Gluten-free diet

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Wheat

A gluten-free diet (GFD) is a diet that excludes gluten, a protein composite found in wheat, barley, rye,[1][2] and all their species and hybrids (such as spelt,[1] kamut, and triticale[1][2]). The inclusion of oats in gluten-free diet remains controversial. Avenin present in oats may be also toxic for coeliac people.[2] Its toxicity depends on the cultivar consumed.[3] Furthermore, oats is frequently cross contaminated with glutencontaining cereals.[2]

Gluten causes health problems in sufferers of gluten-related disorders, which include coeliac disease (CD), non-celiac gluten sensitivity (NCGS), gluten ataxia, dermatitis herpetiformis (DH) and wheat allergy.[4] In these patients, the gluten-free diet is a demonstrated effective treatment.[5]

Other diseases in which has been documented an improvement of gastrointestinal and/or systemic symptoms with a gluten-free diet include irritable bowel syndrome (IBS), type 1 diabetes (T1D), thyroiditis, systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and psoriasis.[5]

While gluten-free diets are a popular fad diet, there is no published experimental evidence that they provide any benefit to the general population, apart from the people suffering the diseases mentioned above.[5]

An unbalanced selection of food and an incorrect choice of commercially prepared gluten-free replacement products, which are poorer nutritional quality and have greater lipid / carbohydrate content compared to the gluten-containing counterparts, may lead to nutritional deficiencies. These nutritional complications can be prevented by a correct dietary education. Gluten free-diet must be mainly based on naturally gluten-free foods, which are more equilibrate in micro and macro nutrients, such as meat, fish, eggs, legumes, nuts, fruits, vegetables, potatoes, rice, maize. A healthy alternative to commercially prepared gluten-free products are pseudocereals (such as quinoa, amaranth and buckwheat) and other minor cereals, which have high biological and nutritional value.[2]

Rationale behind adoption of the diet[edit]

Coeliac disease[edit]

Main article: Coeliac disease

Coeliac disease (American English: celiac) (CD) is a chronic, immune-mediated mainly intestinal process, caused by the ingestion of wheat, barley, rye and derivatives, that appears in genetically predisposed people of all ages. CD is not only a gastrointestinal disease, because it may involve to several organs and cause an extensive variety of non-gastrointestinal symptoms, and most importantly, it may often be completely asymptomatic.[6] Added difficulties for diagnosis are the fact that serological markers (anti-tissue transglutaminase [TG2]) are not always present[7] and many patients may have minor mucosal lesions, without atrophy of the intestinal villi.[8]

CD affects approximately 1% of general population all over the world[9] and appears to be on the increase,[10] but most cases remain unrecognized, undiagnosed and untreated, and exposed to the risk of long-term complications.[11][12] Patients may suffer severe disease symptoms and be subjected to extensive investigations for many years, before a proper diagnosis is achieved.[13] Untreated CD may cause malabsorption, reduced quality of life, iron deficiency, osteoporosis, an increased risk of intestinal lymphomas[6] and greater mortality.[14] CD is associated with some autoimmune diseases, such as diabetes mellitus type 1, thyroiditis,[15][6] gluten ataxia, psoriasis, vitiligo, autoimmune hepatitis, dermatitis herpetiformis, primary sclerosing cholangitis, and more.[15]

CD with “classic symptoms”, which include gastrointestinal manifestations such as chronic diarrhea and abdominal distention, malabsorption, lose of appetite, and impaired growth, is currently the least common presentation form of the disease and affects predominantly to small children generally younger than two years of age.[13][11]

CD with “non-classic symptoms” is the most common clinical found type[13] and occurs in older children (over 2 years old),[13] adolescents and adults.[13] It is characterized by milder or even absent gastrointestinal symptoms and a wide spectrum of non-intestinal manifestations that can involve any organ of the body, and very frequently may be completely asymptomatic[11] both in children (at least in 43 % of the cases[16]) and adults.[11]

Following a lifelong gluten-free diet is the only medically-accepted treatment for people with coeliac disease.[17][18]

Non-celiac gluten sensitivity[edit]

