Abstract
In gluten dependent conditions the gluten free diet is the cornerstone of therapy, decreasing disease activity, improving health and quality of life and treating or preventing the associated complications. Gluten withdrawal implies strict and lifelong elimination not only of wheat, barley, rye, and wheat-contaminated oats, but also of numerous non-nutritional products where components of wheat are often added. Due to multiple reasons the diet is difficult to follow and the long-term adherence is decreased with time. The present review summarizes the dark side of gluten restriction where nutritional deficiencies, toxicity, morbidity, mortality, and mental health problems are reported. The aim being to increase awareness, avoid, detect and treat the side effects and to promote a healthier nutrition, for the patient's benefits.
Highlights
The global population has more than doubled in the last 40 years supported by the “green revolution” in agriculture producing high-yield grain varieties, including semi-dwarf, high-yield, disease resistant varieties of wheat, that are central to the modern diet [1]
Dependence on GI complaints as a prerequisite in considering an adverse reaction to wheat, will allow a majority to escape diagnosis. This is a critical point of recognition for the Clinician when considering an association of wheat related disorders (WRD) and the potential value of a Gluten-Free Diet (GFD)
In view of the rising popularity of gluten restricted products, the present review will summarize the dark side of the GFD, rather than describing the macro and micronutrients deficiencies, extensively described in naïve or untreated celiac disease (CD) patients [46]
Summary
The global population has more than doubled in the last 40 years supported by the “green revolution” in agriculture producing high-yield grain varieties, including semi-dwarf, high-yield, disease resistant varieties of wheat, that are central to the modern diet [1]. Dependence on GI complaints as a prerequisite in considering an adverse reaction to wheat, will allow a majority to escape diagnosis This is a critical point of recognition for the Clinician when considering an association of wheat related disorders (WRD) and the potential value of a Gluten-Free Diet (GFD). In view of the rising popularity of gluten restricted products, the present review will summarize the dark side of the GFD, rather than describing the macro and micronutrients deficiencies, extensively described in naïve or untreated CD patients [46]. Summarizing surveys on nutritional profiles of gluten free, compared to gluten containing food products, Melini et al showed that the GFD is deficient in fibers, proteins, folate, iron, potassium, and zinc, while higher in fat, carbohydrate, sugars, FODMAP’s, and sodium, in most of the surveys [6]. Fat, saturated fatty acids Food additives: enzymes like microbial transglutaminase, proteases
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