I had been hoping that the release of Novak Djokovic’s new book would bring to the surface the truth about his gluten-related diagnosis, and a new editorial in the Wall Street Journal appears to have done just that. It’s been a long wait.
For those of you unfamiliar with my previous thoughts on the subject, this post from July 2011 remains relevant. In summary: Djokovic appeared to have been diagnosed using fringe techniques advocated by a Dr Igor Cetojevic, and his belief – however strong – that his gluten-free diet was responsible for his improvement in form was nowhere near enough evidence of the assertion’s truth.
And now the precise diagnostic technique has been revealed, as this extract from the article shows:
“Dr. Cetojevic persuaded the tennis star to give up gluten by administering a simple test: He told Djokovic to put his left hand on his stomach, hold out his right arm and resist as the doctor pulled down on his arm. Then Dr. Cetojevic gave Djokovic a slice of bread and told him to hold that against his stomach and repeated the test…”
Despite Djokovic describing this as seeming ‘madness’ – “there was a noticeable difference.”
He appears to be describing kinesiology – which uses such muscle/strength tests to supposedly find imbalances or intolerances in the body. It’s nonsense on stilts, and its pseudoscientific silliness is nicely summarised in this Wikipedia article.
The article then describes Djokovic undergoing ELISA testing, finding an “intolerance” to wheat and dairy. I suspect this related to IgG testing, which is unreliable.
This is a rushed post, but I have several points.
Firstly, the article itself is disappointing, albeit illuminating, in that it fails to challenge or call into question the methods of diagnosis and notions Djokovic outlines. Later in the article Djokovic describes some staggering tosh involving positive energy and water – it has to be read to be believed, and I cannot help but wonder how a top athlete can come to be convinced of this stuff. “What matters is that you are open-minded,” is Djokovic’s take. Yes – but not so open-minded that your brains fall out.
The ATP – the Association of Tennis Professionals – has to take some action on this. I don’t know the ins and outs of tennis politics and officialdom, but when their number one tennis player – a hugely popular, talented figure – is communicating at-best questionable health information to readers worldwide, someone needs to speak and point out the lack of scientific basis concerning these ideas.
I assume from the above we can now start laying to rest the idea that Djokovic is a diagnosed coeliac – although I know some out there will find this hard to swallow and would like to maintain the denial of what now appears to be the unchallengeable truth.
I know too that some will argue none of this matters, that all that matters is that Djokovic has improved his life, his ability, his health, and that others may be able to use these techniques to get similar results. And so they might.
But there are problems with this. One lies with how this information will now be used. I can quite easily see applied kinesiologists using his story as evidence that their techniques work and have validity, and to market it to others – perhaps the vulnerable. It is simply not science, and it is the absence of science in this whole business that really disturbs me. Science is doing wonderful things in gluten-related disorders – it is at the centre of a potential new vaccine for coeliac disease, for example – and the idea that it is an optional way of understanding us and our bodies must continue to be challenged.
The fact is that in the absence of good factual science based medicine people turn to other avenues of diagnosis. If they have approached a medical practitioner, who takes no interest in their existing symptoms or has no knowledge on the relevant illnesses and conditions, then they will most likely seek alternative help. It is wise to keep an open mind to holistic therapy but also to assess the reliability of the competence of the practitioner and the advice given. People need more help, advice and suppory from relevant groups like your own.
I do agree that, sadly, those who find lack of sympathy / satisfaction from orthodox means turn to the unorthodox, which has less or no regulation, between no and little evidence base, and often therapists with questionable understanding of science and the body.
Where I perhaps differ slightly concerns keeping an open mind about holistic therapy. Not sure what you're definition of these might be, but each one should be judged on its own merits. Plausibility must be assessed first. Herbalism, acupuncture … these are alternatives which are plausible. Kinesiology, like homeopathy – really isn't. And to my mind the lack of good evidence for them is where the keep-an-open-mind philosophy starts to look shaky …
But yes, can't argue with your last point – the interest in these subjects online is testament enough to that. Thanks for commenting!
