Abstract
In this review, we summarize the clinical data addressing a potential role for gluten in multiple sclerosis (MS), psoriasis, type 1 diabetes (T1D) and autoimmune thyroid diseases (ATDs). Furthermore, data on the prevalence of celiac disease (CD) and gluten-related antibodies in the above patient groups are presented. Adequately powered and properly controlled intervention trials investigating the effects of a gluten-free diet (GFD) in non-celiac patients with MS, psoriasis, T1D or ATDs are lacking. Only one clinical trial has studied the effects of a GFD among patients with MS. The trial found significant results, but it is subject to major methodological limitations. A few publications have found beneficial effects of a GFD in a subgroup of patients with psoriasis that were seropositive for anti-gliadin or deamidated gliadin antibodies, but no effects were seen among seronegative patients. Studies on the role of gluten in T1D are contradictive, however, it seems likely that a GFD may contribute to normalizing metabolic control without affecting levels of islet autoantibodies. Lastly, the effects of a GFD in non-celiac patients with ATDs have not been studied yet, but some publications report that thyroid-related antibodies respond to a GFD in patients with concomitant CD and ATDs. Overall, there is currently not enough evidence to recommend a GFD to non-celiac patients with MS, psoriasis, ATDs or T1D.
Highlights
Wheat is a major component of Western diets, abstaining from gluten is becoming a popular trend [1]
Larger epidemiological studies and meta-analyses of systematic reviews support that psoriasis, Type 1 diabetes (T1D) and autoimmune thyroid diseases (ATDs) are all associated with celiac disease (CD), but this does not seem to be the case for multiple sclerosis (MS)
The only clinical trial to have studied the effects of a gluten-free diet (GFD) among patients with MS found positive results on important MS-specific outcomes, the publication was subject to major limitations
Summary
Wheat is a major component of Western diets, abstaining from gluten is becoming a popular trend [1]. Adhering to a lifelong gluten-free diet (GFD) is the current treatment for celiac disease (CD)—an immune-mediated small intestinal enteropathy triggered by the ingestion of gluten [2]. It has been hypothesized that gluten may contribute to deteriorating the course of immune-mediated disorders [3,4,5]. According to a U.S national survey, a GFD was the most common special diet to be used by patients with psoriasis [6]. Type 1 diabetes (T1D) and autoimmune thyroid diseases (ATDs) affect the endocrine system. The contribution of dietary factors to the pathogenesis of autoimmune endocrine disorders is currently an active research. This review summarizes the currently available clinical data on a potential involvement of gluten in MS, psoriasis, T1D and ATDs
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