New men’s number one and Wimbledon champion Novak Djokovic has lost one match this year, in the French Open semi final, to Roger Federer. He has won his other fifty matches, including two grand slam finals. In April at the Serbia Open, still unbeaten for the season, he explained to the press that he had been gluten free since late 2010, a diet to which he attributed his extraordinary run of success, and for which he had a new health advisor to thank. A Reuters report of it quotes Djokovic thus: “His name is Igor Cetojevic, he is a nutritionist and he's done a great job in changing my diet after we established I am allergic to some food ingredients like gluten.”
That is just about the only informative quote from Djokovic about his diet I can find, and there are several important points to note about it.
1. There was no mention of coeliac disease.
2. ‘Allergy’ to gluten is not coeliac disease.
3. Nutritionists have many abilities, but the means to confidently diagnose coeliac disease is not one of them.
4. ‘Some food ingredients’ – clearly there have been other dietary changes made, as well as gluten.
Naturally, this news spread rapidly and there followed the usual articles speculating over the benefits of a gluten-free diet to health and weight loss and fitness. The first specific and official mention of coeliac disease I have been able to find came in this article in the Independent from mid May, which repeats the quote from the Reuters report, but appears to leap to the conclusion of a coeliac diagnosis without offering further supporting evidence.
Since then, there has been much conversation and speculation online, including on chat forums and on blogs and in a gluten-free manufacturer’s newsletter and this morning on Coeliac UK’s FB page. Twitter has seen a lot of action, and many coeliacs have understandably expressed excitement and pride. There was a sweet tweet from a mum of a coeliac boy who was delighted she could now point to such a positive sporting role model.
But let’s rewind a little. Who is nutritionist Igor Cetojevic? I Googled him and found him here. He appears to be an advocate of ‘Energetic Medicine’, and to hold practices which orthodox medics consider unsubstantiated, such as homeopathy, magnetotherapy and Bach flower remedies, in high regard.
Of more relevance to the issue at hand, he says he uses a system called SCIO – which stands for “Scientific Consciousness Interface Operations System”. The official SCIO website can tell you more about it. Sample extract from that site: “The SCIO is a universal electrophysiological biofeedback system. It coordinates a complex electro-modal, biofeedback program with computer software in order to gather bioenergetic information of a client’s subconscious.”
At this point my internal alarm system is ringing loudly. I found this interview on a Spanish site called Quantum Medicine which appears to confirm that Cetojevic uses the SCIO to help identify ‘stress factors such as allergens, toxins, pathogens, viruses, mental and emotional disturbances…’ and implies that this is what was used on Djokovic.
What evidence do we have that SCIO is a valid tool? I cannot find one reference to it on PubMed – the online database of all published medical studies – which indicates it has probably not undergone any rigorous testing. This is hardly surprising, as it appears to be founded on a system of thinking which sits outside the medical orthodoxy.
I have found some references to it on sceptical scientific sites, however. Dr Stephen Barrett’s Quackwatch demolishes it and other ‘electrodiagnostic’ devices here and here, while Dr Ben Goldacre’s Bad Science blogpost of three years ago on the subject may also be of interest if you wish to learn more.
Their conclusion, essentially, is that the system has no foundation in science.
Where does this leave us?
Getting answers from the internet alone is, I admit, an unsatisfactory means of bringing us towards the truth, but it doesn’t alter the fact that I have been unable to find any reports that Djokovic underwent an endoscopy to confirm coeliac disease, or that he undertook an exclusion and reintroduction diet, which might help diagnose a non-coeliac gluten intolerance. I hate to draw a conclusion from what I’ve read on some, let’s say, unusual internet sites, but until we learn more, and from the information out there, it seems logical to reason that Djokovic was diagnosed with an ‘allergy to gluten’ by an alternative practitioner who uses a system which is at best scientifically questionable.
That Djokovic attributes his success to his gluten free diet cannot be argued with, but improvement in health following gluten exclusion does not necessarily imply any form of gluten sensitivity, as I have explained previously on this blog. Although I am not for one second questioning his honesty, he could be making the common but mistaken assumption that it does. In fact, there could be many possibilities for health improvement following gluten removal:
* psychological benefit, one mentioned in this Wall Street Journal article;
* benefit due simply to an improvement in diet that often comes with the elimination of the junk food gluten is typically found in, rather than a removal of the gluten itself;
* benefit from ingredients other than gluten which have been removed from the diet as a consequence of gluten removal, for instance bread yeast;
* benefit from the weight loss which can occur (and which occurred in Djokovic’s case);
* benefit derived from the replacement foods (and their nutrients) introduced into the diet to compensate for the removed gluten-containing foods.
I do understand why coeliacs and gluten sensitives have leaped on this story and looked to pop Djokovic on a gluten-free pedestal as the most famous coeliac on the planet. And while I cannot be 100% certain given the lack of reliably sourced information, I suspect he is not a coeliac, and I am personally not confident in any diagnosis of ‘gluten allergy’ or other gluten sensitivity either.
There are lots of reasons to like Djokovic: he’s a magnificent champion and athlete, he is talented and great to watch on court, he’s personable and he’s really very funny – as his notorious tennis impersonations testify. But perhaps the ability – or not – of his intestines to properly handle wheat protein should not be one of them.
Labels: coeliac disease, food intolerance tests, gluten, gluten free, Novak Djokovic