Managing symptoms and health through self-prescribed restrictive diets: What can general practitioners learn from the phenomenon of wheat avoidance?

Abstract

Background and objectives: Seven per cent of Australian adults report avoiding wheat products for the relief of symptoms. The objective of this study was to explore the experiences, symptoms, influences and beliefs that may explain the tendency for this behaviour to occur predominantly in the absence of a reported medical diagnosis or expert dietary supervision. Method: Data were collected through preliminary questionnaires and semi-structured interviews with 35 self-identified symptomatic individuals who avoid consumption of wheat-based products without a diagnosis of coeliac disease or wheat allergy. Results: Like other contested health phenomena, symptomatic wheat avoidance is characterised by broad symptomatology, perceived benefits, absence of clear biological markers, dissatisfaction with conventional medicine following previous negative test results, and the fact that presumed treatment - elimination of a dietary factor - requires no medical intervention. Discussion: Self-prescribed food avoidance represents a diagnostic and therapeutic challenge for practitioners, central to which is a tension between patient expectations and biomedical standards of evidence in the diagnostic relationship.