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Gluten Free Diet

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Advances in Celiac Disease

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Abstract

The gluten-free diet is currently the only effective treatment of celiac disease and the diet requires the substitution of gluten-containing products with gluten-free-rendered products. This is a complex task. This chapter addresses ways to explain to patients what is and how we can have a healthy gluten free diet, avoiding the main nutritional deficiencies, but also how to use pseudocereals within the gluten free diet and how to avoid cross contamination. Regarding gluten-free products, this chapter contains the main information about their regulation, the principal challenges of its manufacture and information about the nutritional value of gluten free products. Finally, one of the main keys to preventing long-term complications in celiac patients is a strict adherence to the gluten-free diet. Therefore, it is very important to assess it during follow-up.

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References

  1. Codex Alimentarious Commission. Foods for special dietary use for persons intolerant to gluten. Rome, Italy; 2008.

    Google Scholar 

  2. Radhika V, Rao VSH. Computational approaches for the classification of seed storage proteins. J Food Sci Technol. 2015;52(7):4246–55.

    Article  PubMed  CAS  Google Scholar 

  3. Wieser H, Kieffer R. Correlations of the amount of gluten protein types to the technological properties of wheat flours determined on a micro-scale. J Cereal Sci. 2001;34(1):19–27.

    Article  CAS  Google Scholar 

  4. Wieser H. Chemistry of gluten proteins. Food Microbiol. 2007;24(2):115–9.

    Article  PubMed  CAS  Google Scholar 

  5. Shewry PR, Halford NG. Cereal seed storage proteins: structures, properties and role in grain utilization. J Exp Bot. 2002;53(370):947–58.

    Article  PubMed  CAS  Google Scholar 

  6. Lionetti E, Gatti S, Pulvirenti A, Catassi C. Celiac disease from a global perspective. Best Pract Res Clin Gastroenterol. 2015;29(3):365–79.

    Article  PubMed  Google Scholar 

  7. Leffler DA, Edwards-George J, Dennis M, Schuppan D, Cook F, Franko DL, et al. Factors that influence adherence to a gluten-free diet in adults with celiac disease. Dig Dis Sci. 2008;53(6):1573–81.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Christoph MJ, Larson N, Hootman KC, Miller JM, Neumark-Sztainer D. Who values gluten-free? Dietary intake, behaviors, and sociodemographic characteristics of young adults who value gluten-free food. J Acad Nutr Diet. 2018;118(8):1389–98.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vici G, Belli L, Biondi M, Polzonetti V. Gluten free diet and nutrient deficiencies: a review. Clin Nutr. 2016;35(6):1236–41.

    Article  PubMed  CAS  Google Scholar 

  10. Theethira TG, Dennis M, Leffler DA. Nutritional consequences of celiac disease and the gluten-free diet. Expert Rev Gastroenterol Hepatol. 2014;8(2):123–9.

    Article  PubMed  CAS  Google Scholar 

  11. Wierdsma NJ, Van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, Van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013;5(10):3975–92.

    Google Scholar 

  12. Melini V, Melini F. Gluten-free diet: gaps and needs for a healthier diet. Nutrients. 2019;11(1):170.

    Article  PubMed Central  CAS  Google Scholar 

  13. Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV. Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Nutrients. 2013;5(11):4553–65.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Welstead L. The gluten-free diet in the 3rd millennium: rules, risks and opportunities. Diseases. 2015;3(3):136–49.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Grace-Farfaglia P. Bones of contention: Bone mineral density recovery in celiac disease—a systematic review. Nutrients. 2015;7(5):3347–69.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Gopalsamy GL, Alpers DH, Binder HJ, Tran CD, Ramakrishna B, Brown I, et al. The relevance of the colon to zinc nutrition. Nutrients. 2015;7(1):572–83.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Smulders MJ, van de Wiel CCM, van den Broeck HC, van der Meer IM, Israel-Hoevelaken T, Timmer RD, et al. Oats in healthy gluten-free and regular diets: a perspective. Food Res Int. 2018;110:3–10.

