Gluten Avoidance Research Articles

A107 PATIENT PERSPECTIVES ON THE LONG-TERM MANAGEMENT OF CELIAC DISEASE

Abstract Background Celiac disease (CD) is a common chronic gastrointestinal illness with a range of manifestations. The only available treatment is strict gluten avoidance, therefore patients are effectively self-managed. Despite the critical role patients play in their treatment, patient perspectives on long-term CD care have not been formally assessed and are therefore not represented in current clinical guidelines. Aims To determine the opinions of CD patients on the need for long-term CD follow-up, the utility of various aspects of CD follow-up, and the areas in which further information is desired. Methods The Manitoba Celiac Disease Cohort includes newly diagnosed adults with elevated TTG and/or EMA antibodies and Marsh III histology. At the 24-month follow-up visit, participants were asked to rate the utility of various aspects of CD care from 1–5 (low-high) and their desire for further information on CD-related issues from 1–6 (low-high). Results A total of 213 patients were recruited and 137 participants completed the online survey (median age 41 [interquartile range 29–57] years; 68% female). Adherence to a gluten free diet was variable, with 29% of patients having TTG antibodies above the upper limit of normal. Two-thirds of participants felt they should be seen regularly for their celiac disease, while 79.8% of those who wished to be followed felt they should be seen every 6–12 months. Blood tests were the most highly rated component of CD care (scored ≥4 by 78% of respondents). Celiac symptom review, information on research in celiac disease, and the opportunity to ask questions about vitamins and supplements were also positively regarded. Diet review was not generally considered helpful. 79% of patients desired further information on research in CD, while approximately 60% desired information on the long-term complications of CD and the risk of nutritional deficiencies. Conclusions The majority of CD patients find regular specialist follow-up helpful, particularly for biochemical assessment of disease activity and its complications. Further information on CD research and the long-term complications of CD should be addressed in follow-up visits. These aspects of follow-up care should be reflected in future guidelines. Funding Agencies None

Proteomic analysis of reserve proteins in commercial rice cultivars.

Rice consumption is rising in western countries with the adoption of new nutritional styles, which require the avoidance of gluten. Nevertheless, there are reports of rice allergic reactions. Rice grains contain a low amount of proteins most of which are storage proteins represented by glutelins, prolamins, albumins, and globulins. Some of these proteins are seed allergenic proteins as α‐amylase/trypsin inhibitor, globulins, β‐glyoxylase, and several glutelins. Italy is the major rice producer in Europe, and for this, seed reserve proteins of four Italian rice cultivars were characterized by 2D‐GE analysis. Some differentially abundant proteins were identified and classified as allergenic proteins, prompting a further characterization of the genes encoding some of these proteins. In particular, a deletion in the promoter region of the 19 KDa globulin gene has been identified, which may be responsible for the different abundance of the protein in the Karnak cultivar. This polymorphism can be applied for cultivar identification in commercial samples. Seed proteome was characterized by a variable combination of several proteins, which may determine a different allergenic potential. Proteomic and genomic allowed to identify the protein profile of four commercial cultivars and to develop a molecular marker useful for the analysis of commercial products.

Incidence and prevalence of self-reported non-coeliac wheat sensitivity and gluten avoidance in Australia.