Main article: Non-celiac gluten sensitivity

Non-celiac gluten sensitivity (NCGS) is described as a condition of multiple symptoms that improves when switching to a gluten-free diet, after celiac disease and wheat allergy are excluded.[19][20] Patients may develop gastrointestinal symptoms, which resemble those of irritable bowel syndrome (IBS)[21][22] and/or a variety of nongastrointestinal symptoms.[9][23][24]

Gastrointestinal symptoms may include any of the following: abdominal pain, bloating, bowel habit abnormalities (either diarrhea or constipation),[23][24] nausea, aerophagia, gastroesophageal reflux disease, and aphthous stomatitis.[9][24] Extra-intestinal symptoms, which can be the only manifestation of NCGS even in absence of gastrointestinal sympotms, may be any of the following: headache or migraine, “foggy mind”, fatigue,[9][23][24] fibromyalgia,[23][25][26] joint and muscle pain,[9][23][24] leg or arm numbness,[9][23][24] tingling of the extremities,[9][24] dermatitis (eczema or skin rash),[9][24] atopic disorders,[9] allergy to one or more inhalants, foods or metals[9][23] (such as mites mites, graminaceae, parietaria, cat or dog hair, shellfish, or nickel),[23] depression,[9][23][24] anxiety,[23] anemia,[9][24] iron-deficiency anemia, folate deficiency, asthma, rhinitis, eating disorders,[23] or autoimmune diseases.[9]

NCGS seems to be involved in some neuropsychiatric disorders, principally schizophrenia,[14][24] autism[23][14][24] and peripheral neuropathy,[14][24] and also ataxia[14] and attention deficit hyperactivity disorder (ADHD).[9]

The pathogenesis of NCGS is not yet well understood. It was hypothesized that gluten, like occurs in coeliac disease, is the cause of NCGS.[9] Much recent research on NCGS has aimed at determining which agents trigger a response in NCGS patients: to which extent gluten, FODMAPs, or ATIs (plant-derived proteins present in glutencontaining cereals and gluten) or other substances are involved.[24] In a 2013 double-blind placebo-controlled trial (DBPC) by Biesiekierski et al. in a few patients with irritable bowel syndrome (IBS), the authors found no difference between gluten or placebo groups and the concept of NCGS as a syndrome was questioned. Nevertheless, this study had design errors and an incorrect selection of participants, which could have masked the true effect of gluten reintroduction.[27][12] In a review of May 2015 published in Gastroenterology, Fasano et al. conclude that besides gluten, ATIs and FODMAPs present in gluten, wheat, barley, rye, and their derivatives play a role in the deveolpment of NCGS symptoms. ATIs, which resist proteolytic digestion, may be the inducers of innate immunity in people with coeliac disease or NCGS. FODMAPs cause mild wheat intolerance at most, which is mainly limited to gastrointestinal symptoms.[9]

There is a mistaken idea that NCGS patients don’t need strictly following gluten-free diet. Nevertheless, as occurs in people with coeliac disease, the diet must be strict and maintained, without making any dietary transgression. The ingestion of even small amounts of gluten can cause more immediate and obvious symptoms in people with NCGS than those with coeliac disease.[23] It is not yet known whether NCGS is a permanent, or a transient condition.[16][23]

Also, a subgroup of NCGS patients may not improve by eating commercially available gluten-free products, wich are usually rich of preservatives and additives, because chemical additives (such as sulphites, glutamates, nitrates and benzoates) might have a role in evoking functional gastrointestinal symptoms of NCGS. These patients may benefit from a diet with a low content of preservatives and additives.[28]

NCGS, which is possibly immune-mediated, now appears to be more common than coeliac disease,[29] with a prevalence estimated to be 6-10 times higher.[30]

As a fad diet[edit]

Gluten-free fad diets are endorsed by celebrities such as Miley Cyrus,[31] and are used by some world class athletes who believe the diet can improve energy and health.[32] The book Wheat Belly which refers to wheat as a "chronic poison" became a New York Times bestseller within a month of publication in 2011.[33] People buy gluten-free food "because they think it will help them lose weight, because they seem to feel better or because they mistakenly believe they are sensitive to gluten."[34] However, the gluten-free diet is not recommended as a means to eat healthier or to lose weight.[5] It should not be undertaken to diagnose one's own symptoms,[35] because tests for celiac disease are reliable only if the patient has been consuming gluten.

