Gluten-free Meal Research Articles

From Struggle to Strength: A Multicentric Study on How Public Policies for Celiac Disease Transform Lives.

This multicenter study aims to assess the impact of public policies (PPs) on the health-related quality of life (HRQoL) of individuals with celiac disease (CD) using the Celiac Disease Questionnaire (CDQ) and PPs for Celiac Disease Score (PPCDS). This cross-sectional exploratory study was conducted in four stages: first, standardizing data from countries using the CDQ; second, analyzing PPs aimed at CD patients; third, statistically examining these data; and fourth, associating HRQoL indicators with corresponding PPs. This study analyzed 15 CDQ assessments from 12 countries from 2007 to 2023. It found that comprehensive PPs positively correlated with HRQoL outcomes (Spearman correlation of 0.358). However, policies specifically targeting gluten-free meals and certification did not significantly improve HRQoL individually, suggesting they may be more effective when implemented together. Additionally, specialized health services did not notably reduce gastrointestinal symptoms, underscoring the necessity for improved patient education to enhance the effectiveness of these services. This study concludes that implementing and rigorously monitoring regulations to support CD patients is crucial for enhancing their HRQoL.

Assessment of Knowledge of Gluten-Free Diet Amongst Food Handlers in Hospitals.

Purpose: When admitted to the hospital, individuals with celiac disease rely on food handlers for provision of safe, uncontaminated gluten-free meals. We aimed to assess the knowledge of gluten-free diet (GFD) amongst individuals involved in meal preparation for patients.Methods: A questionnaire with 10 demographic and 35 test items to assess knowledge of GFD, including workplace scenarios encountered in meal preparation, was administered to food handlers including cooks, utility workers, dietary technicians, and supervisors in 2 tertiary care, university-affiliated hospitals. A score of ≥28 of 35 (≥80%) was considered a "pass".Results: A total of 72 individuals completed the study, mean age 40.3 ± 1.6 years, 75% female. Only 42 (56.8%) scored ≥80% and achieved a pass. The average score was 75.9% ± 13.4%, range 25.7%-100%. The supervisors had significantly higher scores (87.9% ± 11.4%) than utility workers (73.0% ± 11.4%; P = 0.01) and cooks (71.7% ± 14.5%; P = 0.01). Cooks had the lowest scores with 80% scoring <80%. Females scored higher than males (77.8% vs. 68.8%; P = 0.02).Conclusions: There are significant differences in GFD knowledge amongst various groups involved in food preparation in hospitals. The gaps identified in knowledge can potentially compromise the safety of patients with celiac disease. Targeted interventions to educate hospital food handlers about GFD are warranted. Registered Dietitians can play an important role in providing this education.

A Cross-Sectional Study of Celiac Disease Awareness in the Food Industry in the Western Region of Saudi Arabia.

BackgroundThe only treatment available for celiac disease (CD), an autoimmune disease, is a gluten-free diet. Restaurant personnel have major roles in understanding the possible risks to consumers with CD, ensuring the availability of and preparing gluten-free foods. We attempted to evaluate the awareness and knowledge of CD among chefs, cooks, restaurant personnel, and owners and assess the availability of gluten-free diet options in the western region of Saudi Arabia.MethodsA cross-sectional, questionnaire-based study was conducted in 126 restaurants based in Makkah al-Mukarramah and Jeddah cities. The chefs and owners of the restaurants were interviewed face-to-face to collect data knowledge about CD, gluten sensitivity, food containing gluten, serving gluten-free food, intention to add gluten-free options in the future, and circumstances related to serving gluten-free food.ResultOur study showed that 17.5% and 51.6% of the participants had heard about CD and gluten sensitivity, respectively, and 34.1% checked a right answer of gluten-containing food with a mean of 0.68 (±1.02). About 17.5% of the participating restaurants serve gluten-free meal options (mean: 0.63±1.57), 14.7% had protocols for the preparation of gluten-free food, 7.1% displayed signs or notices that they sell gluten-free products, and 50.8% disclosed an intention to add gluten-free options in the future. Furthermore, 82.5% of gluten-free options were more expensive. Education level, being a trained chef, and experience years were significantly associated with awareness about CD or gluten sensitivity (p<0.05).ConclusionThere is a general lack of awareness of CD, and most restaurants lack gluten-free options. We recommend adding more gluten-free food options for patients with CD.