To determine the incidence of self-reported non-coeliac wheat sensitivity (SR-NCWS) and factors associated with its onset and resolution; to describe the prevalence of factors associated with gluten avoidance. Longitudinal cohort study; analysis of responses to self-administered validated questionnaires (Digestive Health and Wellbeing surveys, 2015 and 2018). Subset of an adult population sample randomly selected in 2015 from the electoral rolls for the Newcastle and Gosford regions of New South Wales. Prevalence of SR-NCWS (2015, 2018) and incidence and resolution of SR-NCWS, each by demographic and medical factors; prevalence of gluten avoidance and reasons for gluten avoidance (2018). 1322 of 2185 eligible participants completed the 2018 survey (response rate, 60.5%). The prevalence of SR-NCWS was similar in 2015 (13.8%; 95% CI, 12.0-15.8%) and 2018 (13.9%; 95% CI, 12.1-15.9%); 69 of 1301 respondents (5.3%) reported developing new onset (incident) SR-NCWS between 2015 and 2018 (incidence, 1.8% per year). Incident SR-NCWS was significantly associated with a diagnosis of functional dyspepsia, and negatively associated with being male or older. Gluten avoidance was reported in 2018 by 24.2% of respondents (20.5% partial, 3.8% complete avoidance); general health was the most frequent reason for avoidance (168 of 316 avoiders, 53%). All 13 participants with coeliac disease, 56 of 138 with irritable bowel syndrome (41%), and 69 of 237 with functional dyspepsia (29%) avoided dietary gluten. The prevalence of SR-NCWS was similar in 2015 and 2018. Baseline (2015) and incident SR-NCWS (2018) were each associated with functional gastrointestinal disorders. The number of people avoiding dietary gluten exceeds that of people with coeliac disease or SR-NCWS, and general health considerations and abdominal symptoms are the most frequently reported reasons for avoidance.

Stimulatory Response of Celiac Disease Peripheral Blood Mononuclear Cells Induced by RNAi Wheat Lines Differing in Grain Protein Composition.

Wheat gluten proteins are responsible for the bread-making properties of the dough but also for triggering important gastrointestinal disorders. Celiac disease (CD) affects approximately 1% of the population in Western countries. The only treatment available is the strict avoidance of gluten in the diet. Interference RNA (RNAi) is an excellent approach for the down-regulation of genes coding for immunogenic proteins related to celiac disease, providing an alternative for the development of cereals suitable for CD patients. In the present work, we report a comparative study of the stimulatory capacity of seven low-gluten RNAi lines differing in grain gluten and non-gluten protein composition, relevant for CD and other gluten pathologies. Peripheral blood mononuclear cells (PBMCs) of 35 patients with active CD were included in this study to assess the stimulatory response induced by protein extracts from the RNAi lines. Analysis of the proliferative response and interferon-gamma (INF-γ) release of PBMCs demonstrated impaired stimulation in response to all RNAi lines. The lower response was provided by lines with a very low content of α- and γ-gliadins, and low or almost devoid of DQ2.5 and p31–43 α-gliadin epitopes. The non-gluten protein seems not to play a key role in PBMC stimulation.

The Gluten-Free Diet: Use in Digestive Disease Management.

Gluten is a commonly ingested polymeric protein found in wheat, barley, and rye that has gained recent notoriety because of its relationship to disease and health. Avoidance of gluten is appropriate in patients with a diagnosed gluten-related disorder and may have treatment implications in other diseases of the digestive tract. This review highlights current knowledge of gluten related disorders and the use of a gluten-free diet in gastrointestinal disease management. Gluten-free diets should be used in patients with a diagnosed gluten-related disorder including celiac disease, non-celiac gluten sensitivity, and wheat-sensitive eosinophilic esophagitis. Use of this diet in management of other digestive conditions including gastroesophageal reflux disease, irritable bowel syndrome, and inflammatory bowel disease is controversial and not currently supported by the literature. This review provides a framework for classifying gluten-related disorders in terms of pathogenesis, understanding the literature that supports dietary avoidance in modulation of gastrointestinal disease, and identifies limitations of dietary restriction in patients.

Autoimmune and Allergic Disorders are More Common in People With Celiac Disease or on a Gluten-free Diet in the United States.