Although popularly used as an alternative treatment for people with autism, there is no good evidence that a gluten-free diet is of benefit in treating the symptoms of autism.[36][37][38] However, in a subset of autistic patients who have a genuine gluten sensitivity there is limited evidence that suggests that a gluten free diet may improve some autistic behaviours.[38][39][26][22]

This diet adds a financial burden to those who think they can only solve their health issues by cutting gluten out of their diet. There is a consensus in the medical community that people should consult a physician before going on a gluten-free diet, so that a medical professional can accurately test for Coeliac disease or any other gluten-induced health issues.[40] But this decision is often not approached with such precautions, and people continue to pursue this diet despite the fact that it has not been proven to be beneficial to those without Coeliac disease, irritable bowel syndrome, or non-celiac gluten sensitivity.

In a review of May 2015 published in Gastroenterology, Fasano et al. conclude that although there is an evident "fad component" to the recent rise popularity of the gluten-free diet, there are also growing and unquestionable evidences about the existence of non-celiac gluten sensitivity.[41]

Wheat allergy[edit]

In some cases, a wheat allergy is a valid medical reason for eating a gluten-free diet.[citation needed]

Eating gluten-free[edit]

Quinoa is a pseudocereal that is gluten-free.
Rice bread

The gluten-free diet includes naturally gluten-free food, such as meat, fish, nuts, legumes, fruit, vegetables, potatoes, pseudocereals (in particular amaranth, buckwheat, chia seed, quinoa), only certain cereal grains (corn, rice, sorghum), minor cereals (including fonio, Job's tears, millet, teff, called "minor" cereals as they are "less common and are only grown in a few small regions of the world"),[42] some other plant products (arrowroot, mesquite flour[43]) and products made from these gluten-free foods, such as breads and gluten-free beer. Gluten-free bread may be less fluffy, so additives are used to compensate, such as corn starch, eggs, xanthum gum, guar gum, and hydroxypropyl methylcellulose.

Processing of some glutenous ingredients removes the gluten, such as maltodextrin, and some distilled beverages.[44]

Some vineyards use flour paste to caulk the oak barrels, but tests have not detected the presence of gluten in the wine.[45] Gluten may be used as a clarifying agent in wine, some of which might remain in the product.[46]

The diet excludes foods containing gluten, such as wheat, rye, barley, triticale, kamut, malt,[42] and foods that may include them, or shared transportation or processing facilities with them.[47]

Some cereal grains, although gluten-free in themselves, may contain gluten by cross-contamination during processing steps or transport; this includes oats.[48] Some processed foods may contain gluten, so they would need specific labeling, such as gluten-free ice-cream, ketchup, chicken bouillon, corn cereal, ice cream toppings, malt flavoring, and chocolate. And some non-foodstuffs may contain gluten as an excipient or binding agent, such as medications and vitamin supplements, especially those in tablet form.[49][50] People with gluten intolerance may require special compounding of their medication.[47]

Risks[edit]

Unless great care is taken, a gluten-free diet can lack the vitamins, minerals, and fiber which are found in wheat, barley, rye, kamut, and other gluten-containing whole grains[51] and may be too high in fat and calories.[43][52] Processed gluten-free foods are often higher in salt, sugar, glycemic index, transfats and other processed fats.[43] Although the lack of vitamins, minerals and fiber can be mitigated through the consumption of brown rice and quinoa,[53] many practitioners of the diet do not consume the recommended number of grain servings per day.[54][55] Many gluten-free products are not fortified or enriched by such nutrients as folate, iron, and fiber as traditional breads and cereals have been during the last century.[56]

Advances towards higher nutrition-content gluten-free bakery products, improved for example in terms of fiber content and glycemic index, have been made by using not exclusively corn starch or other starches to substitute for flour. In this aim, for example the dietary fiber inulin (which acts as a prebiotic[57]) or quinoa or amaranth wholemeal have been as substitute for part of the flour. Such substitution has been found to also yield improved crust and texture of bread.[58]

Regulation and labels[edit]