Gluten-free meals: What to consider?

The prevalence of gluten-associated diseases has been steadily increasing in recent decades. Today, the gluten-free diet (GFD) is the main treatment for these diseases. But compliance with it is associated with the risks of a deficiency of essential nutrients, vitamins and a violation of the intestinal microbiota, therefore, patients with gluten-associated diseases are under the constant supervision of a gastroenterologist and nutritionist for prompt correction of the diet in case of complications. However, the popularity of GFD is rapidly gaining momentum among individuals who do not have an objective medical indication for restricting gluten. This is primarily due to the fashion trend for observing various diets, wide coverage of this topic on the Internet, the media and popular science literature. But, unfortunately, not all of the information provided has an evidence base, and many do not seek help from specialists for advice about GFD. Thus, a large number of people are not aware of the indications and effects of this diet on the body. The purpose of the publication is to systematize the available data on the risks associated with adherence to GFD.

S1335 Assessment of Knowledge of Gluten-Free Diet Amongst Food Handlers in Hospitals

Introduction: Individuals with celiac disease (CD) and other gluten-related disorders require a strict gluten-free diet (GFD). If ever admitted to hospital, they rely on food handlers for provision of safe, uncontaminated gluten-free meals. Previous studies have assessed knowledge of CD and GFD in restaurant chefs, dietitians, and physicians. However, there is no such research on food service personnel in health care institutions such as hospitals. We aimed to assess the basic knowledge of GFD and food preparation practices amongst individuals involved in making meals for patients in hospital. Methods: A questionnaire was developed with 10 demographic items and 35 test items to assess knowledge of GFD including practical workplace scenarios encountered in food preparation. The questionnaire was developed by members of the research team, which included adult and pediatric gastroenterologists and dietitians with expertise in GFD. Further guidance was obtained from chefs, patients with CD and parents of children with CD. A score of 28 out of 35 (80%) was set as a Pass. Subjects were recruited from food handling services of two tertiary care, university-affiliated hospitals and included cooks, utility workers, dietary technicians and supervisors. Results: A total of 72 individuals completed the study, mean age 40.3 ± 1.6 years, 75% female. Only 42 (56.8%) scored a Pass. The average test score was 75.9 ± 13.4% (26.6 out of 35), range 25.7-100%. The supervisors (87.9 ± 11.4%) had significantly higher scores than utility workers (73.0 ± 11.4%, P = 0.01) and cooks (71.7 ± 14.5%; P = 0.01), but similar to scores of dietary technicians (87.1 ± 8.0%, P = 1.0). Cooks had the lowest scores and highest fail rate (80%). There was a significant difference in scores between male and female participants (68.8 vs 77.8%; P = 0.02). Conclusion: There are significant differences in gluten-free diet knowledge between various individuals involved in food preparation in hospitals. While supervisors and dietary technicians play important roles in the selection of gluten-free meals and accordingly have higher levels of formal education in nutrition, cooks and utility workers are at the frontline in meal preparation and these individuals must be adequately educated on GFD. We identified gaps in knowledge of gluten-free diets amongst food handlers, which has a potential of compromising the safety of patients with celiac disease. Targeted interventions to educate these individuals about gluten-free diet are required.

The Underlying Effects of Celiac Disease and Subsequent Implications on Deployment in the United States Army.

