Walk down the aisles at any grocery store today and you’ll find bread, crackers, cereals, and pastas proudly stamped “Gluten-Free” — as if gluten were some kind of dietary villain lurking in your morning toast. For the roughly 1% of Americans with celiac disease, avoiding gluten isn’t a lifestyle choice; it’s a medical necessity. But for the much larger slice of the population without any gluten-related disorder, the science tells a more complicated story.
What Is Celiac Disease, and What Causes It?
Celiac disease is an autoimmune disorder — meaning the immune system turns on the body itself. The trigger is gluten, a protein found in wheat, barley, and rye. Gluten fragments interact with an enzyme called tissue transglutaminase in the gut. The immune system mistakes this complex for a threat and attacks it, but in the process, it damages the body’s own intestinal tissue. This is what makes celiac disease an autoimmune condition, rather than a simple food allergy. The immune system mounts an attack, generating antibodies that damage the villi, the tiny finger-like projections lining the small intestine that are responsible for absorbing nutrients. Over time, that damage leads to malabsorption and a cascade of health problems.
The disease has a strong hereditary component — about 7.5% of close relatives of people with celiac disease also have it. Researchers have identified two specific genetic variants, HLA-DQ2 and HLA-DQ8, that are present in virtually all celiac patients. But here’s the catch: about 40% of the general population carry one of these genes, yet most of them never develop celiac disease. That means genes load the gun, but something else pulls the trigger. Environmental factors — gastrointestinal infections, timing of gluten introduction in infancy, and other autoimmune conditions like type 1 diabetes and thyroid disease, surgery, even pregnancy — all appear to play a role. Researchers continue to study why some genetically susceptible individuals develop the disease while others do not.
Symptoms and Diagnosis: A Tricky Puzzle
If you’re picturing someone doubled over with stomach pain after eating a sandwich, that’s one version of celiac disease — but far from the only one. The disease presents in more than 200 documented ways. Classic gut symptoms include abdominal pain, bloating, diarrhea, and foul-smelling stools. But celiac disease can also show up as iron-deficiency anemia, bone loss, infertility, nerve damage, depression, liver enzyme abnormalities, and even a distinctive itchy skin rash called dermatitis herpetiformis. Children may experience stunted growth and delayed puberty. Some people, especially seniors, may have no obvious symptoms at all.
This symptom diversity is part of why diagnosis is so often delayed. Researchers estimate that somewhere between 60–70% of Americans with celiac disease remain undiagnosed.
The path to diagnosis typically starts with a blood test measuring tissue transglutaminase IgA antibodies — a marker the immune system produces in response to gluten. If that test is positive, a gastroenterologist performs an upper endoscopy and takes small tissue samples from the small intestine to look for the telltale villous damage under a microscope. Both tests need to be done while the patient is still eating gluten; going gluten-free first can produce falsely normal results and delay or prevent an accurate diagnosis.
Treatment: One Answer, Lifelong Commitment
There are no medications, no injections, no surgical fixes for celiac disease. The only effective treatment is a strict, lifelong gluten-free diet. And “strict” really does mean strict — even trace amounts of gluten can damage the intestinal lining, sometimes without producing obvious symptoms. Gluten hides in surprising places: commercial soups, sauces, ice cream, hot dogs, medications, dietary supplements, and even some communion wafers. Working with a registered dietitian is strongly recommended.
The good news is that the intestinal lining is remarkably resilient. Once gluten is eliminated, symptoms typically improve within one to two weeks, and mucosal healing generally follows over one to two years. Nutritional deficiencies — commonly iron, folate, calcium, and B vitamins — are addressed with supplements during recovery. A small subset of patients develop “refractory celiac disease,” where the intestine doesn’t heal despite strict dietary adherence; these cases may require corticosteroids and carry a less favorable prognosis.
Prognosis: Life After Diagnosis
Most people with celiac disease who strictly follow a gluten-free diet do very well over the long term. Intestinal architecture normalizes, antibody levels drop, and many of the downstream complications — anemia, bone loss, neurological symptoms — improve or resolve. The earlier the diagnosis is made and the gluten-free diet is initiated, the better the outcome.
One significant concern on the long-term horizon is cancer risk. People with longstanding, untreated celiac disease face a roughly 6–8% elevated risk of lymphoma of the small intestine. There is also a modestly increased risk of other gastrointestinal cancers. The reassuring part: patients who achieve normal intestinal histology on a gluten-free diet appear to have the same lymphoma risk as the general population. Adherence to the diet is, quite literally, protective.
