefits of the diet to non-celiacs, then that particular source would make more sense. Anyway, I have to say that I'm still not convinced it's even true that the lack of benefits of the diet have been a subject of comedy. Eflatmajor7th (talk) 21:01, 11 May 2014 (UTC)

Regarding the source: it's superior to the Huffington Post and Time because the author's source is Dr. Fasano who is a coauthor of a study that is a source in this article (ref #58 at this time). Also the author bothered to ask a good question of her readers (Why are you on a gluten-free diet?). She's not making fun of anybody.

I'm sorry for the placement of a sentence and for the poor writing ("the topic" got me in trouble). But I'm not sorry for trying. Kimmel's editors did a great job on their Pedestrian Question. Better to laugh than to cry, maybe. -SusanLesch (talk) 01:36, 12 May 2014 (UTC)

Thanks for being patient with me and my concerns, I see that you removed the sentence, thanks. Again, to be perfectly clear, what's in the Boston Globe article is not important to me because even though that's your source, the content you actually put in the article based on it was not at all unique to that source. If you had put something that that article specifically addressed, it would be different. Eflatmajor7th (talk) 02:22, 13 May 2014 (UTC)

Much safer to argue for Kimmel being hilarious. If I had gotten into Dr. Fasano's ideas this argument could have become one of WP:UNDUE which I'm not prepared to argue. -SusanLesch (talk) 23:53, 13 May 2014 (UTC)

FODMAPs

Under the "Non-celiac gluten sensitivity" section, I'm wondering if it would be worth mentioning the research that has been done to tease apart non-celiac gluten sensitivity (NCGS) from FODMAP sensitivity. For example, see:

Biesiekierski JR, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR: No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates.

The study examined the hypothesis that gluten would cause gastrointestinal symptoms in patients with self-reported NCGS. After controlling for FODMAP intake, the study was not able to confirm the hypothesis (though they did find a "nocebo" effect where participants felt worse when they knowingly consumed higher quantities of gluten). This suggests that most/all patients who think they have NCGS actually have FODMAP sensitivity, and it explains why those patients see a benefit from gluten-free/dairy-free diets -- the patients think they're avoiding two bad proteins, but they're actually avoiding several bad carbohydrates that happen to be in exactly the same foods.

At any rate, given how much research has been published on this topic (the article above has been cited 67 times), it seems like it at least deserves a mention here. SashaMarievskaya (talk) 06:57, 1 February 2015 (UTC)

There's already a section on that in the article Non-celiac gluten sensitivity. I've added the "Main article" information now to make it easier to find. I think readers will likely find information on FODMAPs there now. If you think that's not enough, you could add a sentence on FODMAPs in the "Non-celiac gluten sensitivity" section. --Chris Howard (talk) 19:15, 1 February 2015 (UTC)

Neutrality dispute. Non-celiac gluten sensitivity as a clinically evident syndrome vs. "doesn't exist"

I disputed the claim that non-celiac gluten sensitivity (NCGS) "has not been shown to exist" (stated in initial paragraph of Gluten-Free Diet article, and again asserted, in different wording, under NCGS heading). The claim cited a journal article-- Biesiekierski, et al. (2012)--which does not make this claim. That study found that gluten increased the symptoms for self-reported NCGS patients, but a diet lower in FODMAPs improved symptoms. However the study found that gluten was unlikely to be the culprit in their sample. NCGS may have only recently been seriously studied, but it has been recognized as a clinical syndrome since 2012 (Mansueto, et al., 2014) and certainly "exists" in clinical studies. The condition of NCGS was initially received with skepticism because it was novel and increasing in prevalence (Mooney, Aziz, & Sanders, 2013) and probably due to the extent it is mocked in entertainment. Further scientific study revealed it as a clinical condition with subgroups of varying pathogenesis and symptoms (Mansueto, et al., 2014).²

A review by Nijeboer, et al. (2013)⁴ concluded that the causes of NCGS remain debated. Like the Biesiekiersk et al ¹. study, FODMAPs, found in grain are hypothesized to be responsible (Nijeboer, et al.)⁴. Interestingly, in a response to the Biesiekierski et al.¹ article, Carrochio, Rini & Mansueto (2014) state that "wheat sensitivity" may be a better label than "gluten sensitivity". NCGS is generally diagnosed after Celiac's disease and wheat allergy are ruled out (Mansueto, et al., 2014)². It has also been difficult to locate reliable biomarkers for the disease (Guandalini & Polanco, 2014 ; Catassi et al., 2012 ). Regardless of whether gluten, wheat, grain or FODMAPs (or perhaps all as they relate to the different subgroups of NCGS)are responsible, the prevalence of symptoms including intestinal distress, fatigue and headaches that resolve after excluding wheat from the diet, cannot be ignored (Nijeboer, et al., 2013)⁴.

I don't know whether I should have asked permission to make changes as I did regarding the Wiki article. It is concerning that a study is being erroneously interpreted. The Biesiekierski, et al., article is also incorrectly referenced. It is marked with superscripts 2 and 8, using Gibson incorrectly as the first researcher for the initial reference. This adds an extra reference making it appear as if there are 2 studies to support the claim. My interpretation of the Wikipedia NCGS article is that because gluten wasn't isolated as factor in one study, gluten sensitivity doesn't exist. An article on NCGS (as it's heading) should discuss the clinical syndrome from the perspective of current research, which is abundant. The Wiki article also cites Lundin & Alaedini (2012)(superscripted as 8 and incorrectly referenced) to state research is limited and symptoms are not specific (Knut & Armin, 2012). A more accurate citation would be that specific biomarkers are unknown. NCGS has been recognized since the 1980s and research is quite extensive (Catassi et al., 2013)⁸. I apologize for any mistakes I've made (first time here). I should have drafted this offline and I hope the edits aren't confusing! Miniakiva (talk) 03:29, 3 March 2015 (UTC) — Preceding unsigned comment added by 2601:E:2400:340:7C99:58E3:18B:E7E6 (talk) 00:35, 3 March 2015 (UTC)

There was no need to ask permission. (P.S.: Just in case you're one of the authors of one of the papers, however, then please read WP:COI first.) --Chris Howard (talk) 22:19, 3 March 2015 (UTC) And thanks for your explanations here. But I think you forgot so far to adjust the last sentence of the lead (that is, of the introductory section) of this article "Gluten-free diet" which still says "... may not exist". You may want to adapt that, too. By the way, the article on "Non-gluten celiac sensitivity" gives a more differentiated view of all this.

One suggestion: why not create an account with a nickname under which you can edit? That would give other editors the opportunity to see all your edits and leave you messages etc. But you can also continue as an IP if you prefer. --Chris Howard (talk) 22:16, 3 March 2015 (UTC)

Thank you for your response. I'm not sure I understand what you mean by adapting the "does not exist" part. I cannot edit the introductory paragraph, and my edit to the NCGS would rather contradict it. I understand this is not an article on NCGS so I have attempted to sticking to how gluten may or may not affect these individuals. Please share your opinions on this:

Non-celiac gluten sensitivity (NCGS) has been recognized as a clinical syndrome since 2012. The condition of NCGS was initially described as a condition that improved when switching to a gluten-free diet, after celiac's disease and wheat allergy were excluded. Symptoms include gastrointestinal distress, dizziness, brain fog, ataxia, and dermatitis herpetiformis and improve with either a gluten-free or wheat free diet. It has been concluded that NCGS is a syndrome triggered by gluten ingestion resulting in increased human leukocyte antigen and anti-gliadin antibodies, but it has also been suggested that wheat amylase-trypsin inhibitors and low-fermentable, poorly-absorbed, short-chain carbohydrates (FODMAPs) may be responsible for gastrointestinal symptoms. . Cytokine levels in NCGS patients in response to gluten ingestion was found to be higher than in control groups. As research has evolved, NCGS has been revealed as a complex clinical condition with subgroups of varying pathogenesis and symptoms. Some individuals who have reported to have NCGS symptoms were found to not have gluten-sensitivity but a FODMAPs sensitivity . FODMAPs are found in wheat and therefore self-reported NCGS individuals would notice a reduction in symptoms by switching to either a gluten-free diet or a low FODMAPs diet as both eliminate wheat. There is an ongoing debate whether gluten or wheat is the offending antigen, or whether the term should be non-celiac's gluten sensitivity or non-celiac wheat sensitivity..Miniakiva (talk) 07:31, 4 March 2015 (UTC)

Overall, it's an improvement. It is a bit too technical for this article, and probably with a bit too much detail. Again, our goal here should be to summarize Non-celiac gluten sensitivity, focusing on details relevant to a gluten-free diet. --Ronz (talk) 17:03, 4 March 2015 (UTC)

References

I have now also adapted the introductory paragraph. As far as I am concerned, the "Neutrality" template can be removed. --Chris Howard (talk) 22:42, 4 March 2015 (UTC)

I agree. And I simplified my edit. I hope it is clearer and to the point. Thank you.Miniakiva (talk) 22:56, 4 March 2015 (UTC)

I have doubts about the simplification, because it introduces the expression "silent celiac disease" which is defined differently elsewhere (see Link: "Silent CD is equivalent to asymptomatic CD. We discourage the use of the term silent CD."). True that the cited source of 2013 says "NCGS (also known as silent celiac disease)". However, that reference is a mere Case Report, so we should better stick to the nomenclature used in most other medical review articles where possible. So I think it will need a bit more work. (Maybe I can get round to it later.) --Chris Howard (talk) 23:37, 4 March 2015 (UTC)

I have worked on it more now (Difflink). --Chris Howard (talk) 13:21, 5 March 2015 (UTC)

I removed the new info describing the diagnosis and treatment. --Ronz (talk) 21:04, 5 March 2015 (UTC)

I do not mind whether it's in or out, because anyway the "Symptoms & Diagnosis" information for NCGS is accessible via the indicated main article. Regarding your edit comment ("way beyond"), I point out that by the way the recommendation to first(!) have CD tested before undertaking any gluten-free diet in case of suspected NCGS is indeed a general recommendation that is also put forward in recent review articles on NCGS diagnosis. (I have none at hand right now, but could retrieve one if requested.) Anyway, as far as I am concerned, NCGS symptoms & diagnosis need not be in this article.

In any case, in my view again at this moment the neutrality template is no longer needed. --Chris Howard (talk) 00:22, 6 March 2015 (UTC)

Athletes

Moved here for discussion. I think a MEDRS source is needed if we want to present it this way: --Ronz (talk) 17:25, 2 August 2015 (UTC)

A low-gluten or gluten free diet has also been suggested for athletes such as distance runners, an estimated 20 to 50 percent of whom suffer from gastrointestinal issues, and the risk of inflammation from gluten or wheat.