The purpose of this review is to provide an overview of the etiology, pathology, and treatments for celiac disease (CD), as well as to provide context as to how CD impacts the U.S. military. To conduct this review, the authors surveyed recent epidemiology and immunology literature in order to provide a detailed summary of the current understanding of CD, its diagnosis, and the real-world impacts within the Department of Defense (DoD). We described the gluten proteins and both the immune response in CD. We further describe the underlying genetic risk factors and diagnosis and pathogenesis of the disease and conclude the review with a discussion of how current DoD regulations impact U.S. military readiness. Celiac disease (CD) is an autoimmune disorder that results in damage to the small intestine. Ingestion of gluten in a CD patient is usually followed by villous atrophy in the small intestine, often along with other gastrointestinal symptoms. Around 1% of patients diagnosed with CD can experience complications if gluten-free diet is not followed, including intestinal lymphoma and hyposplenism. Therefore, a patient showing possible symptoms should discuss the diagnostic process with their healthcare providers to ensure adequate understanding of serological and genetic tests along with the histological examination of intestinal biopsy. Patients should seek consults with registered dietitians to structure their diets appropriately. Considering the prevalence and incidence of CD and gluten intolerances are increasing, the military should consider providing gluten-free Meals Ready-to-Eat as an option for all service members. Given the retention of service members with CD, subsequent admission of personnel with mild CD that does not affect the duties will allow the DoD access to a growing population of fully capable service members with critical technical skills who are eager to serve the USA.

Enzyme Therapy for Patients with Celiac Disease - An Update

Enzyme therapy as a management tool for patients with celiac disease (CD) or gluten intolerance is gaining acceptance around the world. Gluten has multiple side effects and limitations of a gluten-free diet (GFD) in management of CD are evident and mainly related to the presence of hidden gluten or cross-contamination of meals in restaurants. The present paper discusses enzyme therapy with caricain, namely Gluteguard, in light of various approaches searching for a treatment or an effective management of CD. Regular users of the supplement Gluteguard report a high level of satisfaction with the product. This indicates that enzyme therapy based on caricain has its place as a safeguard when the gluten-free meals are prepared outside the control of the patients.

Gluten-free meals in public catering.

The Piedmont Region, the Food Hygiene and Nutrition Services of the Local Healthcare Authorities of the Piedmont Region (coordinated by ASL TO 3), and the Italian Coeliac Association Piedmont Onlus, have created a theoretical-practical training pathway for Food Business Operators to ensure a safe gluten-free meal. The aim of the study is to perform a retrospective analysis of the data collected in order to assess whether the Food Business Operators will be able to manage in the short, medium and long term audits (3-month audits, 6-month audits and 1-year audits) all the production stages of a gluten-free meal (storage, production. We have analysed the check-list used for assessing the gluten free meal, recorded from 2010 to 2016 by the staff of the Food Hygiene and Nutrition Services. They were filled out during three educational audits and they refer to 81 facilities. Two-hundred and forty-three audits were conducted (3 per facility). During all stages of production of gluten-free meals (short, medium and long term), non-compliant aspects had decreased (not statistically significant). The data analysis showed a slight increase in non-compliant aspects after a 1-year storage, the trend of non-compliant aspects slightly decreased during the three production stages, the service stage registered a slight upward trend, and finally, during the basic requirements stage and control plan stage, non-compliant aspects were in sharp decline (statistically significant). The decrease of non-compliance guarantees safety and protection of the celiac subject, even if storage and services must be monitored more carefully in the medium term.

Design and evaluation of an HACCP gluten-free protocol in a children's hospital

For patients with gluten intolerance, the most common cause of treatment failure is an inadequate gluten-free diet (GFD), such as because of gluten contamination. Here we describe the design, implementation and validation of an HACCP protocol for preparing gluten-free meals in a children's hospital. Gluten content in prepared meals was analyzed using R5 sandwich ELISA, which indicated that gluten concentrations did not exceed 20 mg/kg. Total daily gluten intake of patients on the GFD was less than 10 mg.

A Gluten-Free Meal Produces a Lower Postprandial Thermogenic Response Compared to an Iso-Energetic/Macronutrient Whole Food or Processed Food Meal in Young Women: A Single-Blind Randomized Cross-Over Trial.