Non-Celiac Gluten Sensitivity: The Gray Zone
Between full-blown celiac disease and perfectly healthy gluten tolerance lies a murkier territory: non-celiac gluten sensitivity (NCGS). People with NCGS experience symptoms similar to celiac disease — bloating, abdominal pain, fatigue, headaches, brain fog — after eating gluten, but their blood tests for celiac antibodies are negative and intestinal biopsies show no structural damage. The condition is real and increasingly recognized, but its biology remains incompletely understood.
Non‑celiac gluten sensitivity does not have a single definitive test. Instead, it is a diagnosis of exclusion. Once all other causes have been excluded, NCGS is what’s left.
Milder Forms of Gluten Intolerance
Not everyone with gluten‑related complaints fits neatly into the categories above. Some people never undergo formal testing but notice a pattern: when they eat bread, pasta, or pastries, they just don’t feel good. When they cut back on those foods, they feel lighter and more energetic.
These milder forms of gluten intolerance can be tricky to interpret. The symptoms overlap with irritable bowel syndrome, lactose intolerance, stress‑related gut issues, and reactions to FODMAPs (fermentable carbohydrates) found in wheat and many other foods. In some cases, it may not be gluten itself causing problems but the overall carbohydrate profile of a highly processed, wheat‑heavy diet. Some scientists suggest renaming the condition “non-celiac wheat sensitivity” to better capture this complexity. Still, for the individual, what matters most is whether changing their diet in a structured way leads to sustained relief.
Wheat allergy is a classic IgE‑mediated food allergy to wheat proteins that can cause hives, wheezing, or even anaphylaxis, and needs to be distinguished from celiac disease and NCGS. It is treated like other food allergies and is best managed by an allergist.
The Gluten-Free Craze: Helpful Trend or Expensive Fad?
Here’s where things get interesting — and a little frustrating for nutritional scientists. Surveys suggest that roughly 30% of American adults are actively trying to reduce or eliminate gluten from their diets. A 2013 poll found that 65% of Americans believed gluten-free foods were simply healthier, and 27% thought going gluten-free would help them lose weight. These numbers vastly outpace the actual prevalence of celiac disease and gluten sensitivity combined.
What does the science actually say? For people without celiac disease, NCGS, or a wheat allergy, there’s no compelling evidence that a gluten-free diet improves health, reduces inflammation, boosts athletic performance, or prevents disease. A large 2017 study of over 100,000 participants without celiac disease found no association between long-term gluten consumption and heart disease risk — and in fact suggested that gluten-avoiders who cut back on whole grains might be inadvertently increasing their cardiovascular risk through lower dietary fiber and an increase in refined starches, sugars and fats in gluten substitutes.
There’s also a nutritional downside worth considering. Gluten-free processed foods — the breads, pastas, crackers, and cookies filling grocery shelves — are often lower in fiber, iron, zinc, B vitamins, and folate than their conventional counterparts. They tend to be higher in sugar and fat to compensate for gluten’s structural role. And they’re almost always more expensive.
On the other hand, for some people, adopting a gluten‑free pattern coincides with broader healthy changes—more fruits, vegetables, and home‑cooked meals—so perceived benefits may come from overall diet quality rather than gluten removal itself.
The bottom line from Harvard Medical School is clear: if you feel well and have no digestive symptoms, there’s no evidence that a gluten-free diet will help, and some modest evidence it might hurt.
That said, if you’re experiencing real, persistent gut symptoms and haven’t been evaluated, the right move isn’t to quietly go gluten-free and see if you feel better — it’s to see a doctor and get tested first. Eliminating gluten before testing can produce falsely negative results and close the diagnostic door on a condition that, left untreated, carries genuine long-term risks.
The Takeaway
Celiac disease is a serious autoimmune condition affecting about 1% of the population, with the majority still undiagnosed. It requires strict, permanent gluten avoidance and careful medical follow-up. Non-celiac gluten sensitivity occupies a legitimate but scientifically murkier space, affecting a real but incompletely defined group of people for whom reducing gluten makes practical sense. For everyone else — the majority of gluten-free shoppers — the science doesn’t support the hype. Gluten itself isn’t the villain; it’s just a protein. The real story is in the individual biology of those who can’t tolerate it.
Illustration generated by author using ChatGPT.