We analyzed demographics, lifestyle patterns, and clinical characteristics of people with celiac disease (CD) and people without CD avoiding gluten (PWAG) to better understand associations with medical conditions and consumer behavior. Clinical significance of CD and gluten avoidance in the general population is incompletely understood. Recently, a high incidence of CD in adolescents with susceptibility genotypes, similar to other autoimmune or allergic disorders, and regional differences in consumer practices of gluten avoidance were reported. Among 22,277 participants in the National Health and Nutrition Examination Survey 2009-2014, we identified persons with CD by testing CD serology or by both a health care provider diagnosis and adherence to a gluten-free diet. Similarly, PWAG were defined as adherent to a gluten-free diet without a CD diagnosis. Consumer behavior and characteristics of both groups, CD and PWAG were compared with those without these conditions, using survey-weighted generalized logistic regression. Participants with CD considered nutrition very important when grocery shopping and tended to have more constipation and thyroid disease. PWAG tended to spend more money on groceries, purchase organic foods, and check food labels more frequently during grocery shopping. They also reported having more food allergies, asthma, and thyroid disease. Our study confirms that CD and PWAG share comorbidities of autoimmune nature. PWAG had more autoimmune/allergy-related disorders that may be associated with non-celiac gluten sensitivity a self-justifiable reason to be on the diet.

In vitro selection of anti-gliadin single-domain antibodies from a naïve library for cDNA-display mediated immuno-PCR

Gluten intolerance, or adverse intestinal reactions to gluten, is a fairly common problem among certain groups of people. Celiac disease is the most severe form of gluten intolerance, which can lead to permanent damage in the digestive system. Since lifelong avoidance of gluten is the only available treatment, development of reliable techniques to identify gluten contamination in food is important. Gliadin, a component of gluten, is known to play a major role in gluten toxicity. In this study, cDNA display method was used to select specific single-domain antibodies against toxic gliadin from an alpaca-derived naïve VHH library. The cDNA display method is a promising in vitro display technique, which uniquely converts an unstable mRNA-protein fusion molecule to a stable mRNA/cDNA-protein fusion molecule using a well-designed puromycin linker. Three candidate VHHs were selected and the affinities of the VHHs were observed by pulldown assay and indirect ELISA method. In addition, a novel cDNA display mediated immuno-PCR method (cD-IPCR) was successfully applied to detect gliadin in food. We believe this work demonstrates the potential application of the cDNA display method in selecting binders against toxic and heterogeneous targets such as gliadin with an immunization-free preparation manner.

Insights in the Evaluation of Gluten Dietary Avoidance in Healthy Subjects

Background: The amount of healthy subjects adopting a gluten-free diet (GFD) for nonmedical reasons actually surpasses the numbers of those who are dealing with a permanent gluten-related disorder.Objective: The study aimed to better clarify the interactions between a GFD and physical and psychological well-being.Methods: Sixty healthy subjects with normal weight were enrolled. Thirty subjects (15 female) were submitted to a normocaloric GFD and considered as the experimental group (EG), and 30 subjects (15 female) were submitted to a normocaloric diet (CG) for 6 months. The hematochemical and psychological parameters before and after the diet were recorded.Results: Significant improvement was demonstrated in red blood count, hemoglobin, total cholesterol, and high-density lipoprotein parameters in the EG after the gluten-free diet. However, a significant increase of α-amylase pancreatic activity and reduction of vitamin B12 and magnesium levels in the EG were observed. Regarding the psychological parameters, the GFD significantly improved scores assessing body satisfaction, but increased social insecurity.Conclusions: The study is the first to consider significant modulation in hematochemical parameters as well as psychological ones by gluten avoidance in healthy individuals. Although these subjects were not characterized by intestinal mucosa damage, some of the effects were similar to those observed in celiac disease patients who began to adhere to a GFD.

Gluten-free diet in French adults without coeliac disease: sociodemographic characteristics, motives and dietary profile.