    Google Scholar 

  18. Poley JR. The gluten-free diet: can oats and wheat starch be part of it? J Am Coll Nutr. 2017;36(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  19. Fritz RD, Chen Y. Oat safety for celiac disease patients: theoretical analysis correlates adverse symptoms in clinical studies to contaminated study oats. Nutr Res. 2018;60:54–67.

    Article  PubMed  CAS  Google Scholar 

  20. La Vieille S, Pulido OM, Abbott M, Koerner TB, Godefroy S. Celiac disease and gluten-free oats: a Canadian position based on a literature review. Can J Gastroenterol Hepatol. 2016;2016.

    Google Scholar 

  21. Hoffmanová I, Sánchez D, Szczepanková A, Tlaskalová-Hogenová H. The pros and cons of using oat in a gluten-free diet for celiac patients. Nutrients. 2019;11(10):2345.

    Article  PubMed Central  Google Scholar 

  22. Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, et al. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Eur Gastroenterol J. 2019;7(5):583–613.

    Article  Google Scholar 

  23. Hosseini SM, Soltanizadeh N, Mirmoghtadaee P, Banavand P, Mirmoghtadaie L, Shojaee-Aliabadi S. Gluten-free products in celiac disease: nutritional and technological challenges and solutions. J Res Med Sci. 2018;28(23):109.

    Google Scholar 

  24. Niro S, D’Agostino A, Fratianni A, Cinquanta L, Panfili G. Gluten-free alternative grains: nutritional evaluation and bioactive compounds. Foods. 2019;8(6):208.

    Article  PubMed Central  CAS  Google Scholar 

  25. Schoenlechner R, Drausinger J, Ottenschlaeger V, Jurackova K, Berghofer E. Functional properties of gluten-free pasta produced from amaranth, quinoa and buckwheat. Plant Foods Hum Nutr. 2010;65(4):339–49.

    Article  PubMed  CAS  Google Scholar 

  26. Doğan H, Karwe M. Physicochemical properties of quinoa extrudates. Food Sci Technol Int. 2003;9(2):101–14.

    Article  Google Scholar 

  27. Wronkowska M, Haros M, Soral-Śmietana M. Effect of starch substitution by buckwheat flour on gluten-free bread quality. Food Bioprocess Technol. 2013;6(7):1820–7.

    Article  CAS  Google Scholar 

  28. Martínez-Villaluenga C, Peñas E, Hernández-Ledesma B. Pseudocereal grains: nutritional value, health benefits and current applications for the development of gluten-free foods. Food Chem Toxicol. 2020;137:111178.

    Google Scholar 

  29. European Commission. 2021. https://ec.europa.eu/food/safety/labelling_nutrition/special_groups_food/gluten_en. Accessed 26 Apr 2021.

  30. Association of European Coeliac Societies. 2021. https://www.aoecs.org/. Accessed 24 Apr 2021.

  31. El Khoury D, Balfour-Ducharme S, Joye IJ. A review on the gluten-free diet: technological and nutritional challenges. Nutrients. 2018;10(10):1410.

    Article  PubMed Central  Google Scholar 

  32. Lee AR, Wolf RL, Lebwohl B, Ciaccio EJ, Green PH. Persistent economic burden of the gluten free diet. Nutrients. 2019;11(2):399.

    Article  PubMed Central  Google Scholar 

  33. Burden M, Mooney PD, Blanshard RJ, White WL, Cambray-Deakin DR, Sanders DS. Cost and availability of gluten-free food in the UK: in store and online. Postgrad Med J. 2015;91(1081):622–6.

    Article  PubMed  CAS  Google Scholar 

  34. Panagiotou S, Kontogianni M. The economic burden of gluten-free products and gluten-free diet: a cost estimation analysis in Greece. J Hum Nutr Diet. 2017;30(6):746–52.

    Article  PubMed  CAS  Google Scholar 

  35. Fry L, Madden A, Fallaize R. An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK. J Hum Nutr Diet. 2018;31(1):108–20.

    Article  PubMed  CAS  Google Scholar 

  36. Miranda J, Lasa A, Bustamante M, Churruca I, Simon E. Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant Foods Hum Nutr. 2014;69(2):182–7.

    Article  PubMed  CAS  Google Scholar 

  37. Missbach B, Schwingshackl L, Billmann A, Mystek A, Hickelsberger M, Bauer G, et al. Gluten-free food database: the nutritional quality and cost of packaged gluten-free foods. PeerJ. 2015;3:e1337.