Sources:
· WebMD — Celiac Disease: Symptoms, Causes, and Treatment https://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease
· Merck Manual (Consumer Version) — Celiac Disease https://www.merckmanuals.com/home/digestive-disorders/malabsorption/celiac-disease
· Merck Manual (Professional Edition) — Celiac Disease https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/celiac-disease
· American Academy of Family Physicians (AAFP) — Diagnosis and Management of Celiac Disease: Guidelines From the American College of Gastroenterology (2024) https://www.aafp.org/pubs/afp/issues/2024/0100/practice-guidelines-celiac-disease.html
· Houston Methodist — Celiac Disease: Symptoms, Treatment and What To Know (2024) https://www.houstonmethodist.org/blog/articles/2024/jun/celiac-disease-symptoms-treatment-and-what-to-know/
· PMC / Nutrients Journal — The Gluten-Free Diet for Celiac Disease and Beyond https://pmc.ncbi.nlm.nih.gov/articles/PMC8625243/
· PMC / Diabetes Spectrum — The Gluten-Free Diet: Fad or Necessity? https://pmc.ncbi.nlm.nih.gov/articles/PMC5439366/
· Harvard T.H. Chan School of Public Health — Gluten: A Benefit or Harm to the Body? https://nutritionsource.hsph.harvard.edu/gluten/
·Harvard Health — Ditch the Gluten, Improve Your Health? https://www.health.harvard.edu/staying-healthy/ditch-the-gluten-improve-your-health
Medical Disclaimer
The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.
Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.
If you are experiencing a medical emergency, call 911 or your local emergency number immediately.
The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.
Russel Vought and the War on the Environment
By John Turley
On February 16, 2026
In Commentary, History, Politics, Science
Recently, there’s been a a lot of attention given to RFK Jr. and his war on vaccines. More potentially devastating than that is Russel Vought and his war on environmental science.
Russell Vought hasn’t exactly been working in the shadows. As the director of the Office of Management and Budget since February 2025, he’s been methodically implementing what he outlined years earlier in Project 2025—a blueprint that treats climate science not as settled fact, but as what he calls “climate fanaticism.” The result is undeniably the most aggressive dismantling of environmental protections in American history.
The Man Behind the Plan
Vought’s resume tells you everything you need to know about his approach. He served as OMB director during Trump’s first term, wrote a key chapter of Project 2025 focusing on consolidating presidential power, and has openly stated his goal is to make federal bureaucrats feel “traumatized” when they come to work. His philosophy on climate policy specifically? He’s called climate change a side effect of building the modern world—something to manage through deregulation rather than prevention.
Attacking the Foundation: The Endangerment Finding
The centerpiece of Vought’s climate strategy targets what EPA Administrator Lee Zeldin has called “the holy grail of the climate change religion”—the 2009 Endangerment Finding. This Obama-era scientific determination concluded that six greenhouse gases (carbon dioxide, methane, nitrous oxide, hydrofluorocarbons, perfluorocarbons, and sulfur hexafluoride) endanger public health and welfare. It sounds technical, but it’s the legal foundation for virtually every federal climate regulation enacted over the past fifteen years.
Just last week EPA Administrator Zeldin announced that the Trump administration has repealed this finding. This action strips EPA’s authority to regulate greenhouse gas emissions under the Clean Air Act—meaning no more federal limits on power plant emissions, no vehicle fuel economy standards tied to climate concerns, and no requirement for industries to measure or report their emissions. White House press secretary Karoline Leavitt said this action “will be the largest deregulatory action in American history.”
More than 1,000 scientists warned Zeldin not to take this step, and the Environmental Protection Network cautioned last year that repealing the finding would cause “tens of thousands of additional premature deaths due to pollution exposure” and would spark “accelerated climate destabilization.” Abigail Dillen president of the nonprofit law firm Earthjustice said “there is no way to reconcile EPA’s decision with the law, the science and the reality of the disasters that are hitting us harder every year.” She further said they expect to see the Trump administration in court. Obviously, the science is less important to Trump, Zeldin and Vought than the politics.
The Thirty-One Targets
In March 2025, Zeldin announced what he proudly called “the greatest day of deregulation in American history”—a plan to roll back or reconsider 31 key environmental rules covering everything from clean air to water quality. The list reads like a regulatory hit parade, including vehicle emission standards (designed to encourage electric vehicles), power plant pollution limits, methane regulations for oil and gas operations, and even particulate matter standards that protect against respiratory disease.
The vehicle standards are particularly revealing. The transportation sector is America’s largest source of greenhouse gas emissions, and the Biden-era rules were crafted to nudge automakers toward producing more electric vehicles. At Vought’s direction, the EPA is now reconsidering these, with Zeldin arguing they “regulate out of existence” segments of the economy and cost Americans “a lot of money.”
Gutting the Science Infrastructure
Vought’s agenda extends beyond specific regulations to the institutions that produce climate science itself. In Project 2025, he proposed abolishing the Office of Domestic Climate Policy and suggested the president should refuse to accept federal scientific research like the U.S. National Climate Assessment (NCA). The NCA, published every few years, involves hundreds of scientists examining how climate change is transforming the United States—research that informs everything from building codes to insurance policies.