The term gluten-free is generally used to indicate a supposed harmless level of gluten rather than a complete absence.[59] The exact level at which gluten is harmless is uncertain and controversial. A 2008 systematic review tentatively concluded that consumption of less than 10 mg (10 ppm) of gluten per day is unlikely to cause histological abnormalities, although it noted that few reliable studies had been done.[59]

Regulation of the label gluten-free varies by country. Most countries derive key provisions of their gluten-free labeling regulations from the Codex Alimentarius international standards for food labeling has a standard relating to the labeling of products as gluten-free. It only applies to foods that would normally contain gluten.[60] Gluten-free is defined as 20 ppm (= 20 mg/kg) or less. It categorizes gluten-free food as:

  • Food that is gluten-free by composition
  • Food that has become gluten-free through special processing.
  • Reduced gluten content, food which includes food products with between 20 and 100 ppm of gluten. Reduced gluten content is left up to individual nations to more specifically define.

The Codex Standard suggests the enzyme-linked Immunoassay (ELISA) R5 Mendez method for indicating the presence of gluten, but allows for other relevant methods, such as DNA. The Codex Standard specifies that the gluten-free claim must appear in the immediate proximity of the name of the product, to ensure visibility.

There is no general agreement on the analytical method used to measure gluten in ingredients and food products.[61] The ELISA method was designed to detect w-gliadins, but it suffered from the setback that it lacked sensitivity for barley prolamins.[62] The use of highly sensitive assays is mandatory to certify gluten-free food products. The European Union, World Health Organization, and Codex Alimentarius require reliable measurement of the wheat prolamins, gliadins rather than all-wheat proteins.[63]

Australia[edit]

The Australian government recommends[64] that:

  • food labeled gluten-free include no detectable gluten (<5ppm [citation needed]), oats or their products, cereals containing gluten that have been malted or their products
  • food labeled low gluten claims such that the level of 20 mg gluten per 100 g of the food

Brazil[edit]

All food products must be clearly labelled whether they contain gluten or they are gluten-free.[65]

Canada[edit]

Health Canada considers that foods containing levels of gluten not exceeding 20 ppm as a result of contamination, meet the health and safety intent of section B.24.018 of the Food and Drug Regulations when a gluten-free claim is made.[66] Any intentionally added gluten, even at low levels must be declared on the packaging and a gluten-free claim would be considered false and misleading. Labels for all food products sold in Canada must clearly identify the presence of gluten if it is present at a level greater than 10 ppm.[67]

European Union[edit]

The EU European Commission delineates[68] the categories as:

  • gluten-free: 20 ppm or less of gluten
  • very low gluten foodstuffs: 20-100ppm gluten.

In the United Kingdom, only cereals must be labelled; labelling of other products is voluntary.[69]

United States[edit]

Until 2013 anyone could use the gluten-free claim with no repercussion. In 2008, Wellshire Farms chicken nuggets labeled gluten-free were purchased and samples were sent to a food allergy laboratory[70] where they were found to contain gluten. After this was reported in the Chicago Tribune, the products continued to be sold. The manufacturer has since replaced the batter used in its chicken nuggets.[71] The U.S. first addressed gluten-free labeling in the 2004 Food Allergen Labeling and Consumer Protection Act (FALCPA). The FDA issued their Final Rule on August 5, 2013.[72] When a food producer voluntarily chooses to use a gluten-free claim for a product, the food bearing the claim in its labeling may not contain:

  • an ingredient that is a gluten-containing grain
  • an ingredient that is derived from a gluten-containing grain that has not been processed to remove gluten
  • an ingredient that is derived from a gluten-containing grain, that has been processed to remove gluten but results in the presence of 20 ppm or more gluten in the food. Any food product claiming to be gluten-free and also bearing the term "wheat" in its ingredient list or in a separate "Contains wheat" statement, must also include the language "*the wheat has been processed to allow this food to meet the FDA requirements for gluten-free foods," in close proximity to the ingredient statement.
  • Any food product that inherently does not contain gluten may use a gluten-free label where any unavoidable presence of gluten in the food bearing the claim in its labeling is below 20 ppm gluten.

