Food Triggers Research Articles

Association between irritable bowel syndrome and micronutrients: A systematic review.

Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut brain interaction with a multifactorial etiology. Food trigger avoidance is common among individuals with IBS and exclusion diets are gaining popularity. However, recent guidelines on IBS management cautioned regarding the use of unsupervised dietary therapy with concerns of development of poor eating habits and even nutritional deficiencies. We aimed to review the available literature on the effect of habitual and exclusion diets on micronutrient status as well as the role of micronutrient supplementation in alleviating IBS symptoms. Four electronic databases (PubMed, Embase, Cochrane, Web of Science) were searched for articles that reported micronutrient data in patients with IBS. Serum micronutrient levels and dietary intake of micronutrients in patients with IBS were collected. The extracted data were tabulated and organized by micronutrient type to observe for trends. Twenty-six articles were included in this systematic review (12 interventional and 14 observational studies). Studies showed that generally IBS subjects had lower levels of vitamin B2, vitamin D, calcium, and iron at baseline compared with non-IBS subjects. Studies also found that exclusion diets were associated with lower intake of micronutrients especially vitamin B1, B2, calcium, iron, and zinc. There was a lack of interventional studies on micronutrients. Irritable bowel syndrome patients are at risk of developing multiple micronutrient deficiencies that may have both localized gastrointestinal as well as systemic effects. Dietary management of IBS patients should include a proper dietitian review to ensure nutritional adequacy where possible.

THE INCIDENCE OF ANEMIA IN PREGNANT WOMEN WHO CONSUME TEA

Tea is the strong inhibitor to absorb non-heme iron because of tannin inside it. The Iron absorption is caused by inhibitor content and food trigger. Iron losing, nutrition factor, iron necessary increasing, and absorption disturbance in the food such as polifenol in the tea are one of iron deficiency anemia cause in pregnancy. The purpose of this research is for knowing what the relationship between tea drinking habit and iron deficiency anemia in woman pregnancy gestational age 37-40 weeks at Singosari Local Government Clinic, Malang Regency. The research design is using cross sectional analytic survey, Purposive Sample about 45 pregnant-woman respondents agree with inclusion criteria. The data collection is using questionnaire. Data analysis is using univariate and bivariate. The result of this research is acquired which the pregnant-woman who experience anemia about 51.1% with often tea consumption about 35.6%. The conclusion of this research has relationship between tea consumption and iron deficiency anemia about 0.574.

Comparison of macro and micronutrients intake in an Indian subpopulation with acne vulgaris versus controls: an observational study

<p><strong>Background:</strong> Diet plays an important role in the development and severity of acne, a debilitating and psychologically distressing skin condition attributable to chronic inflammation. The diverse food cultures, influence of globalisation and confounding genetic and environmental factors have prompted studies of specific diet on acne. However, diet being a controllable factor, it would be useful to discern the beneficial and harmful effects of certain foods on acne. The aim of the study was to compare macro and micronutrient intakes in persons with acne vulgaris versus controls in an Indian subpopulation in Mumbai city. Current case-controlled, prospective, observational survey was conducted during September to December 2017 with 210 participants aged 18 to 40 years.</p><p><strong>Methods:</strong> We used semi-quantitative Food frequency questionnaire and 24-hour recall tests to identify the pattern of food consumption between acne and non-acne individuals. Statistical analysis was performed using “t” test and ANOVA.</p><p><strong>Results:</strong> Our analysis revealed that the individuals with acne consume a higher portion of dairy products, refined cereals and relatively smaller portions of whole cereals. Acne group had a significant lower (p<0.05) intake of pulses, omega-3 and 6 fatty acids, α-linolenic acid than the non-acne group. Significant difference indicated a lower consumption of micronutrients including zinc (p=0.012), thiamine (p<0.05), and niacin (p=0.01) among acne individuals.</p><p><strong>Conclusions:</strong> Study findings suggest an increased consumption of inflammation triggering foods and lower consumption of foods with anti-inflammatory and antioxidant property in the acne group of individuals.</p>

How is laughter used to create and reinforce food attitudes in Japanese Dairy Taster Brunch conversations

Abstract This paper investigates how participants use laughter to create and reinforce food attitudes in conversations over a Dairy Taster Brunch. Previous conversation analytic research on Japanese conversations about food has focused on food assessments, identification, and categorization. This research addresses the following questions: 1) How does food trigger humor and laughter in conversations over food? 2) What about the situation elicits laughter? 3) How is humor and laughter used to create and reinforce food attitudes in the conversational interaction? and 4) What kinds of food attitudes are created using humor and laughter in talk about food? Results show that food attitudes are not lodged in the individual but rather are created and reinforced moment-by-moment in temporally unfolding multimodal conversational interaction. This research contributes to the growing body of research on language and food, sheds light on the relation between laughter and food, and has implications for healthy eating, and cross-cultural communication.