According to reporting from E&E News in January, Vought wants the White House to exert tighter control over the next NCA, potentially elevating perspectives from climate deniers and industry representatives while excluding contributions made during the Biden administration. This is a plan that has been in the works for years. Vought reportedly participated in a White House meeting during Trump’s first term where officials discussed firing the scientists working on the assessment.
The National Oceanic and Atmospheric Administration (NOAA) has also been targeted. In February 2025, about 800 NOAA employees—responsible for weather forecasting, climate monitoring, fisheries management, and marine research were fired. Project 2025 had proposed breaking up NOAA entirely, and concerned staff members have already begun a scramble to preserve massive amounts of climate data in case the agency is dismantled.
Budget Cuts as Policy
Vought’s Center for Renewing America has proposed eliminating the Department of Energy’s Office of Energy Efficiency and Renewable Energy, the EPA’s environmental justice fund, and the Low Income Home Energy Assistance Program. During the first Trump administration, Vought oversaw budgets proposing EPA cuts as steep as 31%—reducing the agency to funding levels not seen in decades. In a 2023 speech, he explained the logic bluntly: “We want their funding to be shut down so that the EPA can’t do all of the rules against our energy industry because they have no bandwidth financially to do so.”
This isn’t just about climate, it is also about fairness and the recognition that environmental policies have had a predominately negative effect on low income areas. EPA has cancelled 400 environmental justice grants, closed environmental justice offices at all 10 regional offices, and put the director of the $27 billion Greenhouse Gas Reduction Fund on administrative leave. The fund had been financing local economic development projects aimed at lowering energy prices and reducing emissions.
Eliminating Climate Considerations from Government
Perhaps more insidious than the high-profile rollbacks are the procedural changes that make climate considerations disappear from federal decision-making. In February, Jeffrey Clark—acting administrator of the Office of Information and Regulatory Affairs (OIRA) under Vought’s OMB—directed federal agencies to stop using the “social cost of carbon” in their analyses. This metric calculates the dollar value of damage caused by one ton of carbon pollution, allowing agencies to accurately assess whether regulations produce net benefits or defects for society.
Vought has also directed agencies to establish sunset dates for environmental regulations—essentially automatic expiration dates after which rules stop being enforced unless renewed. For existing regulations, the sunset comes after one year; for new ones, within five years. The stated goal is forcing agencies to continuously justify their rules, but the practical effect is creating a perpetual cycle of regulatory uncertainty.
The Real-World Stakes
The timing of these rollbacks offers a grim irony. As Vought was pushing to weaken the National Climate Assessment in January 2025, the Eaton and Palisades fires were devastating Los Angeles—exactly the type of climate-intensified disaster the assessment is designed to help communities prepare for. The administration’s response? Energy Secretary Chris Wright described climate change as “a side effect of building the modern world” at an industry conference.
An analysis by Energy Innovation, a nonpartisan think tank, found that Project 2025’s proposals to gut federal policies encouraging renewable electricity and electric vehicles would increase U.S. household spending on fuel and utilities by about $240 per year over the next five years. That’s before accounting for the health costs of increased air pollution or the economic damage from unmitigated climate change.
Environmental groups have vowed to challenge these changes in court, and the legal battles will likely stretch on for years. The D.C. Circuit Court of Appeals will hear many cases initially, though the Supreme Court will probably issue final decisions. Legal experts note that while Trump’s EPA moved with unprecedented speed on proposals in 2025, finalizing these rules through the required regulatory process will take much longer. As of December, none of the major climate rule repeals had been submitted to OMB for final review, partly due to what EPA called a 43-day government shutdown (which EPA blamed on Democrats, though the characterization is widely disputed).
What Makes This Different
Previous administrations have certainly rolled back environmental regulations, but Vought’s approach differs in both scope and philosophy. Rather than tweaking specific rules or relaxing enforcement, he’s systematically attacking the scientific and legal foundations that make climate regulation possible. It’s the difference between turning down the thermostat and ripping out the entire heating system.
The Environmental Defense Fund, which rarely comments on political appointees, strongly opposed Vought’s confirmation, with Executive Director Amanda Leland stating: “Russ Vought has made clear his contempt for the people working every day to ensure their fellow Americans have clean air, clean water and a safer climate.”
Looking Forward
Whether Vought’s vision becomes permanent depends largely on how courts rule on these changes. The 2007 Supreme Court decision in Massachusetts v. EPA established that the agency has authority to regulate greenhouse gases as air pollutants under the Clean Air Act—the very authority Vought is now trying to eliminate. Overturning established precedent is difficult, though the current Supreme Court’s composition makes the outcome possible, if not likely.
