Book Review – Toxic Staple: How Gluten May Be Wrecking Your Health - And What You Can Do About It! Anne Sarkisian (2013)

By Dante Moroni

Note: The statements below are only my opinion and are not to be taken in any way as medical advice.

Sarkisian has the right idea in wanting to help others with gluten related pathologies but is going at it from the wrong angle. A main theme of the book builds off an incorrect belief by Sarkisian that anti-gliadin antibody testing can be used as a reliable marker to detect gluten sensitivity. The whole book ends up feeling like an advertisement AGA Stool Testing which should not be used to diagnose celiac disease (CD) or non-celiac gluten sensitivity (NCGS). Endless anecdotal stories crowd the chapters with stories of individuals using positive results from this test as their reason to adhere to a gluten free diet. Toxic Staple is leading readers on a path to potential mis and un-diagnosis of real CD and other gastrointestinal conditions.

Overall Book Rating: 3.0/10

The book builds its substance off of personal stories of people that have found success using AGA stool testing and is contrarian to contemporary CD diagnostic workups. The method of “detecting gluten sensitivity” using stool testing is not supported by the field of gastroenterology. Relying on it can be dangerous. Aside from an endoscopy, getting a celiac blood panel which contains proper blood tests for anti-tTG, anti-EMA, and anti-DGP is the proper course of action.

Toxic Staple actually has a lot of good information but it is outweighed by misguided information. Anti-Gliadin antibody is a poor diagnostic marker for NCGS. Data from studies in 2011 and 2012 showed AGA being present in about 50% of NCGS individuals. However Volta et al 2014 and Infantino et al 2015 both had associations of 25% and 10% respectively.¹ AGA has never been an accepted marker for diagnosing NCGS and the data supporting its value are diminishing over time. The author is overly-supportive of using anti-gliadin antibody to diagnose gluten sensitivity. While current diagnostic criteria following the Salerno’s Expert Criteria for NCGS does actually say AGA can be a helpful too to aid diagnosis, but not alone. Healthy individuals, and those with other conditions, also often have AGA antibodies. The book references a 50% AGA positivity rate in NCGS which may be an overestimate using current research results. More research is need but current understanding through data analysis by M Infantino in 2016 did not support AGA as a diagnostic marker.³

The Good

Has at least a few reliable sources including Dr. Fasano
Part of book on symptoms with a focus on neurological ones, genetics, family associations etc.
Pretty okay overview of association of CD with increased risk of certain diseases. cancer. etc.
Good part on associations of autoimmune conditions and CD etc, dermatitis herpetiformis..
Links an abundance of symptoms with only light associations with CD etc. as being a reliable marker.
Breaks down difference between celiac disease subgroups (classic, atypical, silent, latent).

The Bad

Dr. Kenneth Fine Stool Test – Seems biased for this and is advertising for them.
Whole chapter on why dairy and casein are bad and other anti dairy promulgating.
References aren’t always the most credible, often un peer reviewed.
No mention of importance -> correlation vs causation.
Often blurs lines between celiac disease and gluten sensitivity.
Supports Dr. Fine’s claims 1/3 or more are gluten sensitive with no evidence.
Advocates GF/CF diet for Autism, herbal supplements, naturopaths, chelation…
Author has no actual qualifications in the field.
Doesn’t get into the details of studies takes them at face value.
Too much value on low participant (n) case studies / stories.
Too many anecdotal stories from non-celiac individuals and broad conclusions on these testimonies.
Lots of occult open ended questions.
Books flow is repetitive and too generalized.
Sometimes combines results from low carb and gluten free diets as the same thing.