17:25, 2 August 2015 (UTC)

Reverted edits

• In this review, @Alexbrn: reverted my edit. Reason: (rmv. weaker source; accurify text to what review says per WP:V) But the sources don’t say what Alexbrn wrote and the sources I used are reliable, secondary, peer-reviewed, reviews articles. In this edition (Sources don't say "There is no good evidence that a GFD of any benefit to people with autism". First one say "Current evidence for efficacy of these diets is poor." and second one "There may be a subgroup of patients who might benefit from a GFD"), I adjusted the text.

• In this revisión, Alexbrn reverted the rest of my edits. Reason: (undo some dubious recent edits) No further explanations. But I also used verifiable secondary, peer-reviewed sources. For example:
  • (→‎Non-celiac gluten sensitivity: Removing information based on primary source. Updating with recent reviews (secondary sources). doi:10.4081/itjm.2013.461 PMID 26109797 PMID 25289132 PMID 24667093) in this edition] I replaced a primary source with secondary sources (view WP:MEDRS), and removed a text that was not supported by the source allegedly backed him.
  • (→‎Non-celiac gluten sensitivity: It's a good source, but doesn't support the information. The article doesn't say anything like that! I remove boht.)

• In these two editions, it was added information, but it was biased. I expanded the text from the source to neutralize it with all points of view:
  • (→‎As a fad diet: Adjusting the text to the really content of the recently added source (revision 689123887).)
  • (→‎As a fad diet: Expanding information from the same source, to neutralize the text. http://www.cbsnews.com/news/gluten-free-diet-fad-are-celiac-disease-rates-actually-rising/)
  • (→‎As a fad diet: Expanding information from a source already present, to neutralize the text. http://www.macleans.ca/society/life/gone-gluten-free/)

Those editions were reverted by Axelbrn, who only maintained biased information that does not correspond to the total focus of the article. I removed the text but I did not add again which I had edited in my first editions: (But, is it or is not verifiable?? I agree that Macleans is the only questionable source of recent editions, but my intention was to respect Ashton Banfield's editions. But if we use it, say all views containing, without biasing the information. WP:NPV) If it is a verifiable source, so we have to write what it says, with neutrality, and therefore include again this text: [https://en.wikipedia.org/w/index.php?title=Gluten-free_diet&oldid=689259700#As_a_fad_diet

• I didn’t see these two edits of @Heaviside glow: and I overwrited them without noticing. I take this opportunity to apologize to him. I have a technical problem. I don’t receive notice of conflicting editions. I left a message to @Jfdwolff:.

Best regards.--BallenaBlanca (talk) 10:16, 6 November 2015 (UTC)

Not sure what the problem is here, but it appears as though recent changes have given this fad far more mainstream acceptance than WP:DUE would suggest. I await further comment. -Roxy the dog™ woof 11:29, 6 November 2015 (UTC)

To take the first bullet first - we should paraphrase sources not copy/paste them - that risks copyright violation/plagiarism. The summary was/is good - yours gives too much weight to weakly-sourced speculation. So, this source is not a good WP:MEDRS, but appears rather fringey. Is it MEDLINE-indexed? (add: answer, no - in fact digging a bit further it seems this publisher features on Beall's list of "Potential, possible, or probable predatory scholarly open-access publishers" - so we've got junk being edit-warred into the article.) It's DOI seems unregistered too. In general, rather than mashing the revert key to get your reverted edits "back in" it's a good idea to discuss them in Talk, perhaps following WP:BRD? Alexbrn (talk) 12:02, 6 November 2015 (UTC); amended 12:37, 6 November 2015 (UTC)

@Alexbrn:, I will try to organize my answer. I agree to discuss, of course.

1. I don't understand you. Sorry, where is a copy/paste? Do you say that is a copy/paste in this edit? There isn't.
2. I agree that this source is not a good WP:MEDRS. I have removed it.
3. I didn't "revert". I have reviewed, adjusted, and expanded the text. I think it is not the same...
4. Do you think that this is a reliable source: http://www.macleans.ca/society/life/gone-gluten-free/? Can we use it?
5. References do not correspond to my answer, they were already present in the talk page. So where do you think to place the template {{reflist-talk}}? I do not want misunderstandings and thus, I have not done.

Best regards. --BallenaBlanca (talk) 14:16, 6 November 2015 (UTC)

and now there is a problem of understanding which I may have contributed to when I moved the reflist template to the end of the page earlier. Frankly, it now makes no sense to me, because the list of references to this page haven't all been produced from refs in this section. some are from earlier in the page. Does Alex think that the reflist is actually a bulleted list entirely produced by Ballena. I don't think that is the case, and you are both talking at cross purposes, assuming each is able to understand the other. Oh dear, this doesn't sound like what I mean. Help? -Roxy the dog™ woof 14:56, 6 November 2015 (UTC)

@BallenaBlanca:

1. I worry that your wording (“Evidence of the diet's efficacy as an autism treatment is poor,”) is a too WP:CLOSEPARAPHRASE of the source's “Current evidence for efficacy of these diets is poor”.
2. You've removed the source, but left its dubious payload (“probably”)
3. Please review WP:EW: “A 'revert' means any edit (or administrative action) that reverses the actions of other editors, in whole or in part, whether involving the same or different material.” Reversing my edit to put your once-reverted wording and source back would count as this type of thing.
4. That source is not reliable for biomedical assertions; it may be for other kinds of content
5. Whoops yes, I misplaced the template. Now fixed. Alexbrn (talk) 15:10, 6 November 2015 (UTC)

@Roxy the dog:, do not worry, there is no problem. Everything is clarified.

1. @Alexbrn: It seems that there is a misunderstanding. I did not write this: “Evidence of the diet's efficacy as an autism treatment is poor”, it was already present before my first edition. I'll go to show:

• This is my first edit in "Gluten-free diet": This is an old revision of this page, as edited by BallenaBlanca (talk | contribs) at 21:27, 25 October 2015 (Cite error: Invalid <ref> tag; name "Kohlstadt2012-p318" defined multiple times with different content. Corrected. I did not find canary seed in source.).
• If you take a look at the previous revision: This is an old revision of this page, as edited by 167.206.17.129 (talk) at 13:20, 16 October 2015 (→‎As a fad diet) , you’ll see that the text “Evidence of the diet's efficacy as an autism treatment is poor.” was already present.

Not much margin in such a short sentence, without the real meaning is changed. Nevertheless, I have made this modification: "Currently, evidence for the efficacy of a gluten-free diet in the management of autism disorders is sparse"

2. I left this text: "but there probably is a subset of patients who might improve with a gluten-free diet" because it is supported by this source (paraphrased from "Conclusions"):

Buie T (2013) "The relationship of autism and gluten". Clin Ther (Review) 35 (5): 578–83. doi:10.1016/j.clinthera.2013.04.011. PMID 23688532 CONCLUSIONS: A variety of symptoms may be present with gluten sensitivity. Currently, there is insufficient evidence to support instituting a gluten-free diet as a treatment for autism. There may be a subgroup of patients who might benefit from a gluten-free diet, but the symptom or testing profile of these candidates remains unclear.

3. Thank you very much, I will review that link.

4. I agree. Then, we can't use this here.

5. Thank you, no problem!  ;)

Best regards. --BallenaBlanca (talk) 17:16, 6 November 2015 (UTC)

You put the close paraphrase back into the article, so are responsible for it. It's still too close I think. There is nothing in the source to support your "probably" - that was a word from the dodgy source which has now been deleted. This speculation about a (possible) subgroup (which possibly might benefit) should not be included as it's undue and will give a lay audience a false impression of where the weight of current knowledge sits. Alexbrn (talk) 17:30, 6 November 2015 (UTC)

• I removed some text in the fad diet section that appeared to be trying to rebut the whole notion that going gluten free is a fad. I don't particularly have a problem with the text in question, but the faddishness of the gluten free diet is well established in secondary sources, so that's what the section should address. Ideally, it should not say anything—pro or con—about the value of going gluten free for people who don't have celiac disease or non-celiac gluten sensitivity unless backed up by sources that meet WP:MEDRS. Heaviside glow (talk) 18:48, 6 November 2015 (UTC)

Wording for autism

@Alexbrn: there are mainly two weaknesses in your reasons for deleting the text I added about autism:

1. You said that “There is nothing in the source to support your "probably" - that was a word from the dodgy source which has now been deleted.” And then, in this edition you removed “but there probably is a subset of patients who might improve with a gluten-free diet.22”. Let’s look again the source 22:

Buie T (2013) "The relationship of autism and gluten". Clin Ther (Review) 35 (5): 578–83. doi:10.1016/j.clinthera.2013.04.011. PMID 23688532 CONCLUSIONS: A variety of symptoms may be present with gluten sensitivity. Currently, there is insufficient evidence to support instituting a gluten-free diet as a treatment for autism. There may be a subgroup of patients who might benefit from a gluten-free diet, but the symptom or testing profile of these candidates remains unclear.

I paraphrased the source and wrote “probabily” to substitute “may be”, wich is perfectly correct:

Oxford dictionaries

probably Sinónimos de probably en inglés (Synonyms for probably in english): adverbio • I knew I would probably never see her again in all likelihood, in all probability, as likely as not, very likely, most likely, likely, as like as not, ten to one, the chances are, doubtless, no doubt, all things considered, taking all things into consideration, all things being equal, possibly, perhaps, maybe, it may be, presumably, on the face of it, apparently

archaic like enough, belike

Collins dictionary

probably (ˈprɒbəblɪ ) Definitions adverb (sentence modifier; not used with a negative or in a question) in all likelihood or probability ⇒ I'll probably see you tomorrow

sentence substitute I believe such a thing or situation may be the case

2. In that same edition, you wrote in the edit summary box (→‎As a fad diet: reword, add quotation to ref for avoidance of doubt), and so you modified the reference:

22. Buie T (2013). "The relationship of autism and gluten". Clin Ther (Review) 35 (5): 578–83. doi:10.1016/j.clinthera.2013.04.011. PMID 23688532. At this time, the studies attempting to treat symp- toms of autism with diet have not been sufficient to support the general institution of a gluten-free or other diet for all children with autism

...but you didn't write the rest of the paragraph of the source: There may be a subgroup of patients who might benefit from a gluten-free diet, but the symptom or testing profile of these candidates remains unclear and you said in this talk page "This speculation about a (possible) subgroup (which possibly might benefit) should not be included as it's undue and will give a lay audience a false impression of where the weight of current knowledge sits."