What we’re witnessing is essentially a test of whether one administration can permanently disable the federal government’s capacity to address climate change, or if these changes represent a temporary setback that future administrations can reverse. The stakes couldn’t be higher: atmospheric CO2 concentrations continue rising, global temperatures are breaking records, and climate-related disasters are becoming more frequent and severe. Nothing less than the future of our way of life is at stake. We must take action now.
Full disclosure: my undergraduate degree is in meteorology, but I would never call myself a meteorologist since I have never worked in the field. But I still maintain an interest, from both a meteorological and a medical perspective. The Grump Doc is never lacking in opinions.
Illustration generated by author using Midjourney.
Sources:
Lisa Friedman and Maxine Joselow, “Trump Allies Near ‘Total Victory’ in Wiping Out U.S. Climate Regulation,” New York Times, Feb. 9, 2026.[nytimes +1]
Lisa Friedman, “The Conservative Activists Behind One of Trump’s Biggest Climate Moves,” New York Times, Feb. 10, 2026.[nytimes +1]
Bob Sussman, “The Anti-Climate Fanaticism of the Second Trump Term (Part 1: The Purge of Climate from All Federal Programs),” Environmental Law Institute, May 7, 2025.[eli]
U.S. Environmental Protection Agency, “Trump EPA Kicks Off Formal Reconsideration of Endangerment Finding,” EPA News Release, Mar. 13, 2025.[epa]
Trump’s Climate and Clean Energy Rollback Tracker, Act On Climate/NRDC coalition, updated Jan. 11, 2026.[actonclimate]
“Trump to Repeal Landmark Climate Finding in Huge Regulatory Rollback,” Wall Street Journal, Feb. 9, 2026.[wsj]
Valerie Volcovici, “Trump Set to Repeal Landmark Climate Finding in Huge Regulatory Rollback,” Reuters, Feb. 9, 2026.[reuters]
Alex Guillén, “Trump EPA to Take Its Biggest Swing Yet Against Climate Change Rules,” Politico, Feb. 10, 2026.[politico]
“EPA Urges White House to Strike Down Landmark Climate Finding,” Washington Post, Feb. 26, 2025.[washingtonpost]
“Trump Allies Near ‘Total Victory’ in Wiping Out U.S. Climate Regulation,” Seattle Times reprint, Feb. 10, 2026.[seattletimes]
“Trump Wants to Dismantle Key Climate Research Hub in Colorado,” Earth.org, Dec. 17, 2025.[earth]
“Vought Says National Science Foundation to Break Up Federal Climate Research Center,” The Hill, Dec. 17, 2025.[thehill]
Rachel Cleetus, “One Year of the Trump Administration’s All-Out Assault on Climate and Clean Energy,” Union of Concerned Scientists, Jan. 13, 2026.[ucs]
Environmental Protection Network, “Environmental Protection Network Speaks Out Against Vought Cabinet Consideration,” Nov. 20, 2024.[environmentalprotectionnetwork]
“From Disavowal to Delivery: The Trump Administration’s Rapid Implementation of Project 2025 on Public Lands,” Center for Western Priorities, Jan. 28, 2026.[westernpriorities]
“Russ Vought Nominated for Office of Management and Budget Director,” Environmental Defense Fund statement, Mar. 6, 2025.[edf]
“Project 2025,” Heritage Foundation/Project 2025 backgrounder (as summarized in the Project 2025 Wikipedia entry).[wikipedia]
“EPA to repeal finding that serves as basis for climate change,” The Associated Press, Matthew Daly
https://vitalsigns.edf.org/story/trump-nominee-and-project-2025-architect-russell-vought-has-drastic-plans-reshape-america
https://en.wikipedia.org/wiki/Russell_Vought
https://www.commondreams.org/news/warnings-of-permanent-damage-to-people-and-planet-as-trump-epa-set-to-repeal-key-climate-rule
https://www.eenews.net/articles/trump-team-takes-aim-at-crown-jewel-of-us-climate-research/
https://www.epa.gov/newsreleases/epa-launches-biggest-deregulatory-action-us-history
https://www.pbs.org/newshour/nation/trump-administration-moves-to-repeal-epa-rule-that-allows-climate-regulation
https://www.scientificamerican.com/article/trump-epa-unveils-aggressive-plans-to-dismantle-climate-regulation/
https://www.bloomberg.com/news/articles/2026-02-10/trump-s-epa-to-scrap-landmark-emissions-policy-in-major-rollback