Consumption of ultra-processed food (PF) is associated with obesity risk compared with whole food (WF) intake. Less is known regarding the intake of gluten-free (GF) food products. The purpose of this study was to directly compare the thermic effect (TEM), substrate utilization, hunger/taste ratings, and glucose response of three different meals containing PF, WF, and GF food products in young healthy women. Eleven volunteers completed all three iso-caloric/macronutrient test meals in a single-blind, randomized crossover design: (1) whole food meal (WF); (2) processed food meal (PF); or (3) gluten-free meal (GF). TEM was significantly lower following GF compared with WF (−20.94 kcal/meal, [95% CI, −35.92 to −5.96], p = 0.008) and PF (mean difference: −14.94 kcal/meal, [95% CI, −29.92 to 0.04], p = 0.04), respectively. WF consumption resulted in significantly higher feelings of fullness compared to GF (mean difference: +14.36%, [95% CI, 3.41 to 25.32%], p = 0.011) and PF (mean difference: +16.81%, [95% CI, 5.62 to 28.01%], p = 0.004), respectively, and enhanced palatability (taste of meal) compared to PF meal (mean Δ: +27.41%, [95% CI, 5.53 to 49.30%], p = 0.048). No differences existed for substrate utilization and blood glucose response among trials. Consumption of a GF meal lowers postprandial thermogenesis compared to WF and PF meals and fullness ratings compared to a WF meal which may impact weight control and obesity risk over the long-term.

Worldwide public policies for celiac disease: are patients well assisted?

To evaluate public policies (PP) to celiac disease (CD) patients and classify countries regarding the level of assistance provided by the Public Policies for Celiac Disease Score. Countries were scored from 0 to 6 according to the existence of PP regarding industrial food and meal regulations, health service support, food allowance/financial incentive, gluten-free (GF) food certification, and CD associations. Subsequently, countries were allocated to continents. In total, 192 countries are registered as members of the World Health Organization. The European continent (score 3.63) is the most advanced in CD patient care, followed by South America (2.86), North America (1.05), Asia (0.53), Oceania (0.5), and Africa (0.27). Industrial food regulations were the most frequent PP (40.6%). 15.6% of the countries display regulations for meals; 13.5% have health service support; 13.5% have policies of food allowance/financial incentive; 19.3% have GF certification; and 34.4% have celiac associations. Policies regarding GF meals and food safety certification, health service support, and financial incentives need improvement to ensure correct treatment and reduce the diseases' financial burden for celiac patients and governments.

Food Allergen and Gluten Training and Awareness Among Restaurant Workers Serving Gluten-Free Foods

Abstract Objectives Adherence to a strict gluten free (GF) diet is critical for patients with gluten related disorders (GRDs). Even though meals that are labeled or advertised as being GF are widely available in restaurants, their safety remains questionable. To protect customers with GRDs, restaurant workers need to be trained in proper procedures regarding food allergens, food intolerances and sensitivities. The purpose of this study was to assess training and awareness about gluten and GRDs among employees in restaurants that offered GF menu options. Methods A 28 question survey was created and distributed to restaurant employees nationwide. Employees were surveyed on food allergen training and their knowledge about gluten. Data were collected from 583 respondents who met the inclusion criteria. Relationships between variables were determined by chi square analysis. Effect size of statistically significant associations was determined by Cramer's V. Results Respondents to the survey were restaurant owners (37.1%), general managers (23.9%), lower level managers (9.8%), executive chefs and sous chefs (11%), culinary workers (chefs, cooks, line cooks and others 10%) and servers (7.9%). A majority (93%) of participants, reported that their restaurant was able to accommodate guests who requested a GF meal. Most (75.4%) employees reported that food allergen training took place at their restaurant. However, only 57.4% of employees had completed the training, with servers and kitchen staff the least likely to receive training at their current work place. At least 24.3% of all restaurant employees had never had training in the knowledge and handling of food allergens and/or gluten. When employees were categorized by job title, 43.5% of chefs, cooks, and line cooks and only 26.3% servers had completed food allergen training at their current restaurant. Most workers had heard of GRDs but only 52.6% of respondents recognized that celiac disease was an autoimmune disease triggered by gluten. Restaurant employees who had received food allergen training were significantly (P = .007) more likely to be aware of GRDs than those who had not. Conclusions Educating restaurant workers catering to clients with GRDs must be mandatory in order to safeguard meals served from inadvertent contamination with gluten. Funding Sources Eastern Michigan University, School of Health Sciences.