Emerging Pattern of Post-COVID-19 Parosmia and Its Effect on Food Perception.

Olfactory dysfunction is amongst the many symptoms of Long COVID. Whilst most people that experience smell loss post COVID-19 recover their sense of smell and taste within a few weeks, about 10% of cases experience long-term problems, and their smell recovery journey often begins a few months later when everyday items start to smell distorted. This is known as parosmia. The aim of this study was to identify the key food triggers of parosmic distortions and investigate the relationship between distortion and disgust in order to establish the impact of parosmia on diet and quality of life. In this cross-sectional study (n = 727), respondents experiencing smell distortions completed a questionnaire covering aspects of smell loss, parosmia and the associated change in valence of everyday items. There was a significant correlation between strength and disgust (p < 0.0001), and when the selected items were reported as distorted, they were described as either unpleasant or gag-inducing 84% of the time. This change in valence associated with loss of expected pleasure and the presence of strange tastes and burning sensations must certainly lead to changes in eating behaviours and serious longer-term consequences for mental health and quality of life.

Should children with immunoglobulin E–mediated food allergy be screened for eosinophilic esophagitis?

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus, involving an allergen-mediated process highly associated with other atopic conditions.1–3 Several studies have identified the significance of food antigens underlying EoE development, evidenced by treatment using food elimination diets and the emergence of EoE with oral immunotherapy.4,5 The progression from immunoglobulin E–mediated food allergy (IgE-FA) to EoE has been illustrated, either from the same or different food triggers.

Predictors of Response to Oral Medications and Low-Histamine Diet in Patients with Chronic Urticaria.

Background Chronic urticaria (CU) is comprised of diverse phenotypes, and thus, a shift towards a precision medical approach is warranted in its management. Methods This study enrolled 78 patients with CU. Serum erythrocyte sedimentation rate, hemoglobin, hematocrit, eosinophil count, IgE, antinuclear antibody (ANA), and serum diamine oxidase (DAO) levels of the patients were measured and were compared according to the patient's response to second-generation antihistamines (sgAH), corticosteroids, leukotriene receptor antagonist (LTRA), H2 blockers, and low-histamine diet. Results Age- and sex-adjusted logistic regression analysis showed that patients with duration of CU > 3 years (adjusted odd ratio [aOR] = 4.39) and a DAO level < 10 U/mL (aOR = 3.90) were significantly associated with a good sgAH response. Age > 50 years (aOR = 0.02), duration of chronic urticaria > 3 years (aOR =0.06), and an ANA titer ≥ 1 : 80 (aOR = 0.03) were significantly and inversely associated with corticosteroid response. A low-histamine diet response was significantly associated with LTRA response (aOR = 67.29). In addition, a DAO level < 5.4 U/mL (aOR = 71.95) was significantly associated with H2 blocker response. Furthermore, concomitant angioedema (aOR = 10.56), multiple food triggers (aOR = 11.69), and a DAO level < 5.4 U/mL (aOR = 3.78) were significantly associated with a low-histamine diet response. Conversely, dermatographic urticaria and a hematocrit level < 36% were significantly and inversely associated with low-histamine diet response. Conclusions Several promising biomarkers were identified in this study to predict the efficacy of chronic urticaria treatment. DAO could be a novel biomarker for predicting the efficacy not only of dietary intervention but also for antagonists of H1 and H2 receptors.

Helicobacter pylori infection and lactose intolerance increase expiratory hydrogen.