In my opinion, this way of acting may be a “cherry picking”:

Cherry picking (fallacy) Cherry picking, suppressing evidence, or the fallacy of incomplete evidence is the act of pointing to individual cases or data that seem to confirm a particular position, while ignoring a significant portion of related cases or data that may contradict that position. It is a kind of fallacy of selective attention, the most common example of which is the confirmation bias.[1][2] Cherry picking may be committed intentionally or unintentionally. This fallacy is a major problem in public debate.[3]

...and not fit WP:NPOV. We must write the information with a neutral point of view, and let the reader to make his own decisions.

Now, let’s take a look at the latest reviews (newer than the 2008 Cochrane review), wich also include the results of Cochrane review in their conclusions:

First, this one of 2013:

PMID:24077239 Nutrients. 2013 Sep 26;5(10):3839-53. doi: 10.3390/nu5103839. Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. Despite its popularity, the efficacy of the GFCF diet in improving autistic behavior remains not conclusively proven. A 2008 Cochrane review reported that only two small RCTs investigated the effect of GFCF diet in children with ASD (n = 35). There were only three significant treatment effects in favor of the diet intervention: overall autistic traits, mean difference (MD) = −5.60; social isolation, MD = −3.20 and overall ability to communicate and interact, MD = 1.70. In addition three outcomes were not different between the treatment and control group while differences for ten outcomes could not be analyzed because data were skewed. The review concluded that the evidence for efficacy of these diets is poor, and large scale, good quality randomized controlled trials are needed (28). By using a two-stage, randomized, controlled study of GFCF diet of children with ASD, Whiteley and coworkers recently reported significant group improvements in core autistic and related behaviors after eight and 12 months on diet. The results showed a less dramatic change between children having been on diet for eight and children in diet for 24 months, possibly reflective of a plateau effect (29). The above data suggest that removing gluten from the diet may positively affect the clinical outcome in some children diagnosed with ASD, indicating that autism may be part of the spectrum of NCGS, at least in some cases. However, a word of caution is necessary to stress the fact that only a small, selected sub-group of children affected by ASD may benefit from an elimination diet. Additional investigations are required in order to identify phenotypes based on best- and non-response to dietary modifications and assess any biological correlates including anthropometry before considering a dietary intervention. 29. Whiteley P., Haracopos D., Knivsberg A.M., Reichelt K.L., Parlar S., Jacobsen J., Seim A., Pedersen L., Schondel M., Shattock P. The ScanBrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutr. Neurosci. 2010;13:87–100. doi: 10.1179/147683010X12611460763922.

Another review, of 2014:

PMID:24789114 J Child Neurol. 2014 Dec;29(12):1718-27. doi: 10.1177/0883073814531330. Epub 2014 Apr 30. Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review. Marí-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Suárez-Varela M Few studies can be regarded as providing sound scientific evidence since they were blinded randomized controlled trials, and even these were based on small sample sizes, reducing their validity. We observed that the evidence on this topic is currently limited and weak. We recommend that it should be only used after the diagnosis of an intolerance or allergy to foods containing the allergens excluded in gluten-free, casein-free diets. Future research should be based on this type of design, but with larger sample sizes.

Another review, of 2014:

PMID:25433099 Nutr Hosp. 2014 Dec 1;30(6):1203-10. doi: 10.3305/nh.2014.30.6.7866. Is gluten the great etiopathogenic agent of disease in the XXI century? Article in Spanish San Mauro Martín I, Garicano Vilar E, Collado Yurrutia L, Ciudad Cabañas MJ Millward C et al. (2008)23 ha sugerido que los péptidos del gluten y la caseína pueden tener un papel en los orígenes del autismo y que la fisiología y la psicología del trastorno pueden ser explicadas por la excesiva actividad opioide vinculada a dichos péptidos23. Catassi C et al.24, en 2013, trabajaron en esta misma línea, sugiriendo una relación entre la SGNC y los trastornos neuropsiquiátricos, entre ellos el autismo. 23. Millward C, Ferriter M, Calver S, Connell-Jones G. Glutenand casein-free diets for autistic spectrum disorder. Cochrane Database Syst Rev. 2008 Apr 16 ;(2):CD003498. 24. Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A et al. Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. Nutrients. 2013 Sep 26; 5(10):3839-3.

Another review, of 2015:

PMID:26060112 Best Pract Res Clin Gastroenterol. 2015 Jun;29(3):477-91. doi: 10.1016/j.bpg.2015.04.006. Epub 2015 May 9. Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders. Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE Among psychiatric disorders, a minority (6%) of patients with NCGS showed a previous clinical history of eating behavior abnormalities, while autism spectrum disorders (ASD) have been hypothesized to be associated with NCGS [47,48]. Notably, a gluten- and casein-free diet might have a positive effect in improving hyperactivity and mental confusion in some patients with ASD. This very exciting association between NCGS and ASD deserves further study before conclusions can be firmly drawn.

Furthermor, the 2008 Cochrane review that you cited found in some studies that the gluten-free diet is effective in some autistic symptoms:

Cochrane Database Syst Rev (2): CD003498. doi:10.1002/14651858.CD003498.pub3. PMID 18425890. “Two small RCTs were identified (n = 35). No meta-analysis was possible. There were only three significant treatment effects in favour of the diet intervention: overall autistic traits, mean difference (MD) = -5.60 (95% CI -9.02 to -2.18), z = 3.21, p=0.001 (Knivsberg 2002) ; social isolation, MD = -3.20 (95% CI -5.20 to 1.20), z = 3.14, p = 0.002) and overall ability to communicate and interact, MD = 1.70 (95% CI 0.50 to 2.90), z = 2.77, p = 0.006) (Knivsberg 2003). In addition three outcomes showed no significant difference between the treatment and control group and we were unable to calculate mean differences for ten outcomes because the data were skewed. No outcomes were reported for disbenefits including harms.”

So, supported for all those reliable secondary, PubMed indexed sources, and adjusting to the recomendations of @Heaviside glow: "Ideally, it should not say anything—pro or con—about the value of going gluten free for people who don't have celiac disease or non-celiac gluten sensitivity unless backed up by sources that meet WP:MEDRS" I think that there is no reason not to say that in a subset of patients, the diet can improve some autistic behaviours. There is no reason to hide this information. And then, I will edit in the gluten-free diet page and add a brief sentence. Nevertheless, I'm going to take another approach, more critical, and instead of saying that "some patients may benefit...", I'll write "Only a subset of patients may improve some autistic behaviours with a gluten-free diet".

Best regards. --BallenaBlanca (talk) 20:16, 7 November 2015 (UTC)

Yeah, but in your wording there "is" a subgroup whereas the source says there only "may be" such a subgroup. All of your wordings are providing a stronger steer than the super-speculative source wording. We needn't include this kind of useless information because in an encyclopedic context it unduly implies weighty things about gluten-free diets and autism. I shall raise a flag at WT:MED. Alexbrn (talk) 07:35, 8 November 2015 (UTC)

My intention is to reflect what the references say, with neutrality.

The fact that there is a subset, subgroup, some... patients who improve with a gluten-free diet is not the doubt.

PMID:26060112 Best Pract Res Clin Gastroenterol. 2015 Jun;29(3):477-91. doi: 10.1016/j.bpg.2015.04.006. Epub 2015 May 9. Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders. Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE Notably, a gluten- and casein-free diet might have a positive effect in improving hyperactivity and mental confusion in some patients with ASD.

PMID:24077239 Nutrients. 2013 Sep 26;5(10):3839-53. doi: 10.3390/nu5103839. Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. The above data suggest that removing gluten from the diet may positively affect the clinical outcome in some children diagnosed with ASD (...) indicating that autism may be part of the spectrum of NCGS, at least in some cases.

The main problem is to determinate "the symptom or testing profile of these candidates" PMID 23688532 (2013) "The relationship of autism and gluten" and what are the "effects in favor of the diet intervention".PMID:24077239 (2013) Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders. (2008) Cochrane Database Syst Rev

The double-blind, placebo-controlled studies, with big sample sizes, that are the gold standard in Medicine, wich in this case also require a gluten challenge and the reappearance of the autistic symptoms to validate the relationship, are very complicated in this population and even questionable from an ethical point of view. Also, they have a very high cost. Other problems detected at current trials are the lack of strict adherence to the diet (that is essential), voluntary or accidental, repeatedly observed, which may make the diet ineffective; the lack of a control group and/or clear definitions of inclusion criteria; interventions being of variable duration and generally short; risk of bias in data on the behavioral variables attributable to memories of parents; etc. Thus, the current studies suffer from "lack of rigor" and it will be difficult to have rigorous trials in the future.

In my opinion, the current text is well adjusted, but I think that is a good idea to talk at WT:MED and see the opinions of other users. Thank you very much, @Alexbrn:. Best regards. --BallenaBlanca (talk) 08:53, 8 November 2015‎ (UTC)

• concur w/ Alexbrn wording there "is" a subgroup whereas the source says there only "may be" such a subgroup. All of your wordings are providing a stronger steer than the super-speculative source wording. We needn't include this kind of... information because in an encyclopedic context it unduly implies weighty things about gluten-free diets and autism.[2]....IMO--Ozzie10aaaa (talk) 12:21, 8 November 2015 (UTC)
• I think it's more complicated than that. Does anyone here actually believe that having autism could make it impossible to have (true) celiac disease? Assuming we're agreed on that point, then as a matter of simple logic, there most definitely is a subset of people with autism who would benefit from a GFD, namely those people who have both autism and (unrelated) celiac disease. I would even expect people with both of these conditions to behave better on a GFD, since most humans behave better when they're not in pain and feeling sick all the time. Consequently, I am theoretically not worried about saying that there truly "is" a subset of people with autism who benefit from this diet. It is undoubtedly true.
  But I've read enough of the work on this subject to have a feel for the overall mainstream POV, and I don't think that it would be fair or appropriate to even suggest that mainstream medical experts on autism believe that GFDs have any effect whatsoever on whether a given child remains autistic or not. IMO it would, however, be fair and neutral to say that GFDs are popular with parents and advocacy groups anyway, and that parents commonly (although not always) attribute any longed-for improvement to the diet. (This is remarkably similar to cancer patients, most of whom believe that months of chemotherapy or their choice of strange diets contributes far more to their cure than surgical removal of the tumor, even though chemo has a far smaller effect for solid tumors. Who wants to believe that a two-hour surgery cured them, and that the year of grueling chemotherapy and five years of painfully restricted dieting was probably a complete waste of time and effort? People prefer to believe that the results are related to, and proportional to, their own effort.) WhatamIdoing (talk) 16:51, 8 November 2015 (UTC)

Yes, @WhatamIdoing:, it's more more... and more complicate than that. We could talk hours about this.

And it is not only that humans behave better when they're not in pain and feeling sick all the time. It is more complex than that. Growing evidences suggest the connection between gluten and a variety of neurological symptoms, in some cases.

