Back نظام غذائي خال من الغلوتين Arabic Dieta sense gluten Catalan Bezlepková dieta Czech Dieta sin gluten Spanish رژیم غذایی بدون گلوتن Persian Gluteeniton ruokavalio Finnish Régime sans gluten French グルテンフリー・ダイエット Japanese 글루텐 프리 식품 Korean Glutenvrij dieet Dutch

Gluten-free diet

Wheat

A gluten-free diet (GFD) is a nutritional plan that strictly excludes gluten, which is a mixture of prolamin proteins found in wheat (and all of its species and hybrids, such as spelt, kamut, and triticale), as well as barley, rye, and oats.[1] The inclusion of oats in a gluten-free diet remains controversial, and may depend on the oat cultivar and the frequent cross-contamination with other gluten-containing cereals.[2][3][4][5]

Gluten may cause both gastrointestinal and systemic symptoms for those with gluten-related disorders, including coeliac disease (CD), non-coeliac gluten sensitivity (NCGS), gluten ataxia, dermatitis herpetiformis (DH), and wheat allergy.[6] In these people, the gluten-free diet is demonstrated as an effective treatment,[7][8][9] but several studies show that about 79% of the people with coeliac disease have an incomplete recovery of the small bowel, despite a strict gluten-free diet.[10] This is mainly caused by inadvertent ingestion of gluten.[10] People with a poor understanding of a gluten-free diet often believe that they are strictly following the diet, but are making regular errors.[10][11]

In addition, a gluten-free diet may, in at least some cases, improve gastrointestinal or systemic symptoms in diseases like irritable bowel syndrome, rheumatoid arthritis, or HIV enteropathy, among others.[12] There is no good evidence that gluten-free diets are an alternative medical treatment for people with autism.[13][14][15]

Gluten proteins have low nutritional and biological value and the grains that contain gluten are not essential in the human diet.[16] However, an unbalanced selection of food and an incorrect choice of gluten-free replacement products may lead to nutritional deficiencies. Replacing flour from wheat or other gluten-containing cereals with gluten-free flours in commercial products may lead to a lower intake of important nutrients, such as iron and B vitamins. Some gluten-free commercial replacement products are not as enriched or fortified as their gluten-containing counterparts, and often have greater lipid/carbohydrate content. Children especially often over-consume these products, such as snacks and biscuits. Nutritional complications can be prevented by a correct dietary education.[4]

A gluten-free diet may be based on gluten-free foods, such as meat, fish, eggs, milk and dairy products, legumes, nuts, fruits, vegetables, potatoes, rice, and corn.[17] Gluten-free processed foods may be used.[4] Pseudocereals (quinoa, amaranth, and buckwheat) and some minor cereals have been labelled commercially as alternative choices but have since been found to be problematic among gluten intolerant and coeliac individuals depending on the quantity consumed.[4][16]