Infection with Helicobacter pylori (H.pylori) may cause dyspepsia and/or unexplained functional nonspecific, gastrointestinal complaints of the irritable bowel syndrome (IBS) spectrum. Hitherto, in H. pylori infected patients with symptoms of the IBS spectrum the occurrence of additional food intolerance/malabsorption is not evaluated. We used a retrospective analysis of charts from 548 patients who presented with gastrointestinal complaints of the irritable bowel syndrome spectrum. An enzyme-linked IgA immunosorbent assay or histologic evaluation of gastric mucosa were used to detect H. pylori infection. A hydrogen breath (H2) test was performed to evaluate fructose malabsorption (FM) and lactose intolerance (LIT). Serum diamine oxidase value of <10 U/ml and a response to a histamine-reduced diet was used to identify histamine intolerance (HIT). We found 293 patients infected with H. pylori, within these were 58 H. pylori patients with LIT, 23 H. pylori LIT patients with FM and 46 H. pylori LIT patients with HIT. Additionally, 13 H. pylori, lactose- and histamine intolerance patients also had FM. The Kruskal Wallis test and pairwise comparison were used to analyze differences of the area under the curve of expiratory hydrogen. In lactose H2 breath tests compared with LIT-only patients, LIT with H. pylori, LIT and H. pylori with HIT, LIT and H. pylori with FM showed significantly higher exhaled H2 levels (p=0.022). Pairwise comparison demonstrated H. pylori infected patients with LIT exhaled more H2 compared to LIT-only (p=0.029). H. pylori with lactose- and histamine intolerance, and H. pylori with lactose-, histamine intolerance and FM compared to H. pylori-only patients indicated a significantly higher occurrence of stomach pain during lactose H2 breath tests (p=0.012 and p=0.005, respectively). We demonstrate that LIT patients with high expiratory H2 levels in lactose breath tests may have H. pylori infection and possibly additional food intolerance/malabsorption. Subsequently, besides H. pylori eradication, a dietician is necessary for an individually tailored reduction- or exclusion diet of symptom triggering food components.

Food and Inflammatory Bowel Diseases: A scoping review on the impact of food on patients' psychosocial quality of life.

Growing bodies of literature show that a controlled diet is important in controlling the symptoms of Inflammatory Bowel Diseases (IBD). This leads patients to avoid foods considered potentially harmful. However, food is not just a nutrient but entails a series of hedonistic, cultural and social values. Thus, there is the concern that having to renounce certain foods might exert an impact on patients’ psychosocial quality of life, particularly in younger patients. The aim of this paper is to review the existing literature to address which aspects of the patients’ quality of life are affected by food restrictions. A scoping review was carried out. Five different databases were searched in January 2021. Retrieved papers were then screened to only include the relevant studies. Data were extracted and the main results of the studies were charted. A thematic analysis was carried out on the main results to identify the areas of psychosocial quality of life more often impacted by the food restrictions. From the initially identified 1967 unique entries, 14 studies were included. Results show that the perceived importance of food in controlling symptoms is confirmed by patients’ accounts. The most common strategy adopted was, thus, the avoidance of trigger foods. The thematic analysis revealed three domains that are impacted by these restrictions: psychological quality of life, social life, family sphere. This study highlights the impact that food restrictions exert on IBD patients’ quality of life, and warrants further studies to fill existing gaps, in particular regarding younger patients.

Maillard Reaction Induced Changes in Allergenicity of Food.

Food allergy is increasing in prevalence, posing aheavier social and financial burden. At present, there is still no widely accepted treatment for it. Methods to reduce or eliminate the allergenicity of trigger foods are urgently needed. Technological processing contributes to producing some hypoallergenic foods. Among the processing methods, the Maillard reaction (MR) is popular because neither special chemical materials nor sophisticated equipment is needed. MR may affect the allergenicity of proteins by disrupting the conformational epitope, disclosing the hidden epitope, masking the linear epitope, and/or forming a new epitope. Changes in the allergenicity of foods after processing are affected by various factors, such as the characteristics of the allergen, the processing parameters, and the processing matrix, and they are therefore variable and difficult to predict. This paper reviews the effects of MR on the allergenicity of each allergen group from common allergenic foods.