See also[edit]

References[edit]

  1. ^ a b c Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L (Mar 16, 2015). "Clinical and diagnostic aspects of gluten related disorders". World J Clin Cases 3 (3): 275–84. doi:10.12998/wjcc.v3.i3.275. PMC 4360499. PMID 25789300. 
  2. ^ a b c d e Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV (Nov 18, 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. 
  3. ^ Comino I, Moreno Mde L, Sousa C (Nov 7, 2015). "Role of oats in celiac disease". World J Gastroenterol 21 (41): 11825–31. doi:10.3748/wjg.v21.i41.11825. PMC 4631980. PMID 26557006. 
  4. ^ Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, Hadjivassiliou M, Kaukinen K, Kelly CP, Leonard JN, Lundin KE, Murray JA, Sanders DS, Walker MM, Zingone F, Ciacci C (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. 
  5. ^ a b c d Gaesser GA, Angadi SS (September 2012). "Gluten-free diet: imprudent dietary advice for the general population?". J Acad Nutr Diet 112 (9): 1330–3. doi:10.1016/j.jand.2012.06.009. PMID 22939437. 
  6. ^ a b c Ciccocioppo R, Kruzliak P, Cangemi GC, Pohanka M, Betti E, Lauret E, Rodrigo L (Oct 22, 2015). "The Spectrum of Differences between Childhood and Adulthood Celiac Disease". Nutrients 7 (10): 8733–51. doi:10.3390/nu7105426. PMID 26506381. 
  7. ^ Fasano, A; Catassi, C (Dec 20, 2012). "Clinical practice. Celiac disease.". The New England Journal of Medicine 367 (25): 2419–26. doi:10.1056/NEJMcp1113994. PMID 23252527. 
  8. ^ Bold J, Rostami K (2011). "Gluten tolerance; potential challenges in treatment strategies". Gastroenterol Hepatol Bed Bench 4 (2): 53–7. PMC 4017406. PMID 24834157. 
  9. ^ a b c d e f g h i j k l m n o p Fasano A, Sapone A, Zevallos V, Schuppan D (May 2015). "Nonceliac gluten sensitivity". Gastroenterology 148 (6): 1195–204. doi:10.1053/j.gastro.2014.12.049. PMID 25583468. 
  10. ^ Anderson B (2011). "Coeliac disease: new tests, new genes and rising prevalence". Medicine Today 12 (6): 69–71. 
  11. ^ a b c d Fasano A (Apr 2005). "Clinical presentation of celiac disease in the pediatric population". Gastroenterology 128 (4 Suppl 1): S68–73. doi:10.1053/j.gastro.2005.02.015. PMID 15825129. 
  12. ^ a b Elli L, Branchi F, Tomba C, Villalta D, Norsa L, Ferretti F, Roncoroni L, Bardella MT (Jun 2015). "Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity". World J Gastroenterol 21 (23): 7110–9. doi:10.3748/wjg.v21.i23.7110. PMC 4476872. PMID 26109797. 
  13. ^ a b c d e Ludvigsson JF, Card T, Ciclitira PJ, Swift GL, Nasr I, Sanders DS, Ciacci C (Apr 2015). "Support for patients with celiac disease: A literature review". United European Gastroenterol J 3 (2): 146–59. doi:10.1177/2050640614562599. PMC 4406900. PMID 25922674. 
  14. ^ a b c d e Lebwohl B, Ludvigsson JF, Green PH (Oct 2015). "Celiac disease and non-celiac gluten sensitivity". BMJ (Review) 5: 351:h4347. doi:10.1136/bmj.h4347. PMC 4596973. PMID 26438584. 
  15. ^ a b Lundin KE, Wijmenga C (Sep 2015). "Coeliac disease and autoimmune disease-genetic overlap and screening". Nat Rev Gastroenterol Hepatol 12 (9): 507–15. doi:10.1038/nrgastro.2015.136. PMID 26303674. 
  16. ^ a b Vriezinga SL, Schweizer JJ, Koning F, Mearin ML (Sep 2015). "Coeliac disease and gluten-related disorders in childhood". Nature Reviews. Gastroenterology & Hepatology (Review) 12 (9): 527–36. doi:10.1038/nrgastro.2015.98. PMID 26100369. 
  17. ^ Lamacchia C, Camarca A, Picascia S, Di Luccia A, Gianfrani C (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. 