The number of people avoiding gluten is growing in many Western countries. However, little information is available on their sociodemographic and dietary profiles. We aimed to describe sociodemographic, behavioural and dietary profiles of participants avoiding gluten in the NutriNet-Santé cohort. Participants of the NutriNet-Santé cohort - excluding coeliac patients - who completed a questionnaire about food exclusions, with complete data on sociodemographic characteristics and dietary intake were included (n 20 456). Food group consumptions and nutrient intakes according to self-reported avoidance of gluten were estimated using ANCOVA adjusted for age, sex and daily energy intake. Based on principal component analysis, three dietary patterns (DP) were identified. Association between DP and avoidance of gluten was investigated using multivariate logistic regression. All data were weighted on the French census. A total of 10·31 (95 % CI 9·90, 10·73) % of the participants declared avoiding gluten, of which 1·65 % totally. They were more likely to be women, older persons, non-smokers, to have a lower educational level and declared more food intolerances. They had higher consumption of fruit, vegetables and lower consumption of dairy products, salty/sweet and fatty foods and alcohol. After adjustments on confounders, a healthy dietary pattern was positively associated with total gluten avoidance (ORQuintile5vsQuintile1 = 14·44, 95 % CI 8·62, 24·19). Our study highlighted that, in this population, individuals who avoid gluten from their diet tend to have a diet more favourable to health. These results can serve as a basis for future studies investigating the potential consequences of a gluten-free diet in non-coeliac population.

Gluten aversion is not limited to the political left

Despite a heightened political discourse surrounding food choices, few studies have identified connections between political beliefs and consumer perceptions. Using gluten as an example, this article identifies how political opinions relate to opinions of food products. If an avoidance of gluten is a biological condition and not a social construct, there should be no correlation between political opinions and gluten avoidance. Our study uncovers a complex relationship between the social construction of gluten avoidance and the potential role of political views. Perhaps most surprising, we find that supporters of Donald Trump are more likely to identify as avoiding gluten, relative to non-supporters. Findings suggest that future research might benefit from considering the political beliefs of consumers when estimating models of food demand.

Going Against the Grains: Gluten-Free Diets in Patients Without Celiac Disease—Worthwhile or Not?

While the gluten-free diet (GFD) is the only known effective therapy for celiac disease, in recent years it has become increasingly popular in the USA and worldwide, with many believing it to be more "healthful" and others claiming that it has beneficial effects for health conditions, many extraintestinal, other than celiac disease. This review examines the evidence for use of the GFD in patients without celiac disease who self-report intestinal and/or extraintestinal symptoms (non-celiac gluten sensitivity), as well as for enhancement of athletic performance and treatment of autism, rheumatoid arthritis, and psychiatric disorders. Overall, the evidence for use of GFDs in conditions other than celiac diseaseis poor. Though non-celiac gluten sensitivity may ultimately emerge as a biomarker-defined condition, a large proportion of patients with apparent non-celiac gluten sensitivity have, after careful investigation, an alternative diagnosis. In light of this, and coupled with the potential physical and psychological harms associated with the avoidance of gluten, initiating a GFD should not be encouraged for people who have these other conditions or are seeking physical/athletic enhancement.

945 – Gluten Avoidance and Self-Reported Non-Celiac Wheat Sensitivity: Incidence and Prevalence from a Longitudinal Cohort Study of 1322 Individuals

945 – Gluten Avoidance and Self-Reported Non-Celiac Wheat Sensitivity: Incidence and Prevalence from a Longitudinal Cohort Study of 1322 Individuals

Gluten-free diet in non-celiac patients: beliefs, truths, advantages and disadvantages.

A gluten-free diet is the safest treatment for the treatment of patient with celiac disease (CD) and other gluten-related disorders. However, in the last years, gluten-free diet is one of the most popular diet followed by the general population and by patients affected from others clinical conditions, such as non-celiac gluten sensitivity (NCGS), irritable bowel syndrome (IBS), autism, neurological, psychiatric and rheumatologic diseases and for improving sports practice. This review highlights some questions about the appropriateness of following this trend answering to some questions such as how safe are the current gluten-free products, what are the benefits and side effects of gluten-free diet and what are clinical conditions that might benefit from gluten avoidance.