I want to make a point. Not that we suggest that "mainstream medical experts on autism" believe that diet may have some effect. First, we only talk about the results of latest reviews on this topic. And second, the problem may be thinking only of "medical experts on autism". Currently, most of the studies in this area (the possible relationship between gluten and some neurological symptoms) are carried out by other specialists such as gastroenterologists, allergists, pediatricians, internal physician, etc.). I hope not to offend anyone by saying this, but most neurologists "do not believe" the existence of non-celiac gluten sensitivity, neither any relationship with neurological disorders. They don't realize gastrointestinal explorations, they see only a "part of the patient".

Currently, most cases of CD remain undiagnosed (it is estimated that are diagnosed only 10-15% of cases) and diagnosis often requires several years (on average, 10-20 years). Patients may suffer severe non-intestinal symptoms for many years, before proper diagnosis is made.

Therefore, once again I want to emphasize that what we are doing is giving a global overview of the problem.

One possibility is be more precise and say something like "The results of some studies have shown, in a small subset of patients, an improvement in some autistic behaviours with a GFD, while others have not found significant changes".

These studies have not been performed by parents, but physicians. We can't talk about the "conclussions of parents".

These are some authors of the cited sources:

Timothy Buie MD is a pediatric Gastroenterologist at the Lurie Center for Autism, a multidisciplinary program that treats children, adolescents and adults with autism spectrum and other neurodevelopmental disorders.

Umberto Volta. University of Bologna, Bologna Gastroenterology, Internal Medicine, Cardiovascular Diseases

Giacomo Caio. University of Bologna, Bologna Gastroenterology, Internal Medicine (General Medicine), Hepatology

Roberto De Giorgio. Settore scientifico disciplinare: MED/09 Internal Medicine

Christine HenriksenUniversity of Oslo, Oslo Pediatrics, Nutritional Biochemistry, Nutrition and Dietetics

Gry Irene Skodje Oslo University Hospital, Kristiania (historical), Oslo, Norway. Division of Clinical Nutrition, Oslo University Hospital

Knut E A Lundin. Oslo University Hospital, Oslo. Gastroenterology, Internal Medicine (General Medicine)

Ismael San Mauro. Complutense University of Madrid. Medicine, Biology, Agricultural Science. Research centers in Nutrition and Health.

Carlo Catassi. Department of Pediatrics. Boston Children's Hospital, Boston, Massachusetts, United States

Julio C BaiUniversity of El Salvador, San Salvador. Gastroenterology

Antonino Salvatore CalabrUniversity of Florence, Florence. Gastroenterology

Antonio CarrocciInternal Medicine, Gastroenterology, Clinical Immunology, Allergology

Gemma CastillejoGastroenterology, Pediatrics, Clinical Trials

Carolina Ciacci Surgery, Infectious Diseases, Hepatology

Jernej DolinsekUniversity Medical Centre Mari..., Maribor Pediatrics

Ruggiero Francavill. Pediatrics, Gastroenterology

Peter H R Green Columbia University, New York City Gastroenterology

Michael Schuman. Charité Universitätsmedizin Berli. Gastroenterology, Infectious Disease

Detlef Schuppa. Beth Israel Deaconess Medical ..., Boston Gastroenterology, Hepatology, Oncology

Andreas Vécsei . St Anna's Kinderspital, Vienna Gastroenterology, Pediatrics

Best regards. --BallenaBlanca (talk) 20:46, 8 November 2015‎ (UTC)

BallenaBlanca, I'm not seeing any reason to believe that mainstream medicine believes any such "growing evidences" of any "connection between gluten and a variety of neurological symptoms" exist, outside of celiac disease and its occasional complications (e.g., nutritional deficiencies because your intestines are so wrecked that they can't absorb nutrients). WhatamIdoing (talk) 01:32, 9 November 2015 (UTC)

I almost don't see this message. I have some troubles to correctly express in english, sorry. This list was intended to demonstrate that there are no neurologists among these physicians.

Growing evidences? Yes, off course.

"Occasional" complications? Not occasional, quite the opposite. Complications of untreated CD are very, very common and not only nutritional deficiencies, because celiac disease is a systemic autoimmune disease that can affects any organ or body system.

Look, for example, this recent review (5 Oct 2015), at British Medical Journal:

Extended content

BMJ. 2015 Oct 5;351:h4347. doi: 10.1136/bmj.h4347. Celiac disease and non-celiac gluten sensitivity. Lebwohl B1, Ludvigsson JF2, Green PH3. CELIAC DISEASE Celiac disease occurs in about 1% of the population worldwide, although most people with the condition are undiagnosed. It can cause a wide variety of symptoms, both intestinal and extra-intestinal because it is a systemic autoimmune disease that is triggered by dietary gluten. Patients with celiac disease are at increased risk of cancer, including a twofold to fourfold increased risk of non-Hodgkin’s lymphoma and a more than 30-fold increased risk of small intestinal adenocarcinoma, and they have a 1.4-fold increased risk of death. (...) Although diarrhea remains one mode of presentation that prompts testing for celiac disease in adults, most patients with the disease do not have diarrhea. Instead, most adults have one of the many “non-classic symptoms” such as anemia (usually as a result of iron deficiency, although it may be caused by chronic disease); osteoporosis; and various other presentations, including dermatitis herpetiformis, abdominal pain, neurological or psychiatric problems, infertility, aphthous stomatitis, and vitamin deficiencies. (...) Autoimmune diseases The prevalence of celiac disease approaches 5% in many autoimmune diseases. The association with celiac disease is often bi-directional—people with celiac disease are at increased risk of immune mediated diseases both before and after the diagnosis of celiac disease. 21 /22 One rationale for diagnosing minimally symptomatic celiac disease is that this may reduce the risk of developing other autoimmune diseases, although the results of studies on such a protective effect are contradicting. 23 Gastrointestinal disease Celiac disease has also been linked to gastrointestinal disorders such as liver disease and pancreatic disease.90-93 The spectrum of disease varies from an asymptomatic increase in serum transaminases,94 to liver failure,91 liver cancer,81 and pancreatic cancer.81 For several gastrointestinal cancers, particularly small intestinal adenocarcinoma, the relative risks are strikingly high in the first year after the diagnosis of celiac disease, suggesting that part of the increased risk may be due to ascertainment bias or confounding by indication. The highest relative risks for liver disease in celiac disease have been seen in primary biliary cirrhosis.95 Although cost effectiveness analyses have not been performed on this subject, it seems prudent to test for celiac disease in patients with raised transaminases of unclear cause and in patients with primary biliary cirrhosis. Cardiovascular disease Of particular interest has been the risk of ischemic heart disease because study results have been contradictory Other comorbidities and complications associated with celiac disease In general, Nordic studies have reported a positive association, 96-98 whereas most British studies have noted an inverse association.20 98-100 This difference in relative risk for cardiovascular disease may reflect underlying factors, such as socioeconomic status and smoking, which seem to differ between countries. NON-CELIAC GLUTEN SENSITIVITY Neuropsychiatric disorders Gluten has been proposed to be involved in various neuropsychiatric disorders including schizophrenia, autism, peripheral neuropathy, and ataxia.

• The following text from the following source should be summarised and referenced appropriately: Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia........only a small, selected sub-group of children affected by ASD may benefit from an elimination diet. I feel that it must also be worded to say that the diet might cause some improvement in symptoms (which is what some preliminary studies say) to make clear to the reader that there is no evidence that diet can cure or reverse ASD. Also this source should be summarised as it says that evidence of a benefit of a gluten free diet for ASD is limited and weak. I feel it is notable enough to include this information but any text added to this article should be restricted to a couple of sentences per WP:WEIGHT.--Literaturegeek | T@1k? 22:13, 8 November 2015 (UTC)
  • It would be nice if we could include the selection criteria that separate the "small, selected sub-group" from everyone else. "Selected patients benefit from X, but we won't tell you who gets selected" is an exercise in frustration. Of course, I'm assuming that selection criteria actually exist, and that "selected" isn't being misused to mean "small"; perhaps my assumption is wrong. WhatamIdoing (talk) 01:31, 9 November 2015 (UTC)

Unfortunately, currently there is no such selection criteria. A neurological symptom itself may be the only symptom of CD or NCGS, even in the absence of any other symptoms. Both disease can occur without digestive symptoms. Once completed the entire protocol to evaluate a possible CD (serology, duodenal biopsies and genetic), if the results are negative for CD, the only way to rule out the relationship with the SGNC is to make a gluten-free diet trial, at least six months and preferably one year. Some SGNC patients (some authors suggest about 50%) may have IgG-AGA+ or a small intraepithelial lymphocyte infiltration in duodenal biopsies, in a few cases. But many others have no alterations at all.

But nearly 100% of physicians don't want to perform duodenal biopsies in absence of positive serology (anti-tTG-). This is a good reflect of the situation, the mother had "to fight" with specialists to get biopsies (in Spanish): PMID:24656390 Clinical features suggesting autism spectrum disorder as a manifestation of non-celiac gluten sensitivity. An Pediatr (Barc). 2014 Dec;81(6):409-11. doi: 10.1016/j.anpedi.2014.02.021. Article in Spanish Probabily, many SGNC patientes have indeed CD. There is no clear separation between this two entities and both remains under recognized, underdiagnosed and undertreated, and patiens are exposed to the risk of long-term complications, like neuropsychiatric disease among other.

Best regards. --BallenaBlanca (talk) 02:30, 9 November 2015‎ (UTC)

In which case, there are no "selected" patients that might benefit from this. You cannot have "selected patients" if there is no way to "select" them.

And I repeat from our earlier exchange: Mainstream medicine (not just neurologists, not just autism experts) does not appear to believe that gluten-free diets affect neurology (unless celiac is so severe that the patient is vitamin-deficient). WhatamIdoing (talk) 03:45, 10 November 2015 (UTC)

Maybe the question is that they have to learn more about this... And learn to recognize celiac patients, because currently 85-90% are undiagnosed and untreated (there are a lot patientes, CD affects about 1% of the general population and NCGS affects about 8-10%), and they develop a lot of complications and associated disease, that are preventable with early diagnosis and diet. And they have to learn that "vitamin deficiency" is not the only problem, perhaps it may be "the least of the problems"; no need to have a vitamin deficiency to develop autoimmune diseases that attack any organ or system body: brain, thyroid, pancreas, kidney, liver, skin, small intestine, colon, etc. And that there is no need to have a "vitamin deficiency" to develop intestinal and non-intestinal malignancies, such as lymphomas, thyroid cancer, oral cancer, esophageal cancer, stomach cancer, etc. It can be a very severe celiac disease with a perfect analytical. And "believe" that it is a reality that can't be ignored. They can not "believe" in something that they don't know. Medicine is a living science and doctors need to be continuously informed of new developments.