  18. ^ De Palma, Giada; Nadal, Inmaculada; Collado, Maria Carmen; Sanz, Yolanda (2009). "Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects". British Journal of Nutrition 102 (8): 1154–1160. doi:10.1017/S0007114509371767. Retrieved 25 July 2013. 
  19. ^ Mooney, P; Aziz, I; Sanders, D (2013). "Non-celiac gluten sensitivity: clinical relevance and recommendations for future research". Neurogastroenterology & Motility 25 (11): 864–871. doi:10.1111/nmo.12216. PMID 23937528. 
  20. ^ Nijeboer, P; Bontkes, H; Mulder, C; Bouma, G (2013). "Non-celiac gluten sensitivity. Is it in the gluten or the grain?". Journal of gastrointestinal and liver disorders 22 (4): 435–40. PMID 24369326. 
  21. ^ Elli L, Roncoroni L, Bardella MT (Jul 2015). "Non-celiac gluten sensitivity: Time for sifting the grain". World J Gastroenterol (Review) 21 (27): 8221–6. doi:10.3748/wjg.v21.i27.8221. PMC 4507091. PMID 26217073. 
  22. ^ a b Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A, Fasano A (Sep 2013). "Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders". Nutrients 5 (10): 3839–53. doi:10.3390/nu5103839. PMC 3820047. PMID 24077239. 
  23. ^ a b c d e f g h i j k l m n Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE (Jun 2015). "Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders". Best Pract Res Clin Gastroenterol 29 (3): 477–91. doi:10.1016/j.bpg.2015.04.006. PMID 26060112. 
  24. ^ a b c d e f g h i j k l m n Catassi C, Bai J, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A, Fasano A (2013). "Non-celiac gluten sensitivity: the new frontier of gluten related disorders". Nutrients (Review) 5 (10): 3839–3853. doi:10.3390/nu5103839. ISSN 2072-6643. PMID 24077239. 
  25. ^ Rossi A, Di Lollo AC, Guzzo MP, Giacomelli C, Atzeni F, Bazzichi L, Di Franco M (2015). "Fibromyalgia and nutrition: what news?". Clin Exp Rheumatol 33 (1 Suppl 88): S117–25. PMID 25786053. 
  26. ^ a b San Mauro I, Garicano E, Collado L, Ciudad MJ (Dec 2014). "[Is gluten the great etiopathogenic agent of disease in the XXI century?] [Article in Spanish]". Nutr Hosp 30 (6): 1203–10. doi:10.3305/nh.2014.30.6.7866. PMID 25433099. 
  27. ^ Aziz I, Hadjivassiliou M, Sanders DS (Sep 2015). "The spectrum of noncoeliac gluten sensitivity". Nat Rev Gastroenterol Hepatol (Review) 12 (9): 516–26. doi:10.1038/nrgastro.2015.107. PMID 26122473. 
  28. ^ Volta U, Caio G, Tovoli F, De Giorgio R (2013). "Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness". Cellular and Molecular Immunology (Review) 10 (5): 383–392. doi:10.1038/cmi.2013.28. ISSN 1672-7681. PMC 4003198. PMID 23934026. 
  29. ^ Hogg-Kollars S, Al Dulaimi D, Tait K, Rostami K (2014). "Type 1 diabetes mellitus and gluten induced disorders". Gastroenterology and Hepatology from Bed to Bench (Review) 7 (4): 189–97. PMC 4185872. PMID 25289132. 
  30. ^ Molina-Infante J, Santolaria S, Montoro M, Esteve M, Fernández-Bañares F (2014). "[Non-celiac gluten sensitivity: a critical review of current evidence] [Article in Spanish]". Gastroenterol Hepatol 37 (6): 362–71. doi:10.1016/j.gastrohep.2014.01.005. PMID 24667093. 
  31. ^ Gluten-Free, Whether You Need It or Not. New York Times.
  32. ^ Lebwohl B, Ludvigsson JF, Green PH (Oct 2015). "Celiac disease and non-celiac gluten sensitivity". BMJ (Review) 5: 351:h4347. doi:10.1136/bmj.h4347. PMC 4596973. PMID 26438584. Some population groups seem to be especially wed to the gluten-free diet, with nearly 50% of 910 athletes (including world class and Olympic medalists) adhering to a gluten-free diet, mainly because of the perceived health and energy benefits. 