Assessing the effects of mining projects on child health in sub-Saharan Africa: a multi-country analysis

BackgroundThe African continent hosts many industrial mining projects, and many more are planned due to recent prospecting discoveries and increasing demand for various minerals to promote a low-carbon future. The extraction of natural resources in sub-Saharan Africa (SSA) represents an opportunity for economic development but also poses a threat to population health through rapid urbanisation and environmental degradation. Children could benefit from improved economic growth through various channels such as access to high-quality food, better sanitation, and clean water. However, mining can increase food insecurity and trigger local competition over safe drinking water. Child health can be threatened by exposure to mining-related air, noise, and water pollution. To assess the impact of mines on child health, we analyse socio-demographic, health, and mining data before and after several mining projects were commissioned in SSA.ResultsData of 90,951 children living around 81 mining sites in 23 countries in SSA were analysed for child mortality indicators, and 79,962 children from 59 mining areas in 18 SSA countries were analysed for diarrhoea, cough, and anthropometric indicators. No effects of the launch of new mining projects on overall under-five mortality were found (adjusted Odds Ratio (aOR): 0.88; 95% Confidence Interval (CI): 0.68–1.14). However, activation of mining projects reduced the mortality risk among neonates (0–30 days) by 45% (aOR: 0.55; 95% CI: 0.37–0.83) and risk for a child to develop diarrhoeal diseases by 32% (aOR: 0.68; 95% CI: 0,51–0.90). The timing analysis of observed changes showed that there is a significant decline in the risk for childhood diarrhoea (aOR: 0.69; 95% CI: 0.49–0.97), and the mean height-for-age z-scores by 28 percentage points, during the prospection and construction phase; i.e., within four years to the initiation of extraction activity. No effects were found for cough and weight-for-height.ConclusionThe results presented suggest that the impacts of mining on child health vary throughout the mine’s life cycle. Mining development likely contributes positively to the income and livelihoods of the impacted communities in the initial years of mining operations, particularly the prospection and construction phase; these potential benefits are likely to be at least partially offset by food insecurity and environmental pollution during early and later mining stages, respectively. Further research is warranted to better understand these health impacts and to identify policies that can help sustain the positive initial health impacts of mining projects in the long term.

Atopic Dermatitis and Food Allergy: Best Practices and Knowledge Gaps—A Work Group Report from the AAAAI Allergic Skin Diseases Committee and Leadership Institute Project

Allergists are often asked to evaluate children with atopic dermatitis (AD) for allergen triggers to disease. Testing, particularly for food triggers, often leads to elimination diets in an effort to improve AD control. However, the dual exposure hypothesis suggests that oral tolerance to food antigens is promoted through high-dose oral exposure, where sensitization occurs through lower dose cutaneous exposure. This suggests that strict elimination diets may pose some risks in children with AD. In addition, emerging evidence suggests an important role of skin inflammation in further allergic disease and the importance of dietary exposure to maintain oral tolerance. This work group report reviews current guidelines-based management for children with moderate-to-severe AD, the evidence for current recommendations for the evaluation and management of these children, provides a nuanced examination of these studies, and addresses current knowledge gaps in the care of these children.

EFFICACY OF A DIGITALLY DELIVERED PERSONALIZED ELIMINATION DIET FOR THE SELF-MANAGEMENT OF INFLAMMATORY BOWEL DISEASE AND IRRITABLE BOWEL SYNDROME