"You cannot have "selected patients" if there is no way to "select" them." So I understand that is better then not put "selected patients" in the text, it is better to let what it says now "subset of autistic patients".

Best regards. --BallenaBlanca (talk) —Preceding undated comment added 07:34, 10 November 2015 (UTC)

Archiving

I hope nobody minds that I archived a whole load of old stuff from this page, and I am aware that the way I did it wasn't elegant, but it is better than having a whole lot of redundant info here that is irrelevant to current discussion. I'm about to move the reflist template to the bottom of the page too, and that probably wont be the best solution either. -Roxy the dog™ woof 12:19, 6 November 2015 (UTC)

Another reverted edit

@Alexbrn: can you, please, explain the reasons for revert this edition (→‎As a fad diet: Expanding. Source: Fasano A, Sapone A, Zevallos V, Schuppan D (May 2015). "Nonceliac gluten sensitivity". Gastroenterology 148 (6): 1195–204. doi:10.1053/j.gastro.2014.12.049. PMID 25583468)?

You said: (Reverted to revision 689838327 by BallenaBlanca (talk): Rv. copyright violation - do not cut and paste text into Wikipedia. (TW))

This is my text:

Although there is a evident "fad component" to the recent rise popularity of the gluten-free diet, there are also growing and unquestionable evidences about the existence of non-celiac gluten sensitivity.

And this one the original:

"Although there is clearly a fad component to the popularity of the GFD, there is also undisputable and increasing evidence for NCGS."

Is this realy a "cut and paste"???

Best regards. --BallenaBlanca (talk) 20:58, 9 November 2015‎ (UTC)

No it's not, it's been altered a bit so that it's a WP:CLOSEPARAPHRASE. Just using synonmys and juggling the word order is not enough to avoid plagiarism, which needs to be avoided for many reasons, not least because it can create an enormous workload for other editors to clear up. Alexbrn (talk) 21:09, 9 November 2015 (UTC)

Yes, it was very similar. I wanted to be faithful the text to avoid problems again. But now I understand, is not a correct practice. I'll keep that in mind, thank you.

I think it would have been wise to write "close parphrase" and not "cut and paste" in the edit box, they are not the same thing.

Best regards. --BallenaBlanca (talk) 22:33, 9 November 2015‎ (UTC)

Text of picture: Amount of gluten that can causes a reaction

Dear Smyth

First, I want to thank your effort rewording the text of the picture Amount of gluten that can causes a reaction. You did a good job.

However, it seems that there was an error in this edition yours: (→‎Rationale behind adoption of the diet: Copyedit)

You deleted this bold text “consuming gluten even in small quantities, whether voluntary or not” due to “copyedit”. Where is a “copyedit”? There is not a copyedit: not a close paragraph, nor copypaste, and therefore there is any copyvio/copyedit problem. Let’s take a look at the text of the source that supported this sentence. This is not a free access article, but I have the paper:

Mulder CJ, van Wanrooij RL, Bakker SF, Wierdsma N, Bouma G (2013). "Gluten-free diet in gluten-related disorders". Dig Dis. (Review) 31 (1): 57–62. doi:10.1159/000347180. PMID 23797124.

Even the most fanatic patients will have occasional issues with contamination. Some are aware that they are less strict than necessary. Some of our patients believe that they are strictly following the diet, but are making regular errors due to their poor basic education and understanding of the diet.

So, I will restore this text “whether voluntary or not”.

Also, I will add a new source:

Makharia GK (Mar 24, 2014). "Current and emerging therapy for celiac disease". Front Med (Lausanne) 1: 6. doi:10.3389/fmed.2014.00006. PMC 4335393. PMID 25705619.

Even small amounts of gluten (50 mg/day) can be immunogenic; therefore all food and food items and drugs that contain gluten and its derivatives must be eliminated from the diet completely

Best regards and very thanks again. --BallenaBlanca (talk) 19:02, 17 December 2015 (UTC)

First, you should know that "copyediting" has nothing to do with copyright.

"Voluntary" is a weird word to use in this context. Obviously your body doesn't care whether it's voluntary or not. The text already makes it clear that small quantities of gluten may be harmful, and the reference to cross-contamination already covers the possibility of eating it unknowingly. So think the previous text already covers everything you want to say. – Smyth\^talk 12:09, 18 December 2015 (UTC)

Dear Smyth

Oops! I apologize for my confusion...

You are quite right in your observations. Very well explained! I agree with you. I will edit. Thank you very much!

Best regards.--BallenaBlanca (talk) 18:45, 18 December 2015 (UTC)

Highlighting oats in the first paragraph

I opened this article to see what Wiki had to say about oats and celiac / gluten free diet because my father's company sells gluten free products made from oats. I was disappointed to see the first paragraph reads like an anti-oat advertisement. I have no intention of trying to use wiki to sell our product, but it would be nice if it less aggressively worded and more accurate. An increasing number of companies are providing safe, truly gluten free oats that are perfectly fine in a gluten free diet. .

Current paragraph "A gluten-free diet (GFD) is a diet that excludes gluten, a protein composite found in wheat, barley, rye,[1][2] and all their species and hybrids (such as spelt,[1] kamut, and triticale[1][2]). The inclusion of oats in gluten-free diet remains controversial. Avenin present in oats may be also toxic for coeliac people.[2] Its toxicity depends on the cultivar consumed.[3] Furthermore, oats is frequently cross contaminated with gluten-containing cereals.[2]"

Proposed revision "A gluten-free diet (GFD) is a diet that excludes gluten, a protein composite found in wheat, barley, rye,[1][2] and all their species and hybrids (such as spelt,[1] kamut, and triticale[1][2]). The inclusion of oats in gluten-free diet is dependent upon the source and variety of the oats in question. "

The lines about avenin and cross contamination should be part of a subsection on contamination in gluten free products. Trust me, you could write a book on the topic.

Scislacker (talk) 23:54, 2 April 2016 (UTC)

Dear Scislacker:

For years we have sought an answer to the issue of inclusion of oats in gluten-free diet. Now we finally have an explanation. We must be clear, and not try to make the information less visible or less adjusted to the reality.

I understand your concerns, but are economical concerns. This is a medical article about one specific diet which is the only treatment available for very serious health diseases.

Consumption of toxic oats (although it is free of gluten-containing grains contamination) may play an important role in a lack of response of a gluten-free diet in patients suffering gluten-related disorders. We need to stay well specified, providing objective and clear information to allow readers to understand.

Celiac disease is a severe disease that can affect any organ or tissue of the body. If remain untreated, or if gluten-free diet is not completely strict, people may have severe disease symptoms, may develope associated disorders (such as autoimmune diseases) and are exposed to the risk of other long-term complications, which include cancers -lymphoma, small bowel adenocarcinoma, and other malignancies (gastric, oesophageal, bladder, breast, brain)- and greater mortality. Actually, 10–30% of patients with celiac disease are non-responders and have persistent symptoms despite being on a gluten-free diet. Non-responsive celiac disease is largely caused by inadvertent exposure to gluten that accounts for 35–50% of persistent symptoms in patients with celiac disease. Non-celiac gluten sensitivity is associated to some serious neuropsychiatric disorders, such as schizophrenia, peripheral neuropathy, ataxia, attention deficit hyperactivity disorder (ADHD) and autism. The main reason for persisten symptoms in these patients is also a poor dietary compliance, whether voluntary and/or involuntary (patients often are inadvertently ingesting gluten). Gluten ataxia is a devastating neurological disease and irreversible once instituted, but preventable with an early diagnosis of gluten sensitivity. The response to treatment with a gluten-free diet depends on the duration of the ataxia prior to the diagnosis of gluten sensitivity. Loss of Purkinje cells in the cerebellum, the end result of prolonged gluten exposure in patients with gluten ataxia, is irreversible, and prompt treatment is more likely to result in improvement or stabilization of the ataxia. And again, the commonest reason for a lack of response is a lack of compliance with the diet, which may also be strict.

Best regards. --BallenaBlanca (talk) 11:27, 3 April 2016 (UTC)

References

Dear BallenaBlanca:

Thank you for taking the time to respond to me last year. I fully understand the seriousness of a gluten free diet (I'm a cell biologist and spent some time researching celiac disease and gluten testing methods).

I wanted to let you know about an article that just came out that describes a "Purity Protocol" for growing gluten free oats, which has become a standard for quality gluten free oat producers. Purity Protocl Publication in Cereal Chemistry Journal

Additionally, a previous publication shows that the varieties of oats which cause reactions in people with CD can be detected by the G12 antibody. Official link and Full Text. This strongly suggests that oats grown with a purity protocol and verified with the G12 antibody are safe for people with CD.

Is there a way to include this information in this wiki page?

Best regards. Scislacker (talk) 15:08, 18 April 2017 (UTC)

Dear Scislacker:

First, thank you for your kindness.

To include information in Wikipedia articles, we need secondary sources. This is especially important in health articles WP:MEDRS.

The article about oats you mention is a primary source PMID 21317420.

To date, there are no firm conclusions about which varieties of oats are safe, how to identify them, nor the repercussions of their long term consumption. There are preliminary studies, which require further revision for validation.

We have already included on the page the conclusions of review articles (secondary sources) that analyze, among others, the study you mention about oats PMID 21317420 (refs 3 and 57): [3] "Some cultivars of pure oat could be a safe part of a gluten-free diet, requiring knowledge of the oat variety used in food products for a gluten-free diet.[3] Nevertheless, the long-term effects of pure oats consumption are still unclear[56] and further studies identifying the cultivars used are needed before making final recommendations on their inclusion in the gluten-free diet.[57]"

Best regards. --BallenaBlanca (Talk) 20:57, 18 April 2017 (UTC)

for discussion - fad diet/autism

Moving this here for discussion - this was in the section on the fad diet - Gluten-free_diet#As_a_fad_diet. This was introduced somewhere in this slew of edits.

However, in a subset of autistic patients who have a genuine gluten sensitivity, there is limited evidence that suggests that a gluten-free diet may improve some autistic behaviors.