  33. ^ David Quick (September 11, 2012). "'Wheat Belly' continues its run on NYT Best Seller list, but is demonizing wheat and gluten justified?". The Post and Courier. Retrieved December 16, 2012. 
  34. ^ "Gluten-free diet fad: Are celiac disease rates actually rising?". CBS News. 2012-07-31. Retrieved 2013-12-06. 
  35. ^ Lewis, Shannon. "Three Reasons to Go Gluten Free and Three Reasons Not to". Related Forms & Information. Province Health & Services. Retrieved 30 March 2014. 
  36. ^ Marí-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Suárez-Varela M (Dec 2014). "Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review". J Child Neurol 29 (12): 1718–27. doi:10.1177/0883073814531330. PMID 24789114. 
  37. ^ Millward C, Ferriter M, Calver S, Connell-Jones G (2008). Ferriter, Michael, ed. "Gluten- and casein-free diets for autistic spectrum disorder". Cochrane Database Syst Rev (2): CD003498. doi:10.1002/14651858.CD003498.pub3. PMID 18425890. 
  38. ^ a b Buie T (2013). "The relationship of autism and gluten". Clin Ther (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 
  39. ^ Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE (Jun 2015). "Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders". Best Pract Res Clin Gastroenterol 29 (3): 477–91. doi:10.1016/j.bpg.2015.04.006. PMID 26060112. 
  40. ^ "What are the benefits of going gluten-free?". www.bodyandsoul.com.au. Retrieved 2015-11-05. 
  41. ^ Fasano A, Sapone A, Zevallos V, Schuppan D (May 2015). "Nonceliac gluten sensitivity". Gastroenterology 148 (6): 1195–204. doi:10.1053/j.gastro.2014.12.049. PMID 25583468. Although there is clearly a fad component to the popularity of the GFD, there is also undisputable and increasing evidence for NCGS. 
  42. ^ a b Saturni L, Ferretti G, Bacchetti T (January 2010). "The gluten-free diet: safety and nutritional quality". Nutrients (Review) 2 (1): 16–34. doi:10.3390/nu20100016. PMC 3257612. PMID 22253989. . See Table 2 and page 21.
  43. ^ a b c O'Brian T, Ford R, Kupper C, Celiac Disease and Non-Celiac Gluten Sensitivity: The evolving spectrum, pp. 305–330. In: Ingrid Kohlstadt (10 December 2012). Advancing Medicine with Food and Nutrients, Second Edition. CRC Press. p. 318. ISBN 978-1-4398-8774-5. 
  44. ^ Adams, Scott. "Which alcoholic beverages are safe?". Retrieved 21 August 2014. 
  45. ^ Celiac.com, referencing a study from The Gluten-Free Dietician, retrieved September 29, 2013
  46. ^ Simonato, Tolin, and Pasini, March 4, 2011 "Immunochemical and Mass Spectrometry Detection of Residual Proteins in Gluten Fined Red Wine," Journal of Agricultural and Food Chemistry
  47. ^ a b Spersud, Erik and Jennifer (January 3, 2008). Everything You Want To Know About Recipes And Restaurants And Much More. USA: Authorhouse. p. 172. doi:10.1007/b62130. ISBN 978-1-4343-6034-2. 
  48. ^ "What Foods Have Gluten?". American Diabetes Association. Retrieved 13 August 2014. 
  49. ^ "Frequently Asked Questions". IPC Americas Inc. February 27, 2008. Archived from the original on April 11, 2008. Retrieved April 15, 2008. 
  50. ^ "Excipient Ingredients in Medications". Gluten-Free Drugs. November 3, 2007. Retrieved April 15, 2008. 
  51. ^ Jaret, Peter. "The Truth About Gluten". WebMD. WebMD. Retrieved 30 March 2014. 
  52. ^ Bernadette Capili; Michelle Chang; Joyce K. Anastasi (October 2014). "A Clinical Update: Nonceliac Gluten Sensitivity—Is It Really the Gluten?". The Journal for Nurse Practitioners. Special Focus: Legal Matters 10 (9). pp. 666–673. 