    Google Scholar 

  38. Calvo-Lerma J, Crespo-Escobar P, Martinez-Barona S, Fornes-Ferrer V, Donat E, Ribes-Koninckx C. Differences in the macronutrient and dietary fibre profile of gluten-free products as compared to their gluten-containing counterparts. Eur J Clin Nutr. 2019;73(6):930–6.

    Article  PubMed  CAS  Google Scholar 

  39. Wu JH, 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(3):448–54.

    Article  PubMed  CAS  Google Scholar 

  40. do Nascimento AB, Fiates GMR, Dos Anjos A, Teixeira E. Analysis of ingredient lists of commercially available gluten-free and gluten-containing food products using the text mining technique. Int J Food Sci Nutr. 2013;64(2):217–22.

    Google Scholar 

  41. Kulai T, Rashid M. Assessment of nutritional adequacy of packaged gluten-free food products. Can J Diet Pract Res. 2014;75(4):186–90.

    Article  PubMed  Google Scholar 

  42. Mazzeo T, Cauzzi S, Brighenti F, Pellegrini N. The development of a composition database of gluten-free products. Public Health Nutr. 2015;18(8):1353–7.

    Article  PubMed  Google Scholar 

  43. Estévez V, Ayala J, Vespa C, Araya M. The gluten-free basic food basket: a problem of availability, cost and nutritional composition. Eur J Clin Nutr. 2016;70(10):1215–7.

    Article  PubMed  Google Scholar 

  44. Allen B, Orfila C. The availability and nutritional adequacy of gluten-free bread and pasta. Nutrients. 2018;10(10):1370.

    Article  PubMed Central  Google Scholar 

  45. Scaramuzza AE, Mantegazza C, Bosetti A, Zuccotti GV. Type 1 diabetes and celiac disease: the effects of gluten free diet on metabolic control. World J Diabetes. 2013;4(4):130–4.

    Google Scholar 

  46. Tortora R, Capone P, De Stefano G, Imperatore N, Gerbino N, Donetto S, et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther. 2015;41(4):352–9.

    Article  PubMed  CAS  Google Scholar 

  47. Ciccone A, Gabrieli D, Cardinale R, Di Ruscio M, Vernia F, Stefanelli G, et al. Metabolic alterations in celiac disease occurring after following a gluten-free diet. Digestion. 2019;100(4):262–8.

    Article  PubMed  CAS  Google Scholar 

  48. Jnawali P, Kumar V, Tanwar B. Celiac disease: Overview and considerations for development of gluten-free foods. Food Sci Hum Wellness. 2016;5(4):169–76.

    Article  Google Scholar 

  49. Catassi C, Fabiani E, Iacono G, D’Agate C, Francavilla R, Biagi F, et al. A prospective, double-blind, placebo-controlled trial to establish a safe gluten threshold for patients with celiac disease. Am J Clin Nutr. 2007;85(1):160–6.

    Article  PubMed  CAS  Google Scholar 

  50. West J, Logan RF, Smith CJ, Hubbard RB, Card TR. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ. 2004;329(7468):716–9.

    Google Scholar 

  51. Corrao G, Corazza GR, Bagnardi V, Brusco G, Ciacci C, Cottone M, et al. Mortality in patients with coeliac disease and their relatives: a cohort study. The Lancet. 2001;358(9279):356–61.

    Article  CAS  Google Scholar 

  52. Tau C, Mautalen C, De Rosa S, Roca A, Valenzuela X. Bone mineral density in children with celiac disease. Effect of a gluten-free diet. Eur J Clin Nutr. 2006;60(3):358–63.

    Google Scholar 

  53. Dewar DH, Ciclitira PJ. Clinical features and diagnosis of celiac disease. Gastroenterology. 2005;128(4):S19–24.

    Article  PubMed  Google Scholar 

  54. Green PH, Fleischauer AT, Bhagat G, Goyal R, Jabri B, Neugut AI. Risk of malignancy in patients with celiac disease. Am J Med. 2003;115(3):191–5.