References

• PMID 26060112 has a very brief relevant passage that says "Among psychiatric disorders, a minority (6%) of patients with NCGS showed a previous clinical history of eating behavior abnormalities, while autism spectrum disorders (ASD) have been hypothesized to be associated with NCGS [47] and [48]. Notably, a gluten- and casein-free diet might have a positive effect in improving hyperactivity and mental confusion in some patients with ASD. This very exciting association between NCGS and ASD deserves further study before conclusions can be firmly drawn." So this absolutely should not be used in a section on the fad diet to support a possible use in ASD.
• PMID 24077239 is an MDPI journal, predatory, shouldn't use it. It actually has a section called "6. Is Autism Part of the NCGS Spectrum?" (oy) but even this source is cautious: "The above data suggest that removing gluten from the diet may positively affect the clinical outcome in some children diagnosed with ASD, indicating that autism may be part of the spectrum of NCGS, at least in some cases. However, a word of caution is necessary to stress the fact that only a small, selected sub-group of children affected by ASD may benefit from an elimination diet. Additional investigations are required in order to identify phenotypes based on best- and non-response to dietary modifications and assess any biological correlates including anthropometry before considering a dietary intervention."
• PMID 23688532 (in spanish) also has a passing mention, (via google translate) "It has been suggested that peptides from gluten and casein, they may have a role in the origins of autism and the physiology and psychology of the disorder can be explained by excessive opioid activity linked such peptides. They worked in the same vein, suggesting a relationship between SGNC and neuropsychiatric disorders, including autism." .. so some "suggestive" studies.
• PMID 23688532 says "Currently, there is insufficient evidence to support instituting a gluten-free diet as a treatment for autism. There may be a subgroup of patients who might benefit from a glutenfree diet, but the symptom or testing profile of these candidates remains unclear." We don't push content into articles - especially content about a fad diet - based on this kind of weak statement.

- This is exactly the kind of hype that Wikipedia needs to be an antidote against per NPOV and I will go so far as to cite PSCI here.Jytdog (talk) 20:49, 8 April 2016 (UTC)

This was introduced somewhere in.... I help locate when and where: Revision as of 15:03, 9 November 2015 Literaturegeek (→‎As a fad diet: rewording so that the paragraph reads and flows better.) and Revision as of 01:04, 9 November 2015 Literaturegeek (→‎As a fad diet: rewording per sources for clarity for our lay readers.) This was the result of discussion and agreements here Talk:Gluten-free diet#Wording for autism, a teamwork talking with Literaturegeek and other users.

Best regards. --BallenaBlanca (talk) 21:22, 8 April 2016 (UTC)

Here is the dif where you, BB introduced that content I discussed above. You did it. that was reverted here. in this series you POV-pushed some of that content back. I am not going to waste more of my time tracking down the blow by blow on this. You POV-pushed this in. Yes people are trying to collaborate with you, but you are relentless. Never uncivil. But relentless.

related but not on the topic of this specific content, in that series of difs I linked to above, this is raw advocacy, seeking to "neutralize" the fad reported in the CBS report, in the "fad diet" section. and the next dif did more of the same. Some of that reverted here with accurate edit note "POV-pushing removed". Jytdog (talk) 22:51, 8 April 2016 (UTC)

The issue is not if I included or not I previously included one text but the text you just removed was the result of work with other users after discusion on this talk page, a text which I did not wrote and I've respected. Therefore, that text was not my view. It is a perfectly correct procedure, is the appropriate procedure in these situations: talking on talk page, reach agreements and accept them.

related but not on the topic of this specific content, in that series of difs... CBS source was added on Revision as of 00:23, 1 February 2013 Bhny (I did NOT add it), but on several successive editions only a biased part of the information was used. All I did was to neutralize. This source was removed because it did not meet WP:MEDRS and I completely agree. Again, I respect the agreements.

Once more I ask you not to make personal attacks WP:NPA: keep saying that I edit POV pushing, advocacy, etc. is a personal attack, because you're getting into personal issues without evidence: you don't know me, I never said what I think, I have never given my opinion, I use secondary sources and seek neutrality, with all points of view.

Best regards. --BallenaBlanca (talk) 00:19, 9 April 2016 (UTC)

I agree I don't know you. I only know your editing in Wikipedia which displays a pattern of POV-pushing. The evidence is right there and so far the developing consensus of editors who have commented at WT:MED is that this pattern exists. Please hear that - if you won't listen to me, please hear the community at WT:MED. Once more I will ask you to address the issue actually being raised, which is your behavior in Wikipedia = your pattern of POV-editing, and please stop framing it as a personal attack. A personal attack would be if I said that you, personally, were bad or stupid or if I cursed at you or actually attacked you, as a person, which I have not done. I have only been addressing your behavior as a Wikipedia editor - your pattern of POV editing, which to be precise, is giving UNDUE weight to gluten and its possible roles in various diseases and conditions and the possible efficacy of a GF diet. Please stop deflecting from that. Thanks. Jytdog (talk) 00:29, 9 April 2016 (UTC)

• PMID 26060112. Publication Types: Review "Notably, a gluten- and casein-free diet might have a positive effect in improving hyperactivity and mental confusion in some patients with ASD. This very exciting association between NCGS and ASD deserves further study before conclusions can be firmly drawn." It supports both of conclusions reflected in the text previously approved here ("is no good evidence that a gluten-free diet is of benefit in..." and "However, in a subset of autistic patients who have a genuine gluten sensitivity, there is limited evidence that...")
• PMID 24077239. Publication Types: Review "is an MDPI journal, predatory, shouldn't use it". MDP journals are not currently on Beall's list. Nutrients have an impact factor of 3.27 and this is a good and reliable article per WP:MEDRS. This reference was approved for use on other pages in subsequent conversations. [4]
• PMID 25433099. Well, I will not use it.
• PMID 23688532. Publication Types: Review "Currently, there is insufficient evidence to support instituting a gluten-free diet as a treatment for autism. There may be a subgroup of patients who might benefit from a glutenfree diet, but the symptom or testing profile of these candidates remains unclear." Again, it supports both of conclusions reflected in the text previously approved here and in fact, it is used to support the first sentence.

I will restore the text which was previously talked, approved and included on version of 15:03, 9 November 2015, and is not supported by "primary sources", nor "weasel wording" not "junk science" [5].

Best regards. --BallenaBlanca (talk) 12:31, 2 July 2016 (UTC)

Alexbrn, you have not convincing reasons to revert this edit. Your reasons to delete the text now are "Rvt. unduly POV gluten content, again". Please, again, avoid harassment and personal attacks as continuing saying POV/pushing, they are not right ways to proceed in Wikipedia. Also, you participated in the talk [6] in which we all have approved this text. If you not argue properly about the sources and why there are "undue", I will retrieve the text. Best regards. --BallenaBlanca (talk) 13:05, 2 July 2016 (UTC)

Current knowledge is adequately summarized as is; surfacing minor possibilities from within the sources and putting them in our high-level summary gives us POV-skewed content, with undue weight. As previously discussed at at WT:MED this kind of thing is problematic. Alexbrn (talk) 13:13, 2 July 2016 (UTC)

Please, again..., leave aside once and for all POV for argue, is a personal attack and is not an argument for discusse. This behaviour does not meet Wikipedia policies. I remind you, again..., that you participated in the debate in which this text was approved by several users after a lengthy debate [7], your views were taken into account, and it is not the result of "my" POV. The final version was included by Literaturegeek: This is an old revision of this page, as edited by Literaturegeek (talk | contribs) at 15:03, 9 November 2015 (→‎As a fad diet: rewording so that the paragraph reads and flows better.).

You continue without showing reasons for reversing the text, you are not demonstrating that the sources don't meet criteria, nor the content is undue.

"Current knowledge is adequately summarized as is; surfacing minor possibilities from within the sources and putting them in our high-level summary gives us POV-skewed content, with undue weight." Even in the case of we only use the source currently present (ref 52) and previously accepted to document the first sentence (a 2013 review of literature PMID 23688532), at its "high-level summary" we can read "There may be a subgroup of patients who might benefit from a gluten-free diet, but the symptom or testing profile of these candidates remains unclear." If we say the first ("there is no good evidence that a gluten-free diet is of benefit in...".), it is our duty to reflect the latter ("However, in a subset of autistic patients who have a genuine gluten sensitivity, there is limited evidence that..."). Otherwise, we are biasing the information. If we do not say all points of view, we must remove all text.

It seems that you are confusing what is a standard treatment with a therapy that may be applied in a specific subset of patients, which is a constant in Medicine. The conclusions of the sources are that gluten-free diet is not recomended as a standard treatment for autism but may be of some effectiveness in a subgroup of people, which is a documented reality.

Again, I must say that if you not argue properly about the sources and why there are "undue", I will retrieve the text.

Best regards. --BallenaBlanca (talk) 14:55, 2 July 2016 (UTC)

Discussion of the POV of content is apt. We don't want undue/POV content - your edit would over-emphasize the gluten angle here. When our gold-standard Cochrane source says "Current evidence for efficacy of these diets is poor" we shouldn't be trying to hint otherwise or surface minor details to complicate this good summary of the field, especially in an article about autism (this is not the gluten article). As has been said before, it's problematic trying to cram loads of marginal gluten information into articles everywhere. Alexbrn (talk) 15:04, 2 July 2016 (UTC); amended 16:46, 2 July 2016 (UTC)

"especially in an article about autism (this is not the gluten article)" !? This article is gluten-free diet, not autism. Do you know what we're talking about...?

To achieve a neutral point of view, we must reflect different informations from reliable sources. Cochrane review is the oldest, from 2008. Neverthless, it says "Current evidence for efficacy of these diets is poor.", which is not synonimous of "no evidence". The other review of 2014 currently present (ref [50]) PMID 24789114, states "We recommend that it should be only used after the diagnosis of an intolerance or allergy to foods containing the allergens excluded in gluten-free, casein-free diets."

In summary: two of the three sources which support the current text ("is no good evidence that..."), also support the text deleted ("However, in a subset of autistic patients who have a genuine gluten sensitivity,...") and we have other three reliable sources for the latter, to meet WP:NPOV. EDITED: 2008 Cochrane review also supports that there is an improvement in some autistic behaviors.

You continue without providing arguments, which comply with the policies of Wikipedia, to reverse and remove the second sentence.

Best regards. --BallenaBlanca (talk) 16:40, 2 July 2016 (UTC)

Your source also says: "Few studies can be regarded as providing sound scientific evidence since they were blinded randomized controlled trials, and even these were based on small sample sizes, reducing their validity. We observed that the evidence on this topic is currently limited and weak". We are accurately summarizing the knowledge here, and not trying for a POV-overreach to big up the gluten angle. Alexbrn (talk) 16:46, 2 July 2016 (UTC)

I rectified: the sources already present that support the deleted phrase are all (three). Also the third, 2008 Cochrane review.

Of all existing literature until 2008, only two studies meet criteria for for include them on Cochrane review, which only focuses on RCTs. One study showed significant lower autistic traits and the other one is questionable because the diet may have been breached by participants. That is, with strict diet, there was positive results.