GENETIC TESTING IDENTIFIES CAUSE OF ENTEROPATHY AND GROWTH FAILURE IN A 10 YEAR OLD MALE

Introduction Enteropathies with features of celiac disease or inflammatory bowel disease (IBD) should spark consideration of an immunodeficiency when presenting at an early age. Case Description We present a 10-year old male with chronic diarrhea starting at 6 weeks of life, initially improved with TPN, steroids, and cow's milk free diet. By 2 years of age, diarrhea returned, and he required frequent courses of steroids to manage his symptoms. The patient had mild dermatitis and poor growth, with otherwise negative review of systems. Endoscopies found duodenitis with severe villous blunting and pancolitis. Laboratory evaluations were notable for negative anti-enterocyte antibodies, elevated antigliadin and tissue transglutaminase IgA levels, and normal T regulatory (Treg) cells and forkhead box P3 (FOXP3) expression. He was diagnosed with Celiac Disease and years later, Crohn's Disease. His clinical course did not improve with gluten avoidance or various immunomodulators. Eventually, sequencing of the FOXP3 gene was performed, revealing a missense mutation consistent with Immune dysregulation Polyendocrinopathy Enteropathy X-linked (IPEX) syndrome. Discussion IPEX is a rare syndrome caused by a mutation in the FOXP3 transcription factor of CD4+ Treg cells. The classic IPEX syndrome includes protracted diarrhea, dermatitis, and endocrinopathies, but phenotypes vary. Endoscopic findings of the IPEX enteropathy can mimic those seen in Celiac Disease and IBD, thus a high index of suspicion should be maintained in select patients with early onset of symptoms. Finally, this case highlights the importance of genetic analysis of the FOXP3 gene itself, as IPEX patients can have normal FOXP3 protein expression and Treg numbers.

Awareness of alternative gluten-free grains for individuals with coeliac disease

Purpose Coeliac disease (CD) is a prevalent autoimmune disorder, affecting 1 in 100 of all individuals in the UK. Currently, the only treatment for CD is the complete avoidance of gluten, a protein commonly found in wheat, rye and barley. The use of alternative grains (AG) is highly recommended to individuals with CD to improve and diversify their diet. The purpose of this paper is to determine the current knowledge of the gluten-free diet (GFD), consumption rates of AG and awareness of AG, for individuals diagnosed with CD. Design/methodology/approach A total of 100 participants were recruited via local coeliac support groups as well as an “Allergy and Free From Show”, to participate in a survey. Consent was obtained from all organisations and all individual participants, prior to collecting data. The questionnaire consists of ten questions, related to participants’ demographic characteristics, knowledge of gluten-free food (GFF) and AG and consumption rate of AG. χ2 analyses were conducted to compare the variables between gender and time of diagnosis. Findings Overall, both genders possessed good knowledge of the GFD. Yogurt, vinegar and oats resulted in the highest incorrect responses. It was found that females possessed better knowledge of both GFF and AG. Rice, quinoa and corn were amongst the most popular AG consumed whilst job’s tears, fonio and sorghum were the least consumed grains. Females reported a higher consumption rate of AG than males. Additionally, those more recently diagnosed had poorer knowledge of the GFD, reduced consumption rates of AG and poor awareness of AG. Originality/value It can be suggested that the incorporation of AG into the diet can prove beneficial for coeliacs and that both knowledge and education play a fundamental role in determining consumption rates amongst individuals.

Regional and National Variations in Reasons for Gluten Avoidance.