Gastric emptying: methodology and normal ranges for two commonly used meals in the UK.

A recent audit has highlighted that there is a large variation in the way gastric emptying scintigraphy is performed, analysed and reported in the UK. In this study, we have established a comprehensive protocol on how to perform gastric emptying including normal ranges for two of the most widely used meals. A standardized scrambled egg sandwich was used as the main meal. Normal ranges were also established for oat porridge as an alternative gluten-free meal. We have calculated normal ranges for several functional parameters which may be used to assess gastric emptying. We hope that establishing a reliable normal range for these two simple and commonly used meals will encourage adoption of a universally accepted protocol for measurement of solid gastric emptying in the UK. A total of 42 volunteers (20 male, 22 female, age range 22-68) with no history of gastrointestinal symptoms or diabetes were studied. Each volunteer fasted overnight and consumed two meals with similar nutritional composition on two separate days: scrambled eggs with two slices of bread were consumed on one day and gluten-free porridge (40 g in 200 mL whole milk) was consumed on a different day. Each meal was radiolabelled with 10 MBq of Tc-DTPA. Simultaneous anterior-posterior 2-min static images were acquired with the patient standing between the gamma camera detectors. Images were acquired every 5 min over a 2 hour period, followed by a single image at 3 hour. The data were modelled using a power-exponential function that allowed measurements of gastric emptying functional parameters including lag time, half-emptying time (HET), peak emptying rate, time-to-peak emptying (TPE) and exponential half-life (EHL). Three-hour retention was also calculated. Paired t-tests were used to compare the two meals and two-sample t-tests were used to assess gender-related differences. Regression analysis was used to assess correlation of the functional parameters with age and body habitus (body surface area, BSA). All gastric emptying functional parameters were significantly different between the two meals (P < 0.001). The normal range for lag time was 0-13 min for porridge and 1-34 min for scrambled egg. The normal range for HET was 18-73 min for porridge and 44-116 min for scrambled egg. The normal range for EHL was 21-57 min for porridge and 20-82 min for scrambled egg. The normal range for 3 hour retention was <7% for porridge and <17% for scrambled egg. Only weak significance was found for gender-related differences in gastric function for the two meals (0.05 < P < 0.10). Weak correlation was also observed for some functional parameters when plotted against age and BSA (0.05 < P < 0.10). We have established gastric emptying normal ranges for the two most commonly used meals in the UK. The normal ranges are meal specific and not interchangeable, with porridge showing significantly faster transit than scrambled egg for all measured parameters. Scrambled egg sandwich is the recommended meal for solid gastric emptying studies as it is more reproducible and more comparable to a normally consumed solid meal for our population. Porridge would be a suitable alternative for patients who are unable to eat egg sandwiches, for example, patients with egg allergy or gluten intolerance.

FOOD SERVICE OPERATORS BEHAVIOR AND KNOWLEDGE ON GLUTEN-FREE MEALS AND REQUIREMENTS OF PUBLIC CANTEENS: English

This study provides a summary of Celiac Disease (CD) epidemiology in Italy, canteens distribution and training courses for food service operators (FSOs) analyzing 2007-2017 data. Furthermore, behavior and knowledge of FSOs and organizational requirements for gluten-free (GF) meals in school and hospital canteens in central Italy were investigated. In parallel to an increased CD occurrence at national level, GF foods demand is significantly growing. Our survey in 20 inspected canteens revealed important knowledge and awareness gaps among FSOs, as well as lack of procedures and structural requirements for safely providing GF meals, underlining the need to improve education on topic.