I would't advocate all holistic therapies either. There are bogus practitioners in all walks of medicine whether regulated or not. I look forward to the continuing advances in social media aiding better information for all those who need it.
Someone suggested to me that I try kinesiology to see if my GI issues were food-related. I had never heard of it so looked it up. My reaction? What a load of twaddle!
I am genuinely gobsmacked that anyone would take a test as daft as holding a piece of bread to your stomach as proof of an illness/allergy. And I'm not even a scientist! It just sounds utterly bonkers.
I do agree with Emma Louise that people turn to alternative therapies sometimes when they are disillusioned with traditional medicine or feel they are not being listened to, but it is worrying to see such high profile role models promoting (actively or otherwise) such unsubstantiated 'therapies'.
Yep, that bread-on-your-tummy thing really takes some beating … and quite agree about your last point. Thanks for commenting.
Oh dear…. I think a cold shower is needed here and then we need to start again….
Djokovic never claimed to be a coeliac or to have been diagnosed as such – I doubt that he even knows what a coeliac is.
That the coeliac community fell on his neck and claimed him as one of their own can scarcely be laid either at his door or at that of his nutritionist advisor, Dr Igor Cetojevic. Nor can the vast amount of unjustified hype that has resulted from his decision, however many months/years ago to cut gluten out of his diet.
I have not (yet anyhow) read his book but, if the NYT article that Alex quotes is accurate, removing gluten from his diet was only one of a whole raft of dietary and lifestyle measures that Dr C. advised: drink lots of warm water and protein pea shakes, eat plenty of avocados and cashew nut butter but very little sugar. Banish caffeine, get plenty of sleep, drink licorice tea, eat Manuka honey…. And…. don't eat gluten or dairy. Yet the only one of these measures which got picked up on was the gluten avoidance.
Djokovic suggests that everyone should remain open minded – not a trait that was obvious in either Alex’s blog or in the comments to date…
Kinesiology and what Alex describes as ‘some staggering tosh involving positive energy and water’ both fall under the heading of ‘energy medicine’ – a concept on which five thousand year’s worth of Chinese medicine is based, but which ‘science-based’ medicine enthusiasts find it very hard to get their heads around because, maybe, they can neither see it nor measure it.
Yet ‘energy’ is, in essence, electrical current. It is what allows the cells in our bodies, and the neurons in our brains to communicate with each other and keep us alive and functioning. This is not the ravings of some far out alternative crank but accepted science. I wonder why it is therefore, that the concept of ‘energy’ playing a larger role in the way that we function is apparently so hard to grasp.
No, we certainly do not understand how it works much of the time – and some people do come up with what, on the surface at least, do appear to be some pretty bizarre ideas (such as water turning green if you project negative emotions at it). But the fact that we do not understand it does not mean that it does not exist. Merely that we do not understand it.
Let’s face it, virtually every medical (and ‘scientific’) discovery that has ever been made has been dismissed as ‘staggering tosh’ by those who purported ‘to know’ when it was first made. Ask Galileo…..
But, to return to Djokovic…
Whether or not his new regime has actually improved his fitness and his ability to win tennis matches, he obviously believes that it has – which may be all that he, or any of the rest of us, need.
Meanwhile, Dr Cetojevic’s suggestions are no more than sound nutritional sense – drinking warm rather than ice cold water is well established as being gentler on the digestion, good hydration is essential if you are expending a lot of energy, avocados and cashew nuts are recognised as excellent sources of nutrition and plenty of sleep is essential to replenish energy sources – and not only many athletes but many of us could benefit by following a number of them.
So, I sincerely hope that the ATP (Association of Tennis Professionals) keeps well out of this. It has nothing to do with tennis – and, as it happens, nothing to do with coeliac disease.
I also hope that coeliac/gluten-free community goes and takes that cold shower, backs off and actually looks at the facts rather than the hype.