Although studies have assessed the prevalence of celiac disease (CD), less is known about the prevalence of gluten avoidance because of nonceliac gluten sensitivity (GS). The avoidance of foods other than gluten is also understudied in these 2 groups. Participants visiting a web site for information about a newly developed portable gluten detection device (Nima) were instructed to complete questions about food and gluten avoidance patterns. We assessed the relative proportion of CD and GS across world regions and United States (US) regions and determined the distribution of food avoidance patterns. CD was reported in 6474 respondents and GS in 2597 respondents. Within the United States, the majority of avoiders of gluten reported having CD (69.8%), with the highest ratio of CD to GS in the Northeast (CD: 74.3%; GS: 25.7%) and the lowest in the West (CD: 67.1%; GS: 32.9%) (P<0.0001). Compared with the United States, all other countries had lower proportions of GS, with the lowest in Argentina (CD: 94.7%; GS: 5.3%; P<0.0001). Food avoidances other than gluten were reported by 25% of respondents, with avoidance in all categories more common in GS than CD (P<0.0001). There is a significant difference in the relative rates of CD and GS within the United States and worldwide. Food avoidance other than gluten seems to be a more common component of GS than CD. Future research should focus on the causes of these international and US regional differences and the significance of other food avoidances.

Non-celiac gluten/wheat sensitivity (NCGS)-acurrently undefined disorder without validated diagnostic criteria and of unknown prevalence: Position statement of the task force on food allergy of the German Society of Allergology and Clinical Immunology (DGAKI).

Within the last decade, non-celiac gluten/wheat sensitivity (NCGS) has been increasingly discussed not only in the media but also among medical specialties. The existence and the possible triggers of NCGS are controversial. Three international expert meetings which proposed recommendations for NCGS were not independently organized and only partially transparent regarding potential conflicts of interest of the participants. The present position statement reflects the following aspects about NCGS from an allergist’s and nutritionist’s point of view: (A) Validated diagnostic criteria and/or reliable biomarkers are still required. Currently, this condition is frequently self-diagnosed, of unknown prevalence and non-validated etiology. (B) Gluten has not been reliably identified as an elicitor of NCGS because of high nocebo and placebo effects. Double-blind, placebo-controlled provocation tests are of limited value for the diagnosis of NCGS and should be performed in a modified manner (changed relation of placebo and active substance). (C) Several confounders hamper the assessment of subjective symptoms during gluten-reduced or gluten-free diets. Depending on the selection of food items, e.g., an increased vegetable intake with soluble fibers, diets may induce physiological digestive effects and can modify gastrointestinal transit times independent from the avoidance of gluten. (D) A gluten-free diet is mandatory in celiac disease based on scientific evidence. However, a medically unjustified avoidance of gluten may bear potential disadvantages and risks. (E) Due to a lack of diagnostic criteria, a thorough differential diagnostic work-up is recommended when NCGS is suspected. This includes a careful patient history together with a food-intake and symptom diary, if necessary an allergy diagnostic workup and a reliable exclusion of celiac disease. We recommend such a structured procedure since a medically proven diagnosis is required before considering the avoidance of gluten.

Characteristics and comorbidities of inpatients without celiac disease on a gluten-free diet.

Despite the increasing popularity of gluten-free diet (GFD), the demographic characteristics and medical features of patients without celiac disease on this diet have not been extensively investigated.We aimed to characterize the medical conditions and demographic backgrounds of hospitalized patients without celiac disease who adhere to a GFD, to further understand their reasons for gluten avoidance. We performed an observational cohort study on all inpatients at Columbia University Medical Center on a GFD in 2011-2016, excluding those with celiac disease, compared with age-matched and sex-matched inpatients on a regular diet. We determined the odds ratio (OR) of being on a GFD for various comorbidities using conditional logistic regression. Of 769 inpatients on a GFD, most (63.6%) did not have celiac disease. Gluten-avoiding patients were more likely to be non-Hispanic Whites [OR: 2.92; 95% confidence interval (CI): 2.31-3.70]. They had a lower prevalence of hypertension (OR: 0.38; 95% CI: 0.27-0.52) and diabetes (OR: 0.58; 95% CI: 0.32-0.75) and higher prevalence of inflammatory bowel disease (OR: 1.56; 95% CI: 1.02-2.41), irritable bowel syndrome (OR: 6.16; 95% CI: 2.11-10.23), hyperthyroidism (OR: 2.73; 95% CI: 1.22-6.10), hypothyroidism (OR: 2.06; 95% CI: 1.39-3.06), lupus (OR: 2.87; 95% CI: 1.13-7.29), and autism spectrum disorder (OR: 23.42; 95% CI: 5.29-103.73). Nonceliac gluten-avoiding patients have higher prevalences of inflammatory bowel disease, irritable bowel syndrome, thyroid disease, lupus, and autism spectrum disorder, suggesting patients with these disorders have turned to a GFD for perceived benefit, despite a scant evidence basis.

