Re: Gluten elimination diets: Drs Cadenhead and Sweeny respond

Issue: BCMJ, vol. 55, No. 6, July August 2013, Pages 272-273 Letters
By: Kathleen Cadenhead, MD Margo Sweeny, MD,

Ms Hammond has made some good points about the emerging literature regarding non-celiac gluten sensitivity. Our COHP column was directed to primary care physicians to briefly give an overview of diagnosis of celiac disease and information to counteract “the misinformation and marketing in the public realm.” The issue of non-celiac gluten sensitivity was beyond the scope of our article with an im­posed maximum of 700 words. 

Ms Hammond claims that the article by Sapone was a consensus document recommending that non-celiac gluten sensitivity be recognized alongside celiac disease and wheat allergy as one of three gluten-induced conditions. We found Sapone’s article to a very good review article; however, it was not an international consensus document. There continues to be significant debate in the academic community about gluten intolerance or non-celiac gluten sensitivity. 

The article did make reference to the fact that there is an association between gluten and irritable bowel syndrome and certainly did not intend to discount patients’ experiences. Trial elimination diets with food and symptom diaries followed by reintroduction food challenges are an option. However, elimination diets are complicated by the fact that it is very difficult to fully eliminate gluten without consulting a professional dietitian, and there is always a placebo effect with the reintroduction food challenge method.

Ms Hammond points out that physicians need to bear in mind when communicating with patients that what is dogma today may be called into question by new evidence tomorrow. This is certainly a point that most physicians are well aware of with ever-changing evidence-based recom­mendations and guidelines. The current evidence on non-celiac gluten sensitivity is under debate. The overwhelming majority of patients adopting gluten-free diets do not need to be so restrictive. Patients with significant symptomatology need to be tested for celiac disease prior to adopting a gluten-free diet. If they remain symptomatic they need further investigation and possible referral to a gastro­enterologist.
— Kathleen Cadenhead, MD
—Margo Sweeny, MD
Council on Health Promotion Nutrition Committee

Kathleen Cadenhead, MD, Margo Sweeny, MD,. Re: Gluten elimination diets: Drs Cadenhead and Sweeny respond. BCMJ, Vol. 55, No. 6, July, August, 2013, Page(s) 272-273 - Letters.


Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply