Concept: Dermatitis herpetiformis
Non-celiac gluten sensitivity is a syndrome characterized by gastrointestinal and extra-intestinal symptoms occurring in a few hours/days after gluten and/or other wheat protein ingestion and rapidly improving after exclusion of potential dietary triggers. There are no established laboratory markers for non-celiac gluten sensitivity, although a high prevalence of first generation anti-gliadin antibodies of IgG class has been reported in this condition. This study was designed to characterize the effect of the gluten-free diet on anti-gliadin antibodies of IgG class in patients with non-celiac gluten sensitivity.
Gluten-free diet (GFD) is the only management for coeliac disease (CD). Available methods to assess GFD compliance are insufficiently sensitive to detect occasional dietary transgressions that may cause gut mucosal damage. We aimed to develop a method to determine gluten intake and monitor GFD compliance in patients with CD and to evaluate its correlation with mucosal damage.
Background: Nonceliac gluten sensitivity (NCGS), occurring in patients without celiac disease yet whose gastrointestinal symptoms improve on a gluten-free diet (GFD), is largely a self-reported diagnosis and would appear to be very common. The aims of this study were to characterize patients who believe they have NCGS. Materials and Methods: Advertising was directed toward adults who believed they had NCGS and were willing to participate in a clinical trial. Respondents were asked to complete a questionnaire about symptoms, diet, and celiac investigation. Results: Of 248 respondents, 147 completed the survey. Mean age was 43.5 years, and 130 were women. Seventy-two percent did not meet the description of NCGS due to inadequate exclusion of celiac disease (62%), uncontrolled symptoms despite gluten restriction (24%), and not following a GFD (27%), alone or in combination. The GFD was self-initiated in 44% of respondents; in other respondents it was prescribed by alternative health professionals (21%), dietitians (19%), and general practitioners (16%). No celiac investigations had been performed in 15% of respondents. Of 75 respondents who had duodenal biopsies, 29% had no or inadequate gluten intake at the time of endoscopy. Inadequate celiac investigation was common if the GFD was initiated by self (69%), alternative health professionals (70%), general practitioners (46%), or dietitians (43%). In 40 respondents who fulfilled the criteria for NCGS, their knowledge of and adherence to the GFD were excellent, and 65% identified other food intolerances. Conclusions: Just over 1 in 4 respondents self-reporting as NCGS fulfill criteria for its diagnosis. Initiation of a GFD without adequate exclusion of celiac disease is common. In 1 of 4 respondents, symptoms are poorly controlled despite gluten avoidance.
Celiac disease is a multisystem immune based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The prevalence of celiac disease has risen in recent decades and is currently about 1% in most Western populations. The reason for this rise is unknown, although environmental factors related to the hygiene hypothesis are suspected. The pathophysiology of celiac disease involves both the innate and adaptive immune response to dietary gluten. Clinical features are diverse and include gastrointestinal symptoms, metabolic bone disease, infertility, and many other manifestations. Although a gluten-free diet is effective in most patients, this diet can be burdensome and can limit quality of life; consequently, non-dietary therapies are at various stages of development. This review also covers non-celiac gluten sensitivity. The pathophysiology of this clinical phenotype is poorly understood, but it is a cause of increasing interest in gluten-free diets in the general population.
Fibromyalgia (FM) syndrome is a disabling clinical condition of unknown cause, and only symptomatic treatment with limited benefit is available. Gluten sensitivity that does not fulfill the diagnostic criteria for celiac disease (CD) is increasingly recognized as a frequent and treatable condition with a wide spectrum of manifestations that overlap with the manifestations of FM, including chronic musculoskeletal pain, asthenia, and irritable bowel syndrome. The aim of this report was to describe 20 selected patients with FM without CD who improved when placed on a gluten-free diet. An anti-transglutaminase assay, duodenal biopsy, and HLA typing were performed in all cases. CD was ruled out by negative anti-transglutaminase assay results and absence of villous atrophy in the duodenal biopsy. All patients had intraepithelial lymphocytosis without villous atrophy. Clinical response was defined as achieving at least one of the following scenarios: remission of FM pain criteria, return to work, return to normal life, or the discontinuation of opioids. The mean follow-up period was 16 months (range 5-31). This observation supports the hypothesis that non-celiac gluten sensitivity may be an underlying cause of FM syndrome.
A gluten-free diet (GFD) is the most commonly adopted special diet worldwide. It is an effective treatment for coeliac disease and is also often followed by individuals to alleviate gastrointestinal complaints. It is known there is an important link between diet and the gut microbiome, but it is largely unknown how a switch to a GFD affects the human gut microbiome.
Exploring the Popularity, Experiences and Beliefs Surrounding Gluten-Free Diets in Non-Coeliac Athletes
- International journal of sport nutrition and exercise metabolism
- Published over 4 years ago
Adherence to a gluten-free diet (GFD) for non-coeliac athletes (NCA) has become increasingly popular despite a paucity of supportive medical or ergogenic evidence. This study aimed to quantify the demographics of NCA and determine associated experiences, perceptions and sources of information related a GFD. Athletes (n=910, female=528, no gender selected=5) completed a 17-question online survey. Forty-one percent of NCA respondents, including 18-world and/or Olympic medalists, follow a GFD 50%-100% of the time (GFD>50): only 13% for treatment of reported medical conditions with 57% self-diagnosing their gluten sensitivity. The GFD>50 group characteristics included predominantly endurance sport athletes (70.0%) at the recreationally competitive level (32.3%), between 31-40 years of age (29.1%). Those who follow a GFD>50 reported experiencing, abdominal/gastrointestinal (GI) symptoms alone (16.7%) or in conjunction with two (30.7%) or three (35.7%) additional symptoms (e.g. fatigue) believed to be triggered by gluten. Eighty-four percent of GFD>50 indicted symptom improvement with gluten-removal. Symptom-based and non-symptom-based self-diagnosed gluten-sensitivity (56.7%) was the primary reason for adopting a GFD. Leading sources of GFD information were: online (28.7%), trainer/coach (26.2%) and other athletes (17.4%). Although 5-10% of the general population is estimated to benefit clinically from a GFD a higher prevalence of GFD adherence was found in NCA (41.2%). Prescription of a GFD amongst many athletes does not result from evidence-based practice suggesting that adoption of a GFD in the majority of cases was not based on medical rationale and may be driven by perception that gluten removal provides health benefits and an ergogenic edge in NCA.
- JAAPA : official journal of the American Academy of Physician Assistants
- Published over 3 years ago
Gluten-free diets have gained popularity with the public at a rate greater than would be expected based on the prevalence of gluten-related disorders such celiac disease, nonceliac gluten sensitivity, and wheat allergy. This article reviews gluten-related disorders, indications for gluten-free diets, and the possible health benefits of gluten. Despite the health claims for gluten-free eating, no published experimental evidence supports weight-loss with a gluten-free diet or suggests that the general population would benefit from avoiding gluten.
We aimed to investigate whether long-term adherence to a gluten-free diet is related to depressive symptoms in coeliac disease (CD) patients.
- Journal of human nutrition and dietetics : the official journal of the British Dietetic Association
- Published about 6 years ago
BACKGROUND: Coeliac disease (CD) is an under-diagnosed and often misunderstood disease, yet is one of the most common food intolerance disorders. The only treatment available to prevent the health impacts of CD is a lifelong, strict gluten-free diet (GFD). There are few studies that explore the experiences of diagnosis and the everyday experiences of living with this chronic condition. METHODS: Utilising a qualitative study design, and purposive sampling, the present study describes the experiences of 10 women with coeliac disease in Victoria, Australia. Individual interviews were conducted with women aged between 31 and 60 years who had been diagnosed with CD for at least 2 years. RESULTS: A thematic analysis of the interview transcripts highlighted a number of issues for those living with the disease. Reactions to diagnosis, transition to a GFD and the changes needed to live with CD are discussed. CONCLUSIONS: A range of recommendations including the need to increase CD awareness and education and further research on the impacts of living with the disease are made.