    Article  PubMed  Google Scholar 

  55. Zarkadas M, Cranney A, Case S, Molloy M, Switzer C, Graham I, et al. The impact of a gluten-free diet on adults with coeliac disease: results of a national survey. J Hum Nutr Diet. 2006;19(1):41–9.

    Article  PubMed  CAS  Google Scholar 

  56. Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Maki M. Gluten-free diet and quality of life in patients with screen-detected celiac disease. Eff Clin Pract. 2002;5(3):105–13.

    PubMed  Google Scholar 

  57. Pynnönen PA, Isometsä ET, Verkasalo MA, Kähkönen SA, Sipilä I, Savilahti E, et al. Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study. BMC Psychiatry. 2005;5(1):1–6.

    Article  Google Scholar 

  58. Addolorato G. Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scand J Gastroenterol. 2001;36(5):502–6.

    Article  PubMed  CAS  Google Scholar 

  59. Rodrigo L, Pérez-Martinez I, Lauret-Braña E, Suárez-González A. Descriptive study of the different tools used to evaluate the adherence to a gluten-free diet in celiac disease patients. Nutrients. 2018;10(11):1777.

    Article  PubMed Central  Google Scholar 

  60. Biagi F, Bianchi PI, Marchese A, Trotta L, Vattiato C, Balduzzi D, et al. A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life. Br J Nutr. 2012;108(10):1884–8.

    Article  PubMed  CAS  Google Scholar 

  61. Wessels MM, Te Lintelo M, Vriezinga SL, Putter H, Hopman EG, Mearin ML. Assessment of dietary compliance in celiac children using a standardized dietary interview. Clin Nutr. 2018;37(3):1000–4.

    Article  PubMed  Google Scholar 

  62. Pedoto D, Troncone R, Massitti M, Greco L, Auricchio R. Adherence to gluten-free diet in coeliac paediatric patients assessed through a questionnaire positively influences growth and quality of life. Nutrients. 2020;12(12):3802.

    Article  PubMed Central  Google Scholar 

  63. Leffler DA, Dennis M, George JBE, Jamma S, Magge S, Cook EF, et al. A simple validated gluten-free diet adherence survey for adults with celiac disease. Clin Gastroenterol Hepatol. 2009;7(5):530–6.e2.

    Google Scholar 

  64. Fueyo-Díaz R, Magallón-Botaya R, Gascón-Santos S, Asensio-Martínez Á, Palacios-Navarro G, Sebastián-Domingo JJ. Development and validation of a specific self-efficacy scale in adherence to a gluten-free diet. Front Psychol. 2018;9:342.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Meyer S, Naveh G. Mobile application for promoting gluten-free diet self-management in adolescents with celiac disease: proof-of-concept study. Nutrients. 2021;13(5):1401.

    Google Scholar 

  66. Rohde JA, Barker JO, Noar SM. Impact of eHealth technologies on patient outcomes: a meta-analysis of chronic gastrointestinal illness interventions. Transl Behav Med. 2019;11:1–10.

    Article  Google Scholar 

  67. Lee JA, Choi M, Lee SA, Jiang N. Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review. BMC Med Inform Decis Mak. 2018;18:1–18.

    Article  CAS  Google Scholar 

  68. Pérez YIV, Medlow S, Ho J, Steinbeck K. Mobile and web-based apps that support self-management and transition in young people with chronic illness: systematic review. J Med Internet Res. 2019;21:e13579.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Health Sciences, Universidad Europea Miguel de Cervantes, Valladolid, Spain

    Paula Crespo-Escobar

  2. Nutrition Unit of Campo Grande Hospital, Valladolid, Spain

    Paula Crespo-Escobar

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  1. Paula Crespo-Escobar
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Editors and Affiliations

  1. Department of Pediatrics, São João University Hospital, Porto, Portugal

    Jorge Amil-Dias

  2. Department of Pediatrics, Autonoma University , Madrid, Spain

    Isabel Polanco

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Crespo-Escobar, P. (2022). Gluten Free Diet. In: Amil-Dias, J., Polanco, I. (eds) Advances in Celiac Disease . Springer, Cham. https://doi.org/10.1007/978-3-030-82401-3_9

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  • DOI: https://doi.org/10.1007/978-3-030-82401-3_9

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