Abstract BACKGROUND A large majority (60-80%) of Inflammatory Bowel Disease (IBD) and irritable bowel syndrome (IBS) patients report that symptoms originate from, or are exacerbated by “trigger foods”, and modify their diets to alleviate discomfort. Dietary interventions appear to be a reasonable complementary treatment to traditional clinical care. Despite demand, there is no consensus on what diet is best for IBD or IBS patients. Popular diets, such as the low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet (FODMAP) have notable limitations (e.g., implementation cost, length, complexity) and are not personalized to an individual. OBJECTIVE The purpose of this study was to evaluate the feasibility, desirability, and impact on gastrointestinal symptoms and quality of life (QoL) of a digitally delivered personalized elimination diet for IBD and IBS patients. METHODS This was a single-center open-labeled uncontrolled prospective cohort study. Participants were recruited online and were provided access to Agora Health, LLC’s digital personalized nutrition tool (N=37; CD = 9, UC = 12, IBS = 16). Over a period of 9 weeks, participants followed Agora’s 4-step elimination diet protocol: identification, elimination and reintroduction of trigger foods, followed by a maintenance phase. At baseline, daily, and at conclusion, symptom scores were calculated. The Patient-Based Simple Clinical Colitis Activity Index (P-SCCAI) and Mobile Health Index for Crohn’s Disease (mHI-CD) were used to calculate IBD disease severity. The Irritable Bowel Syndrome Symptom Severity Score (IBS-SSS) was used to assess IBS symptomatology. In addition to IBD &amp; IBS symptoms, participants provided qualitative assessments of energy, stress, physical activity, and QoL. RESULTS The digital personalized elimination diet program improved symptoms and received strong positive reviews. Significant symptom improvement (p&amp;lt;0.05 two-tailed t-test, Bonferroni-corrected) was seen for 81% of participants at week 5 (phase 2) and persisted for 70% at week 9 (phase 4), measured by the relevant symptom severity score. Clinically significant symptom improvement (&amp;gt;25% reduction in P-SCCAI or mHI-CD scores, &amp;gt;35-point reduction in IBS-SSS) was observed in 78% of participants at week 5 and 62% at week 9. Ninety-five percent of participants felt more empowered and in control of their digestive health and 89% felt their quality of life improved due to the program. Sixty-two percent reported improved energy, 68% reported lower stress and 60% reported more physical activity after completing the program. Daily engagement was seen for 95% of participants and 92% were satisfied with the program. CONCLUSIONS Dietary elimination can improve symptoms in patients with IBD and IBS and digital tools can improve adherence and engagement. Randomized controlled trials are warranted.

EFFICACY OF A DIGITALLY DELIVERED PERSONALIZED ELIMINATION DIET FOR THE SELF-MANAGEMENT OF INFLAMMATORY BOWEL DISEASE AND IRRITABLE BOWEL SYNDROME

A large majority (60-80%) of Inflammatory Bowel Disease (IBD) and irritable bowel syndrome (IBS) patients report that symptoms originate from, or are exacerbated by “trigger foods”, and modify their diets to alleviate discomfort. Dietary interventions appear to be a reasonable complementary treatment to traditional clinical care. Despite demand, there is no consensus on what diet is best for IBD or IBS patients. Popular diets, such as the low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet (FODMAP) have notable limitations (e.g., implementation cost, length, complexity) and are not personalized to an individual.

Accidental Reactions to Foods: Frequency, Causes, and Severity.

Purpose of ReviewIn this review, we present the epidemiology of food allergy and allergic reactions to foods using studies that have been published over the past decade. We review these allergic reactions — how they differ by food trigger, geographic region, demographic distribution, setting, and severity.Recent FindingsThe rising prevalence of food allergy and persistent accidental allergic reactions to foods in various settings remains a worldwide concern. Differences in global prevalence, food triggers for reactions, and severity of accidental reactions may be explained by diversity in diets and food labeling legislation. A number of studies are highlighted that describe the unique challenges and risk factors that contribute to accidental reactions in restaurants and schools, as well as the efforts that have been made to improve safety and outcomes in these settings.SummaryFood allergy prevalence has demonstrated significant variations between regions and age groups. Despite best efforts by individuals, physicians, and legislative bodies to improve safety for food allergic individuals, accidental reactions to foods still occur and can result in fatalities.

Evidence-based treatments for eosinophilic esophagitis: insights for the clinician.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. Left untreated, EoE progresses to fibrous remodeling and stricture formation that impairs quality of life. Therefore, EoE requires either repeated treatments or maintenance therapy. Current guidelines recommend swallowed topical corticosteroids (STCs), proton-pump inhibitors (PPIs), or dietary intervention as initial options to induce and maintain long-term disease remission. Impractical exclusive elemental diets and suboptimal allergy testing-directed food avoidance paved the way for empirical elimination diets. These are moderately effective and highly reproducible in inducing EoE remission and allow for identification of specific food triggers. Step-up strategies, including two- and four-food rather than six-food elimination diets, should be considered as initial approaches for dietary treatment in patients of all ages, as they reduce the need for endoscopic procedures, shorten diagnostic processing time, and avoid unnecessary restrictions. Formulations of STC originally designed for asthma therapy are suboptimal for EoE treatment, with new effervescent orodispersible tablets and viscose formulations designed to coat the esophageal mucosa providing increased effectiveness at reduced doses. The anti-inflammatory effects of PPI in EoE are independent from gastric acid secretion inhibition; despite evidence from observational research, PPIs are the most commonly prescribed first-line therapy for EoE due to their accessibility, low cost, and safety profile. Double doses of PPI only induce remission in half of EoE patients, irrespective of the drug used or patients’ age. Inflammatory rather than stricturing EoE phenotype and treatment duration up to 12 weeks increase chances of achieving EoE remission. Most responders effectively maintain long-term remission with standard PPI doses. Finally, endoscopic dilation should be considered in patients with reduced esophageal caliber or persistent dysphagia despite histological remission. This article provides a state-of-the-art review and updated discussion of current therapies and newly developed options for EoE.