Yes, 'energy' is essentially electrical in nature, and science can measure electrical current perfectly capably. That we have not been able to detect any such current – ie can 'neither see nor measure it' as you say – when it comes to so-called energy 'medicine' tells us all we need to know.
I'm sorry, but energy is not essentially electrical. Alex is right though, if you can't measure something you can't claim to know anything about it. If alternative medicine worked, it wouldn't be called alternative, it would just be called medicine.
Thanks for clarifying, Tom – of course, there are other forms of energy, and I'm forgetting my physics. Quite agree that if you can't measure or detect something, you have no right to insist on its existence.
Well, I have to say something on this… I am an engineer, and I also deeply believe only in science in my core…BUT, I have some health problems for some times, and came to the meter of gluten long before Djokovic, but to my disappointment, doctors could not help me….only because I do not qualify as "coeliac" patient…I have read the book, and first of all, all over the book, he is pointing out, that everything that he is saying, WORKED FOR HIM and that it does not mean that it will work for all the others, because everyone body is different. And yes, you will refer now again to measurements, so let me express myself in the language of science. When it comes to medicine, there is too much parameters involved for the doctors to establish exact connection, whether we like it or not. Medicine is to my biggest disappointment, more about statistics, and some of us are an exemptions that would be excluded from the study. So, I think that all of us who have the problem with gluten, but do not fall in coeliac category are very thankful that somebody finally started to talk about it!!!! I do hope that it will contribute to progress in establishing some more accurate diagnostic test for all of us being ignored and left to suffer, labeled as some people who have a problem in their head.
Without diagnosis from a professional / support from a dietitian, I believe it's very difficult to 'know' that you have a problem with gluten, because you cannot isolate gluten in the diet – it comes together with lots of other proteins, which could be the root of the problem, and lots of other components of wheat / bread (eg yeast, FODMAPs, trypsin inhibitors) as well.
My objections to Djokovic's book are summarised here: http://foodallergyandintolerance.blogspot.co.uk/2013/09/novak-djokovic-serve-to-win-review.html
A recent report I wrote for Foods Matter explains why a perceived gluten problem may not be gluten after all: http://foodsmatter.com/conference_reports/articles/gut-health-allergies-11-13.html
Can I also say, re: 'some people who have a problem in their head' – I don't believe a psychological 'intolerance' is any different in 'value' to a physiological one – and the same applies to one where a combination of both factors come into play.
I do understand that some people are happy that he has raised awareness, and to some extent I agree, but I think the Djokovic case has also caused an awful lot of confusion and misguided comment.
Thanks for stopping by. Hope your problems are fully resolved, and good health to you – Alex.
Haha! Just found your article searching for Novak's absurd diagnosis story to share it with my sister (we both have properly diagnosed story) and wanted to tell you we both found your line about brains falling out absolutely hilarious. Thank you for your humorous take on what is, I agree, a problematic situation for awareness, even if it is good that Novak is feeling well.
Thank you Molly – I have a feeling I pinched that brains gag from someone else, so not sure I can take credit!
searching for the 'diagnosis with slice of bread on belly' on google, i was being led here.
just to give you an update on this: the dutch edition of the free 'newspaper' namdd METRO has an advertorial (marked as an interview) with Djokovic explaining the way he got diagnosed with gliten intolerance using the mentioned method using some bread on the belly.
However, more worrying is that the whole article is also full of embelishments for a line of products from a company named 'Ceréal' for which he has become an official figurehead.
The basis and method on which he has een diagnosed and the fact that he has an example-function make this a worrisome development in my oppinion.
The 'interview' makes no mention of any disclaimers as he , apparently, did in his book. Nor is there any mention of the rather untried/unorthodox method of 'diagnosis', as if putting some bread on your belly is the accepted way one studies intoleracies for gluten.
Thanks for the update. I was aware of his advertising Cereal – i blogged previously here: http://foodallergyandintolerance.blogspot.co.uk/2014/09/what-djokovic-says-what-djokovic-does.html – and find it very hypocritical of him. It's a shame, because I'm a fan of his on the court. Thanks again.
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