Ron Hoggan's Response to Unfortunate "Throwing Out the Wheat" Article in Slate

Scott, thanks for giving me the opportunity to respond on the site. Ron's letter, printed above, captures the sentiments of many readers of my article -- albeit in more pedantic and pugnacious terms.

 

I'll try to address all his points here, but for the sake of efficency let's skip to the bottom of his disquisition, where he finally gets to the crux of the issue. There he claims that I have “defeated [my] own argument†in the piece, since we all define our own well-being:

 

“If a person has symptoms and they get relief from a gluten-free diet,†he says, “they would have to be pretty self destructive, foolish, or self-indulgent to go back to eating gluten.â€

 

That is, of course, the central theme of my article: What should we make of the fact that there now appear to be thousands or millions of Americans who are deriving some sort of benefit from going gluten-free? Is everyone who buys Elizabeth Hasselbeck's book, or otherwise elects to give up gluten, better off? If someone “gets relief†by going on a diet, then how can I or anyone else possibly argue that they shouldn't be on that diet?

 

These are tricky questions, and the answers aren't as clear-cut as Ron would like them to be. As readers of Celiac.com know all too well, there are many costs -- economic and otherwise -- to being a gluten-free diet. So we'd do well to consider whether some of those who “opt in†are really better off for doing so.

 

We know that everyone with diagnosed celiac disease must be on a gluten-free diet, 100-percent of the time. It's also true that anyone with concrete symptoms that can be reliably traced to gluten would do well to avoid gluten. What about the folks whose symptoms are more ambiguous -- the people who feel sluggish, or anxious, or depressed when they have a bowl of pasta?

 

In my piece, I argued there are many reasons why people might decide that a gluten-free diet is good for them, that have little or nothing to do with autoimmune disease. In particular, I focus on our national obsession with weight loss, and the body dysmorphia that plagues Americans.

 

It's worth pointing out that eating disorders affect women far more often than men -- so from that perspective, the relationship between “G-free†and weight loss is primarily a women's issue. Autoimmune disease is a women's issue, too: The medical establishment has a long, sad history of ignoring or trivializing conditions like lupus and MS, since the men with the stethoscopes so rarely experienced them first-hand. Celiac, too, is diagnosed 2 to 3 times more often in women -- despite the fact that it's thought to occur in men and women equally across the population.

 

So we've got a situation where women are doubly vulnerable -- to autoimmune diseases like celiac, and to nefarious social pressures to control one's diet. I am deeply disturbed by both of these issues. Now, one could argue that my article gave the former problem short-shrift in its focus on the latter -- that's a fair criticism which I would grudgingly accept. Still, I think it's vital that we address both sides of the problem.

 

The manifest gender politics of celiac does leave me feeling somewhat uncomfortable about the present exchange. Here we are: A couple of guys debating a women's health issue on a Website run by another guy. What percentage of our readers are men, I wonder?

 

To make matters worse, Ron insists on presenting himself as “Dr. Ron Hoggan,†as if the wisdom and advice he's been doling out were the product of a medical degree. In fact, Ron is a self-published book author and a retired schoolteacher, who happens to have a Ph.D. in education. I have tremendous respect for educators, but the fact that he's using an irrelevant doctorate as a signifier of some higher authority seems especially creepy in this context. It's as if the women who suffer from celiac disease should be impressed by a gentleman in a white coat.

 

(The mere fact that Ron distributes medical information in such a way strikes me as unethical at the very least -- and possibly illegal.)

 

But enough of that: Let's move on to the Doctor's more specific points. He objects to my proposal that beginning a restrictive diet may ameliorate gastrointestinal symptoms. He's right that gluten-free foods are calorie-dense, so this particular diet isn't likely to restrict food intake (or produce weight-loss) over the long term. Yet it's also true that anytime you begin carefully accounting for the foods you eat, you're likely to eat less. That's the basis for an entire chapter of Hasselbeck's book -- which, like it or not, is selling like gluten-free hotcakes. In fact, I first learned of this from Dr. Joseph Murray, though he certainly didn't originate the idea.

 

Then Ron takes issue, for reasons I can't quite understand, with my survey of newspaper mentions of gluten intolerance, lactose intolerance, the Atkins Diet, and the Mediterranean Diet. The broad history of these has little to do with the simple fact that -- from a popular-culture point of view -- they have entered and exited the mainstream like fads. I did acknowledge in my article that the timing of new epidemiological data on celiac disease could help explain the spike of interest in gluten intolerance several years ago. I don't think it explains all the data.