FPIES: Data for Germany in international comparison.

Food protein-induced enterocolitis syndrome (FPIES) is a rare, non-IgE-mediated food allergy. The triggering foods differ significantly from the typical triggers of an IgE-mediated food allergy. Until recently, there were no data on triggers of FPIES in Germany. In order to create an advisory basis for the care of German patients, a large multicenter study was initiated and published at the end of 2021. This revealed clear differences in international comparisons. The most frequent triggers for FPIES in Germany are cow's milk, fish, vegetables, and meat. Most children (84%) react to only one food. The prognosis is usually good, depending on the trigger. Regional data should be used for counseling patients with FPIES. Specific recommendations for this are given in this article.

Allergen immunotherapy for food allergy: Evidence and outlook.

Food allergy represents a significant health issue characterized by a sizeable epidemiological burden, involving up to 5% of adults and up to 8% of children in the Western world. The elimination diet of the trigger food is the cornerstone of food allergy management. However, novel treatment options are most wanted to provide alternative strategies for this potentially fatal medical condition. Allergen immunotherapy for food allergy (FA-AIT) is considered an immunomodulatory intervention where regular exposure to increasing doses of food is performed in the context of an allergist's supervised protocol. The main objective is to decrease reactivity, attenuate life-threatening allergic episodes and reduce frequent access to the emergency department. Achieving food tolerance off-treatment is, however, the ultimate aim. In this review, we aim to summarize FA-AIT evidence and outlook.

Immunotherapy in hen’s egg protein allergy

Food allergy is a significant health issue, for which the standard treatment recommendation is the elimination diet of the trigger foods. Allergen immunotherapy for food allergies is considered a form of immunomodulatory treatment that involves regular exposure to increasing doses of food (ex.: egg, cow’s milk, peanuts) under the supervision of an allergist, with the aim to decrease reactivity, attenuate life-threatening allergic episodes and reduce frequent access to the emergency service. The major goal of immunotherapy is to achieve food tolerance after discontinuation of treatment. The clinical and immunological response is different depending on the route of administration, oral immunotherapy proving a higher rate of effectiveness compared to sublingual or epicutaneous administration, but also a higher frequency of adverse reactions. Current guidelines support clinicians with updated recommendations that provide management options for patients with severe IgE-mediated food allergies.

Nutrition in Patients with Lactose Malabsorption, Celiac Disease, and Related Disorders.

Lactose malabsorption (LM), celiac disease (CD), non-celiac gluten sensitivity (NCGS), and irritable bowel syndrome (IBS) are conditions associated with food triggers, improvement after withdrawal, treatment with dietary restriction, and subsequent nutritional detriments. LM occurs when there is incomplete hydrolysis of lactose due to lactase deficiency and frequently produces abdominal symptoms; therefore, it can cause lactose intolerance (LI). A lactose-restricted diet is frequently recommended, although it can potentially lead to nutrient deficiencies. Furthermore, lactose is an essential component of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) and is subsequently associated with intolerance to these compounds, especially in IBS. LM commonly presents in CD. Nutritional deficits are common in CD and can continue even on a gluten-free diet (GFD). Conditions triggered by gluten are known as gluten-related disorders (GRDs), including CD, wheat allergy, and NCGS. IBS can also be associated with a gluten sensitivity. A GFD is the treatment for CD, GRDs, and gluten sensitive IBS, although compliance with this restricted diet can be difficult. Strict dietary therapies can have a negative effect on quality of life. This review aims to provide an overview of the difficult nutritional elements of these disorders, which are critical for medical providers to recognize when managing these patients.