Book Review – Gluten Exposed. Peter Green MD, Rory Jones MS (2016)

Review by Dante Moroni

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

Gluten Exposed is the follow up to Peter Green’s important 2006 book, Celiac Disease (CD): A Hidden Epidemic. While I gave that book a solid 8.5 out of 10 rating, this time around it did not stack up. Gluten Exposed does do a good job of explaining why patients with conditions like Celiac Disease (CD), Non-Celiac Gluten Sensitivity (NCGS), and Eosinophilic Esophagitis (EOE) should be following a gluten free diet (GFD). Although the central theme of the book is to dispel myths and pseudoscience around gluten and in my opinion the authors go too far. It’s full of skepticism and admonishing those that adhere to a gluten free diet without the recommendation from a Gastroenterologist.

Concerning quote from the book that I don’t agree with: “Very little evidence that diet can affect disease other than CD” – Peter Green MD

Overall Book Rating: 6.0/10

The Good

  • Nice to see whole chapters on: Irritable bowel sydrome, CD, NCGS, inflammatory bowel disease, and eosinophilic esophagitis, wheat and food allergies, fibromyalgis, chronic fatigue syndrome, Autism, ADHD, and diabetes.
  • Rightly emphazies why anti-gliadin antibody (AGA) shouldn’t be used as a biomarker for CD or NCGS etc.
  • Accepts NCGS as a valid reason for a gluten free diet.
  • They rightly explain that the FODMAP diet is a short term elimination diet and should not be followed long term.
  • Highlights the potential for high arsenic load in gluten free diet per overconsumption of rice.
  • Thorough list and explanation of several of gastrointestinal disorders.
  • Notes that many medications can make gastrointestinal symptoms worse.
  • Good overview of drugs and medications that can affect gut health.
  • Nice list of intestinal permeability triggers (excludes gluten…): NSAIDs, alcohol, stress, exercise, medication.
  • Breaks down the different testing used to diagnose or exclude CD.

The Bad

  • Doesn’t quote or cite studies, no bibliography or references, all that’s provided is a list of Green’s publications…
  • Seems ignorant to the fact that a gluten free diet can be done healthily, it’s really about not relying on gluten free replacement foods.
  • A little over cautious about supplements.
  • Fail to mention how a genetic test can be used to rule out CD.
  • Only mention of gums is carrageenan, even though gluten free diet is saturated with all sorts of them. Misses great opportunity to expose how gums may be negatively affecting GI health.
  • No differentiation of soluble and insoluble fibers.
  • Seems to disregard the importance of diet in gut disorders, even IBS!
  • Proponent of using SSRIs to treat some GI disorders, even though he contradicts himself when mentioning GI side effects associated w SSRIs.
  • Typo on page 116: Says glutenins, not gliadins, responsible for CD. Yikes! It’s the opposite…
  • Over cautious fear mongering about oats. Majority of research supports certified GF oat consumption in CD.
  • Blames FODMAPs for why gluten free diet works in some people, and doesn’t mention it’s a trademark of Monash University. The studies on this are conflicting and definitely not settled.
  • No mention of Zonulin in regards to NCGS, general population, only CD.
  • Mistakenly/Typo says commensal bacteria protect the small intestine, it’s actually the large that they protect.
  • Seems all in on FODMAPs but doesn’t mention the shortfalls of those studies.
  • Comes off as blaming a lot of IBS symptoms as originating from phsycotic, hysteric, hypochondriac patients. Doesn’t believe IBS can be improved by diet.
  • Disregards enzyme therapy’s potential for cross-contamination prevention etc.
  • No mention of brain fog and depression in NCGS.
  • Says no enzyme available can break down glute, but then says AN-PEP works! One of several contradictions in the book.
  • Believes fermentation of beer doesn’t affect gluten. In reality, it gets degraded during brewing, not always to “gluten-free” levels but it does get reduced substantially (endogenous barley enzymes).