 

Ron appears especially inflamed by my assertion that you can't “prove†a case of gluten intolerance in the lab, which he calls “the lynchpin of [my] entire article.†In this case, his criticism seems to be predicated on the notion that blood tests for anti-gliadin antibodies are proof-positive of gluten-intolerance. Well, if you want to define “gluten intolerance†as testing positive on a given blood test, then yes, of course it can be proven by just such a blood test.

 

In my article, I was referring not to the presence of antibodies of one sort of another -- which, as Ron admits over and over again, are not specific to any disease -- but rather to the nebulous condition under which people experience the symptoms (classic or atypical) of celiac, without having a strict celiac disease diagnosis. That's in line with the definition used by the Gluten Intolerance Group of North America, and refers to those patients who feel sick to their stomachs or develop rashes or get depressed or feel sluggish when they eat gluten -- despite the fact that doctors have failed to uncover the tell-tale signs of celiac disease.

 

Ron wants to emphasize that, superficial symptoms aside, the mere presence of anti-gliadin antibodies has been associated with serious illness. We may one day discover this is true. So far, the data to support this claim are sparse. For example, Ron seemed quite pleased to have discovered the following report published in a moderately-influential gastroenterology journal:

 

Open Original Shared Link

 

“Maybe this will reach you,†he wrote in an email, along with a copy of the article. But when I looked at the attachment, I discovered that the research was merely a “letter to the editors,†giving the preliminary results of a pilot study. It's not even clear if the journal sends these “letters†out for peer-review.

 

We might excuse Ron his excessive enthusiasm for such speculative studies. After all, the world can see how invested he is -- both personally and financially -- in the idea that gluten is a menace to public health, and that it affects all of us. (As an online shopping mall for gluten-free products, Celiac.com also stands to reap a profit from promoting Ron's ideas, and attacking mine.)

 

Finally, Ron quotes a “private email from another person†at the bottom of his critique, who wonders if I'd been dumped by a gluten-free girlfriend at some time in my life. “I am most inclined to agree with this poster's suspicions,†wrote Dr. Hoggan.

 

I would be remiss if I didn't pass along the following email, which I received from a friend of a friend, who heard the claim in question from a passing hobo:

 

“After looking at Ron Hoggan's response, I had the distinct feeling that this man is obsessed with gluten-intolerance for a reason. He says elsewhere that gluten affects classroom performance ... perhaps he just wasn't a very good schoolteacher? … I don't have any proof, or course â€

 

I take no position whatsoever on this poster's suspicions.

 

Sincerely,

 

Daniel Engber

Give up the hate Danny Boy...not sure why you hate Hasselbeck so...but surely it can't be because she wrote a book that has helped so many people figure out that they have a problem with gluten...can it? Or could it be because she is conservative, beautiful, rich and smart? Anyway, the real reason that your article fails is that 90% of celiacs are still undiagnosed, so we need the gluten-free diet to reach full fad status so that as many people as possible can figure out if they have this dangerous problem. It is the doctors and health care system that have failed many of us who are sensitive to gluten--and that is what your article should have addressed. Choose positive over negative whenever you can Dan...

I was extremely fortunate to be one of those rare people who tested positive to the non-celiac specific antibodies. My MD at the time, based upon her clinical experience, declared that I was in the same boat as a celiac and should never consume gluten again. I thought she was insane--I didn't want to believe it, and found the idea of being on this diet horrifying. But I was so desperately sick I was willing to try it for a few months. I could go into gory gastrointestinal detail, but I will just say that the change was dramatic. At the time I was developing painful neuropathies in addition to having had lifelong GI discomfort. I also was developing some sort of autoimmune disease that to this day nobody has been able to diagnose. My symptoms and related medical problems so closely mimic what doctors will actually diagnose as celiac disease that it is insane to me that I'm not considered by most other doctors to have actual celiac disease. I hate living with this diet every day, but you couldn't pay me lottery winnings to eat gluten and knowingly make myself that sick again.

 

I get filled with rage when I read thoughtless junk that insinuates that people on a gluten free diet are misguided faddists. Maybe the medical world, and world at large, should just begin to realize that if people are willing to follow a difficult, grossly expensive, inconvenient and time-consuming dietary regimen that makes them social pariahs, perhaps there's a valid reason for it.