Accidental Gluten Contamination in Traditional Lunch Meals from Food Services in Brasilia, Brazil

This study aimed to evaluate the occurrence of gluten contamination in naturally gluten-free meals from food services in the Federal District, Brazil. This is an exploratory cross-sectional quantitative study in which a total of 180 samples of naturally gluten-free dishes were collected from 60 food services in Brazil. The enzyme-linked immunosorbent assay was used for the quantification of gluten. As established by the Codex Alimentarius, the threshold of 20 ppm of gluten was considered as the accepted upper gluten level for gluten-free food. A total of 2.8% (95% CI: 0.3–5.2%) gluten contamination was found in the samples. Among the 60 food services, 6.7% (95% CI: 2.7–10.6%) displayed at least one contaminated food in our sample. The occurrence of gluten contamination in naturally gluten-free preparations was uncommon and low on a quantitative basis.

Randomized controlled trial of a gluten-free diet in patients with schizophrenia positive for antigliadin antibodies (AGA IgG): a pilot feasibility study

Approximately one-third of people with schizophrenia have elevated levels of anti-gliadin antibodies of the immunoglobulin G type (AGA IgG) — a higher rate than seen in healthy controls. We performed the first double-blind clinical trial of gluten-free versus gluten-containing diets in a subset of patients with schizophrenia who were positive for AGA IgG. In this pilot feasibility study, 16 participants with schizophrenia or schizoaffective disorder who had elevated AGA IgG (≥ 20 U) but were negative for celiac disease were admitted to an inpatient unit for a 5-week trial. All participants received standardized gluten-free meals and were randomized in a double-blind fashion to receive a shake containing 10 g of gluten flour or 10 g of rice flour each day. Participants were rated for psychiatric, cognitive and gastrointestinal symptoms at baseline and endpoint. Of the 16 participants, 14 completed the 5-week trial (2 discontinued early for administrative reasons). Compared with participants on the gluten-containing diet, participants on the gluten-free diet showed improvement on the Clinical Global Impressions scale (Cohen d = –0.75) and in negative symptoms (Cohen d = –0.53). We noted no improvement in positive or global cognitive symptoms, but did observe an improvement in attention favouring the gluten-free diet (Cohen d = 0.60). Robust improvements in gastrointestinal adverse effects occurred in the gluten-free group relative to the glutencontaining group. Adverse effects were similar between groups. This study was limited by its small sample size; larger studies are needed. This feasibility study suggests that removal of gluten from the diet is associated with improvement in psychiatric and gastrointestinal symptoms in people with schizophrenia or schizoaffective disorder.

Appetite and Gastrointestinal Hormone Response to a Gluten-Free Meal in Patients with Coeliac Disease.

Coeliac disease (CeD) is an immune-mediated inflammatory enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Gastrointestinal (GI) hormone response related to appetite and glucose metabolism is still under-investigated in patients with CeD. This study aimed at shedding light on the appetite sensations, glycaemia and hormone response induced by a complex meal in patients with coeliac disease. Twenty-two women with CeD, nine at the diagnosis (CeDD) and thirteen under a gluten-free diet (CeDGF), and ten healthy subjects (HS) were enrolled in a single day intervention study. All subjects consumed a test meal, recorded their appetite sensations, and blood was collected over three hours after meal consumption. The study found a lower decrease in hunger in CeDD compared to CeDGF and HS after meal intake. Data showed no difference of fullness and satiety between the groups. CeDD had lower insulin and glucose-dependent insulinotropic polypeptide (GIP) than CeDGF and HS. Both CeDD and CeDGF experienced a lower post-prandial response of glucose than HS. Data suggested that patients with CeD have an impaired glucose absorption after more than 12 months of gluten-free diet. Postprandial GIP may play a significant role in appetite cues and insulin response to a complex meal.

Cross-Contamination with Gluten by Using Kitchen Utensils: Fact or Fiction?

