Going Gluten Free: the History and Nutritional Implications of Today’s Most Popular Diet
- 1.7k Downloads
Purpose of Review
The gluten-free diet (GFD) has become one of the most popular diets in modern history. Claims of improved health and increased energy fuel this popularity, though there is little evidence to substantiate these claims. The present review focuses on outlining known gluten-related disorders (GRD), discussing the GFD in the general population, exploring nutritional considerations, and providing advice for physicians in managing these patients.
Currently, about a quarter of the population reports keeping a GFD despite GRDs affecting less than half of these individuals. Reduced intake of calcium, B vitamins, and fiber as well as enhanced consumption of fat and simple carbohydrates has consistently been reported and needs to be continually addressed.
Although a necessity in proper management of GRDs, unforeseen nutritional complications may develop in patients who are gluten free for which enhanced physician awareness is vital to achieving optimal patient care.
KeywordsGluten-free diet Nutrition Gluten-related disorder Celiac disease Non-celiac gluten sensitivity
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance
- 5.•• Hill ID, Fasano A, Guandalini S, Hoffenberg E, Levy J, Reilly N, et al. NASPGHAN clinical report on the diagnosis and treatment of gluten-related disorders. J Pediatr Gastroenterol Nutr. 2016;63(1):156–65. Most recent published guidelines on management of gluten related disorders including diagnosis, classification and treatment from a pediatric perspective (though also would be generally applicable to adult patients) CrossRefPubMedGoogle Scholar
- 8.• Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PH, Hadjivassiliou M, et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012;10(1). This article discussed the newest classification model of adult gluten related disorders as defined by pathogenesis based on expert consensus guidelines. Google Scholar
- 15.Cianferoni A. Wheat allergy: diagnosis and management. J Asthma Allergy. 2016;13.Google Scholar
- 17.Elli L, Tomba C, Branchi F, Roncoroni L, Lombardo V, Bardella M, et al. Evidence for the presence of non-celiac gluten sensitivity in patients with functional gastrointestinal symptoms: results from a multicenter randomized double-blind placebo-controlled gluten challenge. Nutrients. 2016;8(2):84.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Peters SL, Biesiekierski JR, Yelland GW, Muir JG, Gibson PR. Editorial: noncoeliac gluten sensitivity—a disease of the mind or gut? Authors’ reply Alimentary Pharmacology & Therapeutics 2014;40(1):114–5.Google Scholar
- 21.Sabatino AD, Volta U, Salvatore C, Biancheri P, Caio G, Giorgio RD, et al. Small amounts of gluten in subjects with suspected nonceliac gluten sensitivity: a randomized, double-blind, placebo-controlled, cross-over trial. Clin Gastroenterol Hepatol. 2015;13(9).Google Scholar
- 25.The Nielsen Company. Healthy eating trends around the world. https://www.nielsen.com/content/dam/nielsenglobal/eu/nielseninsights/pdfs/Nielsen%20Global%20Health%20and%20Wellness%20Report%20-%20January%202015.pdf. Accessed 29 Dec 2016.
- 26.Davis W. Wheat belly: lose the wheat, lose the weight, and find your path back to health. Emmaus: Rodale; 2011.Google Scholar
- 27.Perlmutter D, Loberg K. Grain brain: the surprising truth about wheat, carbs, and sugar—your brain’s silent killers. Little, Brown, and Co., 2013.Google Scholar
- 28.Lis D, Fell J, Shing C, Stellingwerff T. Athletes and gluten-free diets: exploring the popularly, experiences and beliefs of this diet in non-coeliac athletes. J Sci Med Sport. 2013;16.Google Scholar
- 29.Severson K. Gluten-Free Eating Appears to Be Here to Stay. https://www.nytimes.com/2014/06/18/dining/gluten-free-eating-appears-to-be-here-to-stay.html?_r=0. Accessed 29 Dec 2016.
- 45.•• Wu J, Neal B, Trevena H, Crino M, Stuart-Smith W, Faulkner-Hogg K, et al. Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia. Br J Nutr. 2015;114:448–54. Largest study of the nutritional profiles of gluten-free food products in comparison to their classic alternatives CrossRefPubMedGoogle Scholar
- 46.Mueller C, McClave S, Kuhn JM. The A.S.P.E.N. adult nutrition support core curriculum. Silver Spring: American Society for Parenteral and Enteral Nutrition; 2012.Google Scholar
- 59.Aziz I, Hadjivassiliou M, Sanders D. Does gluten sensitivity in the absence of coeliac disease exist? Br Med J. 2012;345(7887):45–7.Google Scholar
- 60.• Lee AR, Ng DL, Dave E, Ciaccio EJ, Green P. The effect of substituting alternative grains in the diet on the nutritional profile of the gluten-free diet. J Hum Nutr Diet. 2009;22:359–63. Well done study that characterizes patient’s eating habits on the gluten free diet, providing tangible alternatives to traditional gluten-containing grains to increase fiber, protein, and micronutrient content CrossRefPubMedGoogle Scholar