Thanks for your words. I fall into your category too. I tested positive to the non-celiac form of gluten intolerance. I had severe joint pain, endocrine issues, and terrible gastrointestinal problems before I stopped eating gluten.

I am quite hypersensitive to comments from "real celiacs" who say that my kind of sensitivity isn't as real as what they have. It's true that I may not have the intestinal damage, but I did have other health issues that warranted removing gluten from my diet.

I guess it's human nature for people to want to have an identity and feel they are the authentic example of something while others who don't quite fit the scientific definition are simply faddists. It's unfortunate that people think this way. I didn't expect it in the realm of diseases, I thought it just happened with race, ethnicity, religion, sexual orientation, etc. I guess it happens with folks who also have health conditions. Go figure.

Thank you for trying to set him straight. No one calls Diabetics or people with peanut allergies followers of fad diets. Yet someone who avoids gluten to avoid the damage to our intestines, vitamin absorption, or other health issues... somehow we are on a fad diet. I nearly had to get a blood transfusion because my hemoglobin and iron counts were so low when I was diagnosed, I nearly screamed when I read his article referring to my gluten free diet as me following a fad, likening it to bell bottom pants or a new hairstyle.

 

THANK YOU !!!!

I got such a kick out of this response. My son has both diabetes and celiac disease (ahem, "Gluten Intolerance")....therefore I guess that makes him doubly fashionable!!!!!!! ha ha.

Thanks for the giggle.

Scott, thanks for giving me the opportunity to respond on the site. Ron's letter, printed above, captures the sentiments of many readers of my article -- albeit in more pedantic and pugnacious terms.

 

I'll try to address all his points here, but for the sake of efficency let's skip to the bottom of his disquisition, where he finally gets to the crux of the issue. There he claims that I have “defeated [my] own argument†in the piece, since we all define our own well-being:

 

“If a person has symptoms and they get relief from a gluten-free diet,†he says, “they would have to be pretty self destructive, foolish, or self-indulgent to go back to eating gluten.â€

 

That is, of course, the central theme of my article: What should we make of the fact that there now appear to be thousands or millions of Americans who are deriving some sort of benefit from going gluten-free? Is everyone who buys Elizabeth Hasselbeck's book, or otherwise elects to give up gluten, better off? If someone “gets relief†by going on a diet, then how can I or anyone else possibly argue that they shouldn't be on that diet?

 

These are tricky questions, and the answers aren't as clear-cut as Ron would like them to be. As readers of Celiac.com know all too well, there are many costs -- economic and otherwise -- to being a gluten-free diet. So we'd do well to consider whether some of those who “opt in†are really better off for doing so.

 

We know that everyone with diagnosed celiac disease must be on a gluten-free diet, 100-percent of the time. It's also true that anyone with concrete symptoms that can be reliably traced to gluten would do well to avoid gluten. What about the folks whose symptoms are more ambiguous -- the people who feel sluggish, or anxious, or depressed when they have a bowl of pasta?

 

In my piece, I argued there are many reasons why people might decide that a gluten-free diet is good for them, that have little or nothing to do with autoimmune disease. In particular, I focus on our national obsession with weight loss, and the body dysmorphia that plagues Americans.

 

It's worth pointing out that eating disorders affect women far more often than men -- so from that perspective, the relationship between “G-free†and weight loss is primarily a women's issue. Autoimmune disease is a women's issue, too: The medical establishment has a long, sad history of ignoring or trivializing conditions like lupus and MS, since the men with the stethoscopes so rarely experienced them first-hand. Celiac, too, is diagnosed 2 to 3 times more often in women -- despite the fact that it's thought to occur in men and women equally across the population.

 

So we've got a situation where women are doubly vulnerable -- to autoimmune diseases like celiac, and to nefarious social pressures to control one's diet. I am deeply disturbed by both of these issues. Now, one could argue that my article gave the former problem short-shrift in its focus on the latter -- that's a fair criticism which I would grudgingly accept. Still, I think it's vital that we address both sides of the problem.

 

The manifest gender politics of celiac does leave me feeling somewhat uncomfortable about the present exchange. Here we are: A couple of guys debating a women's health issue on a Website run by another guy. What percentage of our readers are men, I wonder?