  53. ^ Lee AR, Ng DL, Dave E, Ciaccio J, Green PHR (2009). "The effect of substituting alternative grains in the diet on the nutritional profile of the gluten-free diet". Journal of Human Nutrition and Dietetics 22 (4): 359–363. doi:10.1111/j.1365-277X.2009.00970.x. PMID 19519750. 
  54. ^ Cortigiani, L.; Nutini, P.; Caiulo, V. A.; Ughi, C.; Ceccarelli, M. (1989). "Selenium in celiac disease". Minerva pediatrica 41 (11): 539–542. PMID 2622422. 
  55. ^ Stazi, A. V.; Trinti, B. (2008). "Selenium deficiency in celiac disease: Risk of autoimmune thyroid diseases". Minerva medica 99 (6): 643–653. PMID 19034261. 
  56. ^ "Side Effects of the Gluten-Free Diet". about.com. 2009. 
  57. ^ Gibson GR, Roberfroid MB (1995). "Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics". The Journal of Nutrition (Review) 125 (6): 1401–12. PMID 7782892. 
  58. ^ Gallagher E, Gormley TR, Arendt EK (2004). "Recent advances in the formulation of gluten-free cereal-based products". Trends in Food Science & Technology 15 (3-4): 143–152. doi:10.1016/j.tifs.2003.09.012. ISSN 0924-2244. 
  59. ^ a b Akobeng AK, Thomas AG (June 2008). "Systematic review: tolerable amount of gluten for people with coeliac disease". Aliment. Pharmacol. Ther. 27 (11): 1044–52. doi:10.1111/j.1365-2036.2008.03669.x. PMID 18315587. 
  60. ^ "Codex Standard For "Gluten-Free Foods" CODEX STAN 118-1981" (PDF). Codex Alimentarius. February 22, 2006. 
  61. ^ Hischenhuber C, Crevel R, Jarry B, Makai M, Moneret-Vautrin DA, Romano A, Troncone R, Ward R (2006) Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease. Aliment Pharmacol Ther 23(5):5590575
  62. ^ Poms, R. E.; Klein, C. L.; Anklam, E. (2004). "Methods for allergen analysis in food: A review". Food Additives and Contaminants 21 (1): 1–31. doi:10.1080/02652030310001620423. PMID 14744677. 
  63. ^ Codex Alimentarius (2003) Draft revised standards for gluten-free foods, report of the 25th session of the Codex Committee on Nutrition and Foods for Special Dietary Uses, November 2003
  64. ^ "FINAL ASSESSMENT REPORT PROPOSAL P264 REVIEW OF GLUTEN CLAIMS WITH SPECIFIC REFERENCE TO OATS AND MALT". Australian Government. Retrieved 9 August 2014. 
  65. ^ "General labeling for Packaged Foods (free translation)". ANVISA. July 2014. 
  66. ^ "Health Canada's Position on Gluten-Free Claims". Health Canada. Retrieved 9 August 2014. 
  67. ^ Canadian Celiac Association
  68. ^ "Gluten-free food". Directorate-General for Health and Consumers. Retrieved 25 July 2015. 
  69. ^ "Guidance Notes on the Food Labelling (Amendment) (No. 2) Regulations 2004" (PDF). Food Standards Agency. November 2005. 
  70. ^ Roe, Sam. "Children at risk in food roulette". Chicagotribune.com. Retrieved September 20, 2009. 
  71. ^ Roe, Sam. "Whole Foods pulls 'gluten-free' products from shelves after Tribune story". Chicagotribune.com. Retrieved September 20, 2009. 
  72. ^ 78 FR 47154 (5 August 2013). Codified at 21 C.F.R. 101.91.
Basic types
Religious diets
Vegetarianism
and veganism
Supplement diets
Non-solid diets
Specific restrictions
Other feeding
behaviors
Food faddism
List of diets
Conditions
general
nervous system
digestive system
integumentary system
Antibodies
HLA-DQ
Other
Index of digestion
Description
Disease
Treatment
Wikibooks Cookbook has a recipe/module on
Retrieved from "https://en.wikipedia.org/w/index.php?title=Gluten-free_diet&oldid=692476142"