Gluten-Free Diet Indications, Safety, Quality, Labels, and Challenges

Rostami, Kamran; Bold, Justine; Parr, Alison; Johnson, Matt

doi:10.3390/nu9080846

Cited by 49 publications

(42 citation statements)

References 18 publications

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“…On the other hand, we found the proportion of participants testing positive for depression tended to be higher in GFD-treated patients compared to healthy controls at both one and four years, which was unaffected by the level of compliance. In line with this, previous studies suggest that up to 30% of CD patients show persistent enteropathy after one year on a GFD [ 75 ], potentially due to consuming trace amounts of gluten via cross-contamination [ 76 , 77 ]. Despite this, recent RCTs suggest that a low-FODMAPs diet can further reduce the severity of depressive symptoms in those with NCGS [ 29 ] and CD [ 78 ] already on a GFD, although further research is needed in this area.…”

Section: Discussionsupporting

confidence: 59%

Mood Disorders and Gluten: It’s Not All in Your Mind! A Systematic Review with Meta-Analysis

et al. 2018

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Gluten elimination may represent an effective treatment strategy for mood disorders in individuals with gluten-related disorders. However, the directionality of the relationship remains unclear. We performed a systematic review of prospective studies for effects of gluten on mood symptoms in patients with or without gluten-related disorders. Six electronic databases (CINAHL, PsycINFO, Medline, Web of Science, Scopus and Cochrane Library) were searched, from inception to 8 August 2018, for prospective studies published in English. Meta-analyses with random-effects were performed. Three randomised-controlled trials and 10 longitudinal studies comprising 1139 participants fit the inclusion criteria. A gluten-free diet (GFD) significantly improved pooled depressive symptom scores in GFD-treated patients (Standardised Mean Difference (SMD) −0.37, 95% confidence interval (CI) −0.55 to −0.20; p < 0.0001), with no difference in mean scores between patients and healthy controls after one year (SMD 0.01, 95% CI −0.18 to 0.20, p = 0.94). There was a tendency towards worsening symptoms for non-coeliac gluten sensitive patients during a blinded gluten challenge vs. placebo (SMD 0.21, 95% CI −0.58 to 0.15; p = 0.25). Our review supports the association between mood disorders and gluten intake in susceptible individuals. The effects of a GFD on mood in subjects without gluten-related disorders should be considered in future research.

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Section: Discussionsupporting

confidence: 59%

Mood Disorders and Gluten: It’s Not All in Your Mind! A Systematic Review with Meta-Analysis

et al. 2018

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“…Although new treatment strategies for CD are being developed, until now the only accepted therapy for patients with CD continues to be a lifelong adherence to a gluten-free diet (GFD). It involves the avoidance of foods containing even small amounts of prolamins found in wheat, rye, and barley [ 2 ]. Toxicity of avenin, the prolamin of oats, is somewhat disputable [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…It involves the avoidance of foods containing even small amounts of prolamins found in wheat, rye, and barley [ 2 ]. Toxicity of avenin, the prolamin of oats, is somewhat disputable [ 2 , 3 ]. Following a strict GFD can induce disease remission and can also reduce the risk of long-term complications such as malignancy (mainly T-cell lymphoma), liver disease, osteoporosis, microcytic anemia, malocclusion, psychiatric diseases, reproductive tract disorders, and other autoimmune diseases [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Celiac Dietary Adherence Test and Standardized Dietician Evaluation in Assessment of Adherence to a Gluten-Free Diet in Patients with Celiac Disease

et al. 2020

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Adherence to a gluten-free diet (GFD) is currently the mainstay of treatment strategy for celiac disease (CD). The aim of our study was measuring a GFD adherence in CD patients using two newly validated methods of dietary assessment—Standardized Dietician Evaluation (SDE) and the Celiac Dietary Adherence Test (CDAT). Ninety-two adults with CD were evaluated by a registered dietitian with extensive experience with the use of SDE and CDAT. Duodenal biopsy was performed and blood was drawn for serum anti-endomysial, anti-deamidated gliadin peptide and anti-tissue transglutaminase antibodies in forty four of those patients. The results of CDAT and SDE were very convergent, but SDE scores better correlated with serologic and histologic findings. As many as 24–52% of study participants did not adhere well enough to a GFD. Insufficient adherence to a GFD in CD patients is still a significant problem. The knowledge about gluten content in food ingredients and additives is very low among adults with CD. SDE is the most accurate method in assessing compliance with a GFD and is especially helpful in determining hidden sources of gluten. The CDAT may be a fast tool for screening for a GFD adherence in CD patients.

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“…Carrying HLA-DQ2/HLA-DQ8 genes are a key, but not sufficient, component of genetic susceptibility to developing CD [22]. Treatment is lifelong adherence to a strict GFD and although oats are generally considered safe for most people with CD [25], it appears to cause sensitivity for some people [26] most likely due to contamination with wheat, barley or rye during the production chain [27]. For the majority of individuals with CD after GFD symptoms subside and villi recover [28].…”

Section: Gluten and Coeliac Diseasementioning

confidence: 99%

A Gluten Free Diet in the Management of Epilepsy in People with Coeliac Disease or Gluten Sensitivity

Gilbey

Bold

2020

Gastrointestinal Disorders

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The aim of this review was to assess the effects of a gluten free diet (GFD) in the management of epilepsy in people with coeliac disease (CD) or gluten sensitivity (GS). A systematic approach was used to undertake a literature review. Five electronic databases (PubMed; Scopus; Google Scholar; Cochrane Epilepsy Group specialised register; Cochrane Register of Controlled Trails (CENTRAL) via the Cochrane Register of Online Trials) were searched using predetermined relevant search terms. In total, 668 articles were identified. Duplicates were removed and predefined inclusion and exclusion criteria were applied, and a PRISMA flow chart was produced. Data was extracted using Covidence software. Twelve studies on Epilepsy and CD involving a total of 70 participants were selected for analysis; narrative synthesis was used owing to the small sample sizes in the selected studies. None of the 12 studies meeting inclusion criteria investigated gluten sensitivity and epilepsy. All the included studies support a link between epilepsy and CD. GFD was effective in 44 out of 70 participants across the studies in terms of a reduction of seizures, reduction of antiepileptic drugs (AEDs) or normalisation of EEG pattern. A total of 44 participants showed a reduction in seizures (across eight studies) and complete cessation of seizures was reported in 22 participants. In general, the earlier the GFD is implemented after the onset of seizures, the better the likelihood of the GFD being successful in supporting control of seizures. Mechanisms linking gluten with epilepsy are not fully understood; possible hypotheses include gluten mediated toxicity, immune-induced cortical damage and malabsorption. Evidence suggests the effectiveness of a GFD in supporting the management of epilepsy in patients with CD, although the quality of evidence is low. There appears to be a growing number of neurologists who are prepared to advocate the use of a GFD. A multidisciplinary approaches and further research are recommended. It could be argued that when balancing potential treatments such as AEDs or surgery, a GFD has a low likelihood of harm.

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Gluten-Free Diet Indications, Safety, Quality, Labels, and Challenges

Cited by 49 publications

References 18 publications

Mood Disorders and Gluten: It’s Not All in Your Mind! A Systematic Review with Meta-Analysis

Mood Disorders and Gluten: It’s Not All in Your Mind! A Systematic Review with Meta-Analysis

Celiac Dietary Adherence Test and Standardized Dietician Evaluation in Assessment of Adherence to a Gluten-Free Diet in Patients with Celiac Disease

A Gluten Free Diet in the Management of Epilepsy in People with Coeliac Disease or Gluten Sensitivity

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