 

To make matters worse, Ron insists on presenting himself as “Dr. Ron Hoggan,†as if the wisdom and advice he's been doling out were the product of a medical degree. In fact, Ron is a self-published book author and a retired schoolteacher, who happens to have a Ph.D. in education. I have tremendous respect for educators, but the fact that he's using an irrelevant doctorate as a signifier of some higher authority seems especially creepy in this context. It's as if the women who suffer from celiac disease should be impressed by a gentleman in a white coat.

 

(The mere fact that Ron distributes medical information in such a way strikes me as unethical at the very least -- and possibly illegal.)

 

But enough of that: Let's move on to the Doctor's more specific points. He objects to my proposal that beginning a restrictive diet may ameliorate gastrointestinal symptoms. He's right that gluten-free foods are calorie-dense, so this particular diet isn't likely to restrict food intake (or produce weight-loss) over the long term. Yet it's also true that anytime you begin carefully accounting for the foods you eat, you're likely to eat less. That's the basis for an entire chapter of Hasselbeck's book -- which, like it or not, is selling like gluten-free hotcakes. In fact, I first learned of this from Dr. Joseph Murray, though he certainly didn't originate the idea.

 

Then Ron takes issue, for reasons I can't quite understand, with my survey of newspaper mentions of gluten intolerance, lactose intolerance, the Atkins Diet, and the Mediterranean Diet. The broad history of these has little to do with the simple fact that -- from a popular-culture point of view -- they have entered and exited the mainstream like fads. I did acknowledge in my article that the timing of new epidemiological data on celiac disease could help explain the spike of interest in gluten intolerance several years ago. I don't think it explains all the data.

 

Ron appears especially inflamed by my assertion that you can't “prove†a case of gluten intolerance in the lab, which he calls “the lynchpin of [my] entire article.†In this case, his criticism seems to be predicated on the notion that blood tests for anti-gliadin antibodies are proof-positive of gluten-intolerance. Well, if you want to define “gluten intolerance†as testing positive on a given blood test, then yes, of course it can be proven by just such a blood test.

 

In my article, I was referring not to the presence of antibodies of one sort of another -- which, as Ron admits over and over again, are not specific to any disease -- but rather to the nebulous condition under which people experience the symptoms (classic or atypical) of celiac, without having a strict celiac disease diagnosis. That's in line with the definition used by the Gluten Intolerance Group of North America, and refers to those patients who feel sick to their stomachs or develop rashes or get depressed or feel sluggish when they eat gluten -- despite the fact that doctors have failed to uncover the tell-tale signs of celiac disease.

 

Ron wants to emphasize that, superficial symptoms aside, the mere presence of anti-gliadin antibodies has been associated with serious illness. We may one day discover this is true. So far, the data to support this claim are sparse. For example, Ron seemed quite pleased to have discovered the following report published in a moderately-influential gastroenterology journal:

 

Open Original Shared Link

 

“Maybe this will reach you,†he wrote in an email, along with a copy of the article. But when I looked at the attachment, I discovered that the research was merely a “letter to the editors,†giving the preliminary results of a pilot study. It's not even clear if the journal sends these “letters†out for peer-review.

 

We might excuse Ron his excessive enthusiasm for such speculative studies. After all, the world can see how invested he is -- both personally and financially -- in the idea that gluten is a menace to public health, and that it affects all of us. (As an online shopping mall for gluten-free products, Celiac.com also stands to reap a profit from promoting Ron's ideas, and attacking mine.)

 

Finally, Ron quotes a “private email from another person†at the bottom of his critique, who wonders if I'd been dumped by a gluten-free girlfriend at some time in my life. “I am most inclined to agree with this poster's suspicions,†wrote Dr. Hoggan.

 

I would be remiss if I didn't pass along the following email, which I received from a friend of a friend, who heard the claim in question from a passing hobo:

 

“After looking at Ron Hoggan's response, I had the distinct feeling that this man is obsessed with gluten-intolerance for a reason. He says elsewhere that gluten affects classroom performance ... perhaps he just wasn't a very good schoolteacher? … I don't have any proof, or course â€

 

I take no position whatsoever on this poster's suspicions.

 

Sincerely,

 

Daniel Engber

Thank you Mr. Engber for being the voice of reason. I seriously doubt anyone here will listen to you. They hear and see what they want, and there's nothing you or I or anyone else can do to help them. The name of this site needs to be changed. It's definitely misleading. It implies it's for celiacs, but the majority here are not. The majority rules.