We can read at the abstract PMID 18425890: "Two small RCTs were identified (n = 35). No meta-analysis was possible. There were only three significant treatment effects in favour of the diet intervention: overall autistic traits, mean difference (MD) = -5.60 (95% CI -9.02 to -2.18), z = 3.21, p=0.001 (Knivsberg 2002) ; social isolation, MD = -3.20 (95% CI -5.20 to 1.20), z = 3.14, p = 0.002) and overall ability to communicate and interact, MD = 1.70 (95% CI 0.50 to 2.90), z = 2.77, p = 0.006) (Knivsberg 2003). In addition three outcomes showed no significant difference between the treatment and control group and we were unable to calculate mean differences for ten outcomes because the data were skewed. No outcomes were reported for disbenefits including harms." (Again, it supports "...gluten-free diet may improve some autistic behaviors.")

We can read at the full text [8]: One study showed significant lower autistic traits in the intervention group compared to the control group and the other study showed no difference between the intervention and the control group.... The second trial... was a small scale study, intended only as a pilot for a much larger study and the authors declared their suspicions that the integrity of the diet may have been breached by participants requesting food from siblings and peers.

Besides knowing what means "standard treatment", we must differentiate "solid scientific evidence" (RCTs, 2008 Cochrane review) from "documented evidence". Nevertheless, in both cases it is clear that gluten-free diet can improve some autistic behaviors.

What we can do is change the wording and be more specific. The objective is that readers know the reality, without vagueness, and find the specific details here, and not resort to trashy forums or websites, or put unfounded hopes (sorry if I do not get properly express what I mean).

First, I will now add the results of 2008 Cochrane (Main results, at abstract). You cannot be opposed because as you said, is a gold-standard source.

And second, I propose to modify the deleted text, and say something like this, to achieve a neutral point of view ("As a general rule, do not remove sourced information from the encyclopedia solely on the grounds that it seems biased. Instead, try to rewrite the passage or section to achieve a more neutral tone.... Keep in mind that, in determining proper weight, we consider a viewpoint's prevalence in reliable sources, not its prevalence among Wikipedia editors or the general public") and make a necessary distinction between standard treatment and a therapy useful in a subgroup of patients, supported by the more recent reviews of 2013 and 2015:

At more recent reviews, other authors suggest that only a small group of people with autism may get some improvement with gluten-free diet, whose profile remains unclear, possibly related to non-celiac gluten sensitivity.

I await your opinions.

Best regards. --BallenaBlanca (talk) 17:33, 3 July 2016 (UTC)

Still POV. We only need to say what we currently do without scraping for the mights and maybes that, in reality, are compromised by the very poor quality of evidence the journals take care to emphasize. Alexbrn (talk) 17:44, 3 July 2016 (UTC)

Alexbrn it seems that you have not read the text you've just reverted [9], which are the results of 2008 Cochrane review and not the text above. I think you are wrong, as when you thought that this is the autism page. This is the text that you just have deleted:

A 2008 Cochrane review found only three meaningful positive effects with gluten- and casein-free diet (improvement of overall autistic traits, social isolation and overall ability to communicate and interact), three outcomes showed no clear difference and ten outcomes were impossible to calculate, and authors conclude that this diet should not be used as standard treatment for autism.

What reasons to remove it? You are edit warring. And remember, please, neutral point of view: "Keep in mind that, in determining proper weight, we consider a viewpoint's prevalence in reliable sources, not its prevalence among Wikipedia editors or the general public". Or now, do you consider that the Cochrane review is not a reliable source? Please focus, this is not a game.

Best regards. --BallenaBlanca (talk) 18:24, 3 July 2016 (UTC)

References

Of course it's reliable, but the problem - again - is of neutrality. The autism/gluten detail you want to insert is not due and not properly contextualized within the overall accepted knowledge in this field. It is a hallmark of POV pushing to harp on reliability. We are an encyclopedia that summarizes, not a compendium of undue detail. If you want a widened consensus I suggest maybe posting again to WT:MED so other medical editors can give views. Alexbrn (talk) 19:27, 3 July 2016 (UTC)

Not enough info on fad diets

I think there has been an effort in this article to focus on a gluten-free diet as a medical practice, in an attempt to avoid promoting pseudoscience. It might make more sense to give more space to addressing/debunking the pop culture, non-scientifically supported forms of this diet, rather than pretending they do not exist. 2601:644:0:DBD0:7D80:BEBE:70E2:E197 (talk) 21:20, 23 April 2017 (UTC)

Management

NB: I did this. Was reverted here. (added this header Jytdog (talk) 18:19, 2 May 2017 (UTC))

NOTE: This was not a "reversion". Jytdog made 8 changes, I modified 5 of them and did not touch the other 3. See this below. --BallenaBlanca (Talk) 13:27, 4 May 2017 (UTC)

so a gluten-free diet is put under the "treatment" bucket in schematic discussions, as it is the only way we have to manage the condition. it doesn't really treat the condition. Happy to have an RfC on this. The distinction is somewhat important. Jytdog (talk) 22:35, 1 May 2017 (UTC)

• There is no reason to replace the term "treatment" with "management". It is in fact a treatment and is the only one available. When the gluten-free diet is performed correctly (strict and maintained for life) is effective in the vast majority of cases, making the related symptoms to disappear, normalizing the serology and the findings in the intestinal biopsies. Therefore, this achieve in the remission of the disease and the normalization of all disorders related to it, specially when the diagnosis is not delayed.

Treatments are not just drugs. There are very important and very effective dietary treatments.

Let's see the definition of "treatment":

Collins dictionary: "Treatment is medical attention given to a sick or injured person or animal."

Oxford dictionary: "Medical care given to a patient for an illness or injury."

Also, we must remember that Wikipedia does not admit original research. If all international consensus and guidelines about celiac disease and gluten-related disorders clasify the gluten-free diet as a "treatment", we are nobody to change it.

Best regards. --BallenaBlanca (Talk) 08:51, 2 May 2017 (UTC)

• I support using "treatment". Note that this does not mean it has to be effective -- "ineffective treatment" is a common term. However in Coeliacs, a gluten-free diet is reported by our source as excellent restorative therapy.Jrfw51 (talk) 10:33, 2 May 2017 (UTC)
• "Management" is the more appropriate terminology, as there's no "treatment" (cure) for this condition. It can only be managed. Modifying one's diet is not the same as receiving "medical care", AFAIK. K.e.coffman (talk) 18:09, 2 May 2017 (UTC)
• While I prefer management over treatment: BallenaBlanca is more knowledgable than any of us, and I would use the terminology they suggest. And frankly, K.e.coffman it is a treatment, as it a gluten-restricted diet entirely cures all manifestation of the disease, removing inflammation in the intestine. Carl Fredrik ^talk 18:32, 2 May 2017 (UTC)
• no doubt we can say "treatment". we can also say "management" and plenty of MEDRS talk about "management". eg PMID 25922674 which is a review and guide for talking to people with celiac. This from American Gastro. Assoc., etc. In my view "management" is better, more descriptive, for what is actually going on with use of GFD in this condition. Will let this discussion run a bit and if no clear consensus emerges will do a more formal RfC. Jytdog (talk) 18:38, 2 May 2017 (UTC)

We "manage" celiac disease with the gluten-free diet treatment. GFD is a treatment and the only available.

Jytdog, the source you mentioned from American Gastro. Assoc. says at the bottom of the page: "For additional information on treating celiac disease, visit the patient care section of the AGA website." And if we look at the AGA guidelines, we see this: This clinical guideline addresses the diagnosis, treatment, and overall management of patients with celiac disease (CD) (...) The treatment for celiac disease is primarily a gluten-free diet (GFD) etc...

The other source you mentioned PMID 25922674 says: "Currently, the GFD constitutes the only available treatment for CD. (...) CD is a lifelong disorder, requiring dietary treatment. (...) Whenever possible, the first information about CD and treatment with a GFD should be given at time of diagnosis, or shortly thereafter. (...) One recent Finnish paper also suggested that treatment of children with a GFD might reduce the use of health care services. etc, etc....

There are still many inaccuracies and discrepancies about certain aspects of celiac disease, but no one, absolutely no one, any physician, any specialist worldwide doubt that the gluten-free diet is a treatment and the only one possible. It is something universally established and accepted since tens of years. Why Wikipedia has to go against it?? We have to adjust to the sources. This is not an issue to be debated, it does not depend on Wikipedia editors.

Best regards. --BallenaBlanca (Talk) 19:22, 2 May 2017 (UTC)

you made your opinion clear in your first response. Jytdog (talk) 19:29, 2 May 2017 (UTC)

• 'Treatment' suggests acting on the underlying propensity to react; 'management' is a better term. Alexbrn (talk) 19:40, 2 May 2017 (UTC)

We have to argue based on sources. Please, cite a verifiable source that defines treatments as "acting on the underlying propensity to react" as something applicable to all treatments. Following your logic, we should practically eliminate the word "treatment" of Wikipedia.

Best regards. --BallenaBlanca (Talk) 20:08, 2 May 2017 (UTC)

There are sources for both. Please don't bludgeon the discussion. Jytdog (talk) 20:10, 2 May 2017 (UTC)

Propose the other sources and see my comment below. Barbara (WVS) ✐ ✉ 11:40, 3 May 2017 (UTC)

Well, if there are sources then there is no problem in you cite some of them to allow us to base our decisions on verifiable data. I am striving to argue with reliable sources, it's the way to argue. Wikipedia:Requests for comment#Suggestions for responding. Best regards. --BallenaBlanca (Talk) 20:34, 2 May 2017 (UTC)

Did already and there are plenty more as you know - both terms are used in the literature. There is no "right answer" here; is really a style thing. Jytdog (talk) 20:37, 2 May 2017 (UTC)

Also bear in mind we are writing for the general reader. And yes, enough WP:BLUDGEONing. I have given my view. Alexbrn (talk) 20:40, 2 May 2017 (UTC)

...whose first thought about Management is likely his or her employer, rather than a series of actions taken to mitigate medical symptoms. WhatamIdoing (talk) 20:44, 2 May 2017 (UTC)

Using the term treatment is even more important for the general readers (patientes and their relatives, friends, restaurant Staff, etc...) because they need to understand without no doubts that their diet is their treatment, and the only one. --BallenaBlanca (Talk) 20:47, 2 May 2017 (UTC)

• Use both. I'd rather see "This diet can be used to manage celiac's symptoms" and "Untreated celiac is bad", than to see only one term used throughout. But if, for some unknown reason, we are required to pick only one term, then I choose the simpler/more obviously medical treatment over the vaguer management. (Speaking of which, someone needs to have a look at Management (disambiguation), and add a link to Therapy.) WhatamIdoing (talk) 20:44, 2 May 2017 (UTC)
• Go Back to the References - If the references use the term 'treatment', then that is how it is to be described in the article. If the references use the term 'management', then this is how is to be described in the article. Remember to give due weight to the frequency of each term. An editor's opinion is irrelevant i.e., it doesn't matter at all what we think about a certain medical intervention - go back to the sources.

