Celiac Disease and the Gluten-Free Diet: Consequences and Recommendations for Improvement

Abstract

Background: Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically susceptible individuals. CD-related enteropathy leads to multiple nutritional deficiencies involving macro- and micronutrients. Currently, medical nutrition therapy consisting of the gluten-free diet (GFD) is the only accepted treatment for CD. Key Messages: The GFD is the cornerstone of treatment for CD. Prior published studies have concluded that maintenance of the GFD results in improvement of the majority of nutritional deficiencies. In the past, counseling for CD focused mainly on the elimination of gluten in the diet. However, the GFD is not without its inadequacies; compliance to the GFD may result in certain deficiencies such as fiber, B vitamins, iron, and trace minerals. Paucity of fortified gluten-free foods may be responsible for certain deficiencies which develop on the GFD. Weight gain and obesity have been added to the list of nutritional consequences while on the GFD and have been partially attributed to hypercaloric content of commercially available gluten-free foods. Follow-up of patients diagnosed with CD after starting the GFD has been reported to be irregular and, hence, less than ideal. Conclusions: Monitoring of the nutritional status using blood tests and use of appropriate gluten-free supplementation are integral components in the management of CD. The ideal GFD should be nutrient-dense with naturally gluten-free foods, balanced with macro- and micronutrients, reasonably priced, and easily accessible. Rotation of the pseudo-cereals provides a good source of complex carbohydrates, protein, fiber, fatty acids, vitamins and minerals. Fortification/enrichment of commonly consumed gluten-free commercial grain products should be encouraged. Dietitians specializing in CD play a critical role in the education and maintenance of the GFD for patients with CD.

Celiac disease: understanding the gluten-free diet

“…This is currently relevant considering that at present obesity is increasing among celiac patients, even at the initial presentation [82]. Celiac patients are at risk of overweight/obesity especially during the first year after initiating GFD; probably influenced by the fact that they can eat without suffering symptoms and feeling ill and that their absorptive capacity improves.…”

Navigating Gluten-Related Health Disorders and Nutritional Considerations of Gluten-Free Diets

“…Patients should rotate their intake of gluten-free whole grains to include brown rice, quinoa, buckwheat, teff, amaranth, and certified gluten-free oats. Intake of glutenfree products fortified with nutrients such as B vitamins, calcium, and vitamin D should also be encouraged [9]. There are also many naturally gluten-free starches that can augment the diet with important nutrients, including sweet potatoes, butternut or acorn squash, beans, and lentils.…”

Gluten-free Diet - Tough Alley in Torrid Time

“…As mentioned above, the place of the RDNs in counseling, implementing, updating, anthropometric assessment and follow-up of the CD population is pivotal, indispensable and crucial among the team dealing with gluten-sensitive populations [4,59,60,61,62]. Their duties can be summarized, following CELIAC DISEASE letters*:…”