A risk of cross-contamination exists when preparing a gluten-free (GF) meal in kitchen facilities that usually handle gluten-containing (GC) foods. Cross-contamination with gluten may occur during the preparation or cooking process; however, published data are lacking on gluten cross-contamination from kitchenware. This study was conducted to determine whether cross-contamination occurs through shared domestic kitchenware and, if so, which cleaning method is most reliable for avoiding this cross-contamination. Kitchenware (wooden spoon, colander, ladle, and knife) previously used to cook and/or prepare GC foods was used for the preparation of GF foods (bread and pasta). The gluten concentration of the GF foods was then determined using an established enzyme-linked immunosorbent assay. A PCR assay was also used to detect the presence of wheat ω-gliadin DNA in the food samples. Three cleaning methods were assessed to determine the concentrations of gluten and wheat DNA in GF foods cooked with utensils cleaned directly after the preparation of GC foods. Contrary to our expectations, gluten was not detected in relevant and quantifiable amounts in our samples (<20 mg/kg). The cleaning method used did not influence gluten concentrations: all samples contained <10 mg/kg. Based on PCR analyses, the only sample with lower cycle threshold ( CT) values (i.e., higher concentration of wheat DNA) was from the contaminated ladle used to serve GF pasta. This outcome led to the hypothesis that shared ladles pose a higher risk for contamination of GF foods than do shared wooden spoons, colanders, or knives. Cross-contamination with gluten in a kitchen environment may occur, but kitchen utensils used for preparing GC pasta and for cutting GC bread should not pose a relevant problem to patients with celiac disease, at least in a domestic environment.

Effects of a Gluten-Containing Meal on Gastric Emptying and Gallbladder Contraction

The ingestion of gluten has been associated with gastrointestinal symptoms even in the absence of detectable immune responses. Little is known about the pathophysiological effects of gluten on the upper gastrointestinal tract. We aimed to assess whether the ingestion of gluten leads to an impairment of the physiological mechanisms of gastric emptying, gallbladder contraction and relaxation. A total of 17 healthy subjects underwent ultrasound evaluation of gastric emptying dynamics and gallbladder contractions at baseline and every 30 min after a standard gluten-containing and gluten-free meal (250 kcal, 70% carbohydrates). The pattern of gastric emptying was similar after a standard meal with or without gluten, but differed in terms of the peak of the antral filling curve, which was wider (mean area 5.69, median 4.70, range 3.71‒9.27 cm2 vs. mean 4.89, median 4.57, 2.27‒10.22 cm2, p = 0.023) after the gluten-containing meal. The pattern of gallbladder contractions was different after the gluten-free meal (p < 0.05), with higher gallbladder volumes in the late refilling phases. The results of this study show that gluten ingestion exerts objective effects on gastric and gallbladder motility. Although the underlying pathophysiological mechanism remains unknown, these results could account for some of the gluten-related symptoms reported by patients with celiac disease and non-celiac gluten sensitivity.

Awareness of coeliac disease among chefs and cooks depends on the level and place of training.

Coeliac disease is triggered by gluten. The only treatment is lifelong avoidance of dietary gluten. Dining out and travelling are particular challenges with a huge impact on quality of life. We examined the knowledge about coeliac disease and gluten-free food preparation among chefs and cooks, and culinary students in Dunedin, New Zealand. Outlets serving gluten-free food were identified. The head chefs or cooks were invited to complete a questionnaire regarding demographics, education, qualification, experience and knowledge of coeliac disease and gluten-free food preparation. Ninety restaurant chefs and cooks, and 35 first-year culinary students participated. Half of participating chefs and cooks had received no formal training, but all were aware of the term gluten-free diet. Twelve (13%) were unaware of coeliac disease, all of whom were non-European and worked at an ethnic restaurant which did not have gluten-free policies in place. There was no significant difference in awareness of coeliac disease between chefs and students (p=0.36). However, students were significantly more aware of necessary gluten-free food preparation (p=0.007) and scored better in the gluten-free quiz (p=0.01) than chefs and cooks. Awareness of coeliac disease did not necessarily mean that policies were in place to prepare contamination-free gluten-free meals. Chefs and cooks from countries with a low incidence of coeliac disease lacked knowledge about gluten-free food preparation and had difficulties recognising gluten containing foods. Patients with coeliac disease wanting to dine out should be advised to choose a restaurant with care.