Best Regards,

Barbara (WVS) ✐ ✉ 11:12, 3 May 2017 (UTC)

WhatamIdoing and Barbara (WVS), you are so right. We must be clear and specific, adjusting to the sources.

Management is a broader term. To manage celiac disease we need, in summary, to establish the treatment, which is a life-long strict gluten-free diet; a periodical life-long follow-up including physical examination, analytics, and the specific tests required in each case, depending on the presence or suspicion of associated diseases (as average once a year); if necessary, additional treatment for associated disorders or complications (added to the treatment with the gluten-free diet); review of compliance with the treatment of the gluten-free diet (many people make big mistakes...); and counseling by a nutritionist if necessary.

The gluten-free diet is always referred to as "treatment". And whenever we talk about a person with celiac disease who does not perform the gluten-free diet we talk about "untreated", not "unmanaged". Let's see, for example, how many references appear that use the term "unmanaged" celiac disease, as Jytdog edited here: 0. And how many use the term "untreated" celiac disease: 90 reviews. --BallenaBlanca (Talk) 11:34, 3 May 2017 (UTC)

You are overplaying your hand. See this and this. Jytdog (talk) 15:47, 3 May 2017 (UTC)

Of course the word "management" may be mentioned in articles related to celiac disease. I have already explained what it means. Here it is very clear: World Gastroenterology Organisation Global Guidelines. Celiac disease. July 2016. "6. Management of celiac disease. The only treatment for celiac disease, at present, is a strictly gluten-free diet for life" (and below, the rest of recommendations for managing CD, I will no copy all here)

More guidelines, added to those of WGO and AGA (that I mentioned here):

• National Institutes of Health (NIH). Treatment for Celiac Disease. "Doctors treat celiac disease with a gluten-free diet."
• National Health Service (NHS). Treating coeliac disease. "Coeliac disease is usually treated by simply excluding foods that contain gluten from your diet."
• Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology "Gluten-free diet. The mainstay of treatment of CD and DH is a GFD." (DH: dermatitis herpetiformis)
• Guideline for the Diagnosis and Treatment of Celiac Disease in Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. "Currently the only available treatment is lifelong adherence to a gluten-free diet (GFD)."
• European Society for Pediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease. "Finally, a GFD is the only lasting treatment for CD."

What you have to do is go into the references you have found in your searches and you will see that they talk about diet as a treatment. This search does not contradict that the diet is the treatment. Let's see for example some of the references found that talk about celiac disease:

PMID 27887897 good response to the GFD treatment

PMID 27803799 The only accepted treatment for CD is to completely remove gluten from the diet

PMID 22324389 Gluten-free diet is still the only practical treatment for patients with coeliac disease

Summarizing: You want to change the term treatment because in your opinion the gluten-free diet does not treat the disease. But the sources are very clear about it and you have not provided any reference that says otherwise. It has also been explained what management implies and in what context and for what purpose it is used. We must adjust to the sources, is as simple as this, and there is not a slightest doubt. --BallenaBlanca (Talk) 20:46, 3 May 2017 (UTC)

Two questions: 1) Are you insisting that we only use the term "treatment" in this article with respect to using the GFD? 2) Does that reflect the developing consensus of discussion here in your view? Just brief answers please. Yes or no would be enough actually. Jytdog (talk) 20:52, 3 May 2017 (UTC) (redact to clarify Jytdog (talk) 04:04, 4 May 2017 (UTC))

Please, note that "of discussion here" was added here (Revision as of 06:04, 4 May 2017), after I answered (My answer: Revision as of 23:50, 3 May 2017) --BallenaBlanca (Talk) 16:25, 4 May 2017 (UTC)

You will know the answers if you read my arguments and the sources, and if you look at this edit of mine and compare with your previous edit. I have already respected some of your changes and I have done what I have considered necessary. IMO the article is fine as it is now. Best regards. --BallenaBlanca (Talk) 21:21, 3 May 2017 (UTC)

I would not have asked if it were obvious. Please answer. Thanks. Jytdog (talk) 21:27, 3 May 2017 (UTC)

Already answered. The word treatment (or untreated) is currently used where it has to be used. And yes, it reflects the current international consensus. --BallenaBlanca (Talk) 21:41, 3 May 2017 (UTC)

So it appears that your answers are 1) "yes" and 2) "I don't care" - is that accurate?. Jytdog (talk) 04:02, 4 May 2017 (UTC)

Aah! So the question 2 probably does refer to consensus on this page? Other editors have already talked and most agree that the use of the term treatment is correct. Please, stop harassing me. Stop trying to corner me. I'm not going to tell that I'm "opposing", that's not what I'm saying, I have already respected some of your changes. You would have understood it if you had read what I said here and you had done the effort to check it out. Stop scorning my effort to argue correctly, with verifiable sources and quotes, suggesting that my answers are too long. There is no other way to explain and understand, just so, for which there is no choice but to read even if you do not like it. Please, take the time to read. My answers are clear. I'm sure the other editors have understood them. This is that I have to say. Best regards. --BallenaBlanca (Talk) 07:29, 4 May 2017 (UTC)

Nope. If you are willing to acknowledge that there is consensus for using either term, and will not revert using "management" sometimes, we are good. (Please note I am hearing what everyone is saying, and am happy to have use "treatment" some) If you are going to ignore the discussion here and insist that we use only "treatment" then I will need to launch an RfC. The questions were practical. I would like to avoid posting an RfC if it can be avoided. If you would provide your own answers to the questions, which you still haven't done, it would be useful. Jytdog (talk) 07:34, 4 May 2017 (UTC)

Please look at and check this dif and you will see that I agree to use management or treatment, depending on the context, or substituting treatment for another expression. I have already maintained it.

I have been explaining all the time that I agree to use management or treatment when correctly employed and that this depends on the context. [10] [11] [12] And to understand the context and do this, we have to adjust to the reliable sources, guidelines and consensus. And that IMO, the page is now adjusted, after having respected some of your changes. --BallenaBlanca (Talk) 08:10, 4 May 2017 (UTC)

The first dif you offered there was a mistake as it bridged my two changes. I made two changes. My first change, changed "patients" >> "people" throughout per MOS. You left that alone. Yes you respect MOS. My second change, changed "treat" to "manage", and what you did, was a near straight reversion of that, with a very clear edit note that you would not accept "manage" with regard to GFD for gluten-related disorders. I am sure the mistake was unintentional. Interacting with you is not productive so I am going to step away from this and let others try.Jytdog (talk) 11:52, 4 May 2017 (UTC)

@Jytdog: I've been asking you several times to take the time to read and check. It is clear you did not do it, because otherwise you would not be saying these things. Please, it's not a game. Respect my work, I am wasting a lot of time for explaining clearly, trying to reach an agreement, that you are not valuing.

This diff is the result of the page after my edit, therefore, those are your changes (that I did not touch) what is being shown. It's just a matter of choosing the versions to compare.

I will detail them and, please, take the time to check them. In your second change, you made 8 changes. I undid 5 and maintained 3 of them:

02:31, 1 May 2017‎ Jytdog (talk | contribs)‎ . . (62,616 bytes) (+2)‎ . . ("treat" >> "manage")

1. In these people, the gluten-free diet is demonstrated as an effective treatment, --> In these people, the gluten-free diet is effective in managing these conditions,
2. current evidence for their efficacy in treating the symptoms of autism is limited and weak.--> but the current evidence for their efficacy in making any change in the symptoms of autism is limited and weak.
3. (CD) but most cases remain unrecognized, undiagnosed and untreated --> but most cases remain unrecognized, undiagnosed and unmanaged,
4. Untreated CD may cause --> Unmanaged CD may cause
5. Following a lifelong gluten-free diet is the only medically-accepted treatment for people with coeliac disease. --> Following a lifelong gluten-free diet is the only medically-accepted way to manage coeliac disease.
6. the subsequent step for diagnosis and treatment of NCGS is to start a strict gluten-free --> the subsequent step for diagnosis and management of NCGS is to start a strict gluten-free
7. The treatment of wheat allergy --> The management of wheat allergy
8. there is no good evidence that a gluten-free diet is of benefit in treating the symptoms of autism. --> there is no good evidence that a gluten-free diet is of benefit in reducing the symptoms of autism.

12:44, 1 May 2017‎ BallenaBlanca (talk | contribs)‎ . . (62,627 bytes) (+11)‎ . . (Adjusted to refs. Gluten-free diet is a treatment (the only one) (Treatments are not just drugs...) http://www.nhs.uk/Conditions/Coeliac-disease/Pages/Treatment.aspx https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/treatment)

1. In these people, the gluten-free diet is effective in managing these conditions, --> In these people, the gluten-free diet is demonstrated as an effective treatment,
2. but the current evidence for their efficacy in making any change in the symptoms of autism is limited and weak. I DID NOT CHANGE IT
3. but most cases remain unrecognized, undiagnosed and unmanaged, --> (CD) but most cases remain unrecognized, undiagnosed and untreated,
4. Unmanaged CD may cause --> Untreated CD may cause
5. Following a lifelong gluten-free diet is the only medically-accepted way to manage coeliac disease. --> Following a lifelong gluten-free diet is the only medically-accepted treatment for people with coeliac disease.
6. the subsequent step for diagnosis and management of NCGS is to start a strict gluten-free --> the subsequent step for diagnosis and treatment of NCGS is to start a strict gluten-free
7. The management of wheat allergy I DID NOT CHANGE IT
8. there is no good evidence that a gluten-free diet is of benefit in reducing the symptoms of autism. I DID NOT CHANGE IT

And all these changes are the same as this dif.

I do not know what else I can do to make you understand me... --BallenaBlanca (Talk) 12:49, 4 May 2017 (UTC)

It must be time to move on from this discussion. Management and Treatment are both reasonable in context. See what the sources use. This kind of bitter, to-and-fro is likely to be what puts editors off from continuing to be part of the WP community. Jrfw51 (talk) 18:07, 4 May 2017 (UTC)

Not me! I get energized to do the right thing. Regards, Barbara (WVS) ✐ ✉ 11:11, 6 May 2017 (UTC)

Arthritis source question

Hi @BallenaBlanca: I was wondering if you could tell me why a magazine article by a doctor didn't qualify as a reliable source. I read the link you provided, https://en.wikipedia.org/wiki/Wikipedia:Identifying_reliable_sources_(medicine), but I don't really see where the source I included, which relates to rheumatoid arthritis and gluten, doesn't meet the requirements. I wasn't sure where to ask you about this either, so I apologize if this isn't the correct place to ask this question.

Thank you for your help! M.Renae (talk) 19:58, 27 June 2017 (UTC)