  1. ^ Biesiekierski JR (March 2017). "What is gluten?". Journal of Gastroenterology and Hepatology (Review). 32 (Suppl 1): 78–81. doi:10.1111/jgh.13703. PMID 28244676. Similar proteins to the gliadin found in wheat exist as secalin in rye, hordein in barley, and avenins in oats and are collectively referred to as 'gluten.' Derivatives of these grains such as triticale and malt and other ancient wheat varieties such as spelt and kamut also contain gluten. The gluten found in all of these grains has been identified as the component capable of triggering the immune-mediated disorder, coeliac disease.Open access icon
  2. ^ Ciacci C, Ciclitira P, Hadjivassiliou M, Kaukinen K, Ludvigsson JF, McGough N, et al. (April 2015). "The gluten-free diet and its current application in coeliac disease and dermatitis herpetiformis". United European Gastroenterology Journal (Review). 3 (2): 121–35. doi:10.1177/2050640614559263. PMC 4406897. PMID 25922672.
  3. ^ Cite error: The named reference CominoMoreno2015 was invoked but never defined (see the help page).
  4. ^ a b c d Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV (November 2013). "Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet". Nutrients. 5 (11): 4553–65. doi:10.3390/nu5114553. PMC 3847748. PMID 24253052. For CD patients on GFD, the nutritional complications are likely to be caused by the poor nutritional quality of the GFPs mentioned above and by the incorrect alimentary choices of CD patients. (...) the limited choice of food products in the diet of children with CD induces a high consumption of packaged GFPs, such as snacks like biscuits. (..) It has been shown that some commercially available GFPs have a lower content of folates, iron and B vitamins or are not consistently enriched/fortified compared to their gluten containing counterparts. (...) Within the range of naturally GF foods, it is preferable to consume those rich in iron and folic acid, such as leafy vegetables, legumes, fish and meat.
  5. ^ de Souza MC, Deschênes ME, Laurencelle S, Godet P, Roy CC, Djilali-Saiah I (2016). "Pure Oats as Part of the Canadian Gluten-Free Diet in Celiac Disease: The Need to Revisit the Issue". Canadian Journal of Gastroenterology & Hepatology (Review). 2016: 1576360. doi:10.1155/2016/1576360. PMC 4904650. PMID 27446824.
  6. ^ Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. (January 2013). "The Oslo definitions for coeliac disease and related terms". Gut. 62 (1): 43–52. doi:10.1136/gutjnl-2011-301346. PMC 3440559. PMID 22345659.
  7. ^ Mulder CJ, van Wanrooij RL, Bakker SF, Wierdsma N, Bouma G (2013). "Gluten-free diet in gluten-related disorders". Digestive Diseases (Review). 31 (1): 57–62. doi:10.1159/000347180. PMID 23797124. S2CID 14124370. The only treatment for CD, dermatitis herpetiformis (DH) and gluten ataxia is lifelong adherence to a GFD.
  8. ^ Hischenhuber C, Crevel R, Jarry B, Mäki M, Moneret-Vautrin DA, Romano A, et al. (March 2006). "Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease". Alimentary Pharmacology & Therapeutics. 23 (5): 559–75. doi:10.1111/j.1365-2036.2006.02768.x. PMID 16480395. S2CID 9970042. For both wheat allergy and coeliac disease the dietary avoidance of wheat and other gluten-containing cereals is the only effective treatment.
  9. ^ Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE (June 2015). "Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders". Best Practice & Research. Clinical Gastroenterology. 29 (3): 477–91. doi:10.1016/j.bpg.2015.04.006. PMID 26060112. A recently proposed approach to NCGS diagnosis is an objective improvement of gastrointestinal symptoms and extra-intestinal manifestations assessed through a rating scale before and after GFD. Although a standardized symptom rating scale is not yet applied worldwide, a recent study indicated that a decrease of the global symptom score higher than 50% after GFD can be regarded as confirmatory of NCGS (Table 1) [53]. (…) After the confirmation of NCGS diagnosis, according to the previously mentioned work-up, patients are advized to start with a GFD [49].
  10. ^ a b c Cite error: The named reference SeeKaukinen2015 was invoked but never defined (see the help page).
  11. ^ Cite error: The named reference MulderWanrooij was invoked but never defined (see the help page).
  12. ^ El-Chammas K, Danner E (June 2011). "Gluten-free diet in nonceliac disease". Nutrition in Clinical Practice (Review). 26 (3): 294–9. doi:10.1177/0884533611405538. PMID 21586414. The prescription of a GFD has been recommended for patients with IBS-like symptoms without histologic evidence of CD and who have positive IgA tTG antibodies or have the at-risk haplotypes DQ2 or DQ8.46 (...) Historically, a GFD was occasionally used in the management of multiple sclerosis (MS), because anecdotal reports indicated a positive effect (reversal of symptoms) of a GFD in MS patients. (…) what has been demonstrated so far is that a glutenfree vegan diet for 1 year significantly reduced disease activity and levels of antibodies to β-lactoglobulin and gliadin in patients with RA. (...) The beneficial effect of a GFD on diarrhea and weight gain in patients with HIV enteropathy has been demonstrated in a few case series. Treatment with a GFD has been observed to decrease the frequency of diarrhea and thus allow weight gain.84 (IBS=irritable bowel syndrome; RA=rheumatoid arthritis; GFD=gluten-free diet)
  13. ^ Marí-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Suárez-Varela M (December 2014). "Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review". Journal of Child Neurology. 29 (12): 1718–27. doi:10.1177/0883073814531330. hdl:10171/37087. PMID 24789114. S2CID 19874518.
  14. ^ Buie T (May 2013). "The relationship of autism and gluten". Clinical Therapeutics (Review). 35 (5): 578–83. doi:10.1016/j.clinthera.2013.04.011. PMID 23688532. At this time, the studies attempting to treat symptoms of autism with diet have not been sufficient to support the general institution of a gluten-free or other diet for all children with autism. ...There may be a subgroup of patients who might benefit from a gluten-free diet, but the symptom or testing profile of these candidates remains unclear.
  15. ^ Millward C, Ferriter M, Calver S, Connell-Jones G (April 2008). Ferriter M (ed.). "Gluten- and casein-free diets for autistic spectrum disorder". The Cochrane Database of Systematic Reviews (2): CD003498. doi:10.1002/14651858.CD003498.pub3. PMC 4164915. PMID 18425890.
  16. ^ a b Lamacchia C, Camarca A, Picascia S, Di Luccia A, Gianfrani C (January 2014). "Cereal-based gluten-free food: how to reconcile nutritional and technological properties of wheat proteins with safety for celiac disease patients". Nutrients (Review). 6 (2): 575–90. doi:10.3390/nu6020575. PMC 3942718. PMID 24481131.
  17. ^ Cite error: The named reference Saturni-etal-2010-table2-p21 was invoked but never defined (see the help page).

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