Abstract
Gluten-free diet (GFD) is enjoying increasingly popularity, although gluten-free products are considerably more expensive. GFD is absolutely necessary for patients with celiac disease, as in this case even minor amounts of gluten can lead to the destruction of the intestinal mucosa. In addition, GFD is currently the best therapy to improve clinical symptoms of patients with non-celiac gluten sensitivity (NCGS), although the diet may not be as strict as that for patients with celiac disease. Beside gluten, other wheat components such as oligosaccharides and amylase trypsin inhibitors are discussed as triggers of NCGS in this review. An overlap between gastrointestinal symptoms in NCGS and irritable bowel syndrome (IBS) is described. Patients with NCGS attribute their symptoms to the consumption of gluten, while patients with IBS rarely describe gluten as a trigger. Recently, several studies have demonstrated that the introduction of a low FODMAP (fermentable oligo-, di-, monosaccharides, and polyols) diet reduced gastrointestinal symptoms in patients with IBS and this diet is suggested as the first choice of therapy in IBS. However, a low FODMAP diet also eliminates prebiotica and may negatively influence the gut microbiota. For this reason, the diet should be liberalized after symptom improvement. There is no evidence that a GFD is healthier than the standard diet. In contrast, GFD often is accompanied by nutritional deficiencies, mainly minerals and vitamins. Therefore, GFD and low FODMAP diets are not recommended for healthy subjects. Since wheat contains fructans belonging to FODMAPs), a GFD is not only gluten-free but also has less FODMAPs. Thus, symptom improvement cannot be correctly correlated with the reduction of either one or the other.
Highlights
The market for gluten-free products has been increasing steadily and gluten-free diet (GFD) is becoming more and more popular
GFD and low FODMAP diets are not recommended for healthy subjects
While all these patients need to follow a GFD, the vast majority of consumers of gluten-free products buy them for other reasons, e.g., a belief that the products are better for health, weight loss, or for fear of a toxic gluten effect [3,4,5]
Summary
The market for gluten-free products has been increasing steadily and gluten-free diet (GFD) is becoming more and more popular. 12.5 g wheat flour) per day for four weeks showed even higher densities in intraepithelial lymphocytes, a more reduced Vh/Cd ratio, and an increased intestinal permeability [16] Another multicenter double-blind, placebo-controlled follow-up study was performed with 49 adult patients that had been on a GFD for at least two years. A recent study showed that the reduction of dietary FODMAP intake for only one month have already led to a significant improvement of quality of life and clinical symptoms in these patients This data justify testing a low FODMAP diet in celiac patients with persistent gastrointestinal complaints while on a GFD [17]. A double-blind placebo-controlled challenge with 8 g of gluten per day is recommended to provoke typical NCGS symptoms This approach is often difficult to perform and, especially for daily clinical practice, a single-blind procedure is suggested [23]. The threshold values are highly variable and should be evaluated and adapted individually
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