Celiac Disease: aA Rare Cardiac Sequel

We explore the case of a 52-year-old woman who was transferred to our facility with recurrent torsade de pointes requiring repeated defibrillations. She had no previous medical history nor did she report any clear emotional or stressful triggers. In transit there were 14 episodes of polymorphic ventricular tachycardia, 11 of which required defibrillation. Her presenting electrocardiogram showed sinus rhythm with wide spread T-wave inversions and a QTc of 544 ms. In transit she was treated with intravenous potassium and magnesium. On arrival an isoprenaline infusion was commenced, which stabilised the patient. Coronary angiography showed non–obstructive disease with the left ventricular (LV) gram showing mid-wall variant Takotsubo cardiomyopathy. Bedside echocardiography showed low–normal LV systolic function of 55%, with no significant valvulopathy. Cardiac magnetic resonance imaging showed the resolving Takotsubo cardiomyopathy with no evidence of infiltrative disease. Despite clinical improvement, she had persistent hypomagnesaemia. Cardiomyopathy screening and investigations for hypomagnesaemia returned unremarkable with the exception of a strongly positive coeliac serology. With beta blockade, aggressive magnesium replacement, and gluten avoidance her QTc shortened and episodes of polymorphic ventricular tachycardia also settled as a consequence. She was discharged when stable and at the 6-month follow-up she remained asymptomatic with a resolution of her prolonged QT interval. This case identifies coeliac disease as a cause of severe electrolyte disturbances that resulted in recurrent torsade de pointes and Takotsubo cardiomyopathy that was treated conservatively (Figure 1, Figure 2). Figure 2Takotsubo LV gram. View Large Image Figure Viewer Download Hi-res image

An exploration into the motivation for gluten avoidance in the absence of coeliac disease.

To explore the motivation for gluten avoidance in the absence of coeliac disease (CD) and ascertain what symptoms are triggered by gluten and what beliefs/reasons influence this decision. Links between physical/psychological symptoms and gluten in CD are well known but less is known about those who self-select a gluten-free diet (GFD) in the absence of CD. An empirical study using responses to an anonymous on-line questionnaire. Closed questions were used as a screening tool to exclude participants who had CD, wheat allergy or were following a low FODMAP diet. Data from participants using a GFD in the absence of a medical diagnosis was then analysed using thematic analysis. 120 initial responses, 87 were completed in full. 23 respondents fulfilled the inclusion criteria for thematic analysis. 7 different themes emerged, including one for signs/symptoms. Other themes identified included difficulties of a GFD, health beliefs, feelings and influence on decision to follow a GFD. Responses indicate that the reasons for gluten avoidance are in the most part reasoned and logical and were based around participants' self-management of symptoms. Symptoms included those typical of irritable bowel syndrome (IBS), but also infertility, low mood/energy, immune function and weight management and visual and auditory hallucinations. It appears the majority of responses analysed thematically could fit into the spectrum of non-coeliac gluten sensitivity (NCGS). Findings also suggest more support at all levels of medical care may help patients establish if it is gluten, rather than wheat or FODMAPs particularly fructans that are contributing to signs/symptoms.