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A gluten-free diet (GFD) is a diet that excludes gluten, a protein composite found in wheat, barley, rye and all their species and hybrids (such as spelt, kamut and triticale. The inclusion of oats in gluten-free diet remains controversial. Avenin present in oats may be also toxic for coeliac people. Its toxicity depends on the cultivar consumed. Furthermore, oats are frequently cross contaminated with gluten-containing cereals.
Gluten causes health problems in sufferers of gluten-related disorders, which include coeliac disease (CD), non-coeliac gluten sensitivity (NCGS), gluten ataxia, dermatitis herpetiformis (DH) and wheat allergy. In these patients, the gluten-free diet is a demonstrated effective treatment. In addition, at least in some cases, the gluten-free diet may improve gastrointestinal and/or systemic symptoms in other diseases, such as irritable bowel syndrome, rheumatoid arthritis, multiple sclerosis or HIV enteropathy, among others.
Gluten proteins have low nutritional and biological value, and the grains that contain gluten are not essential in the human diet. However, an unbalanced selection of food and an incorrect choice of gluten-free replacement products may lead to nutritional deficiencies. The replacement of gluten-containing cereals flour with gluten free flours in commercial products traditionally made with wheat or other gluten-containing cereals may lead to a lower intake of some important nutrients, such as iron and B vitamins. Some gluten-free commercially replacement products are not enriched / fortified as their gluten-containing counterparts and often have greater lipid / carbohydrate content. Especially children often abuse the consumption of these products, such as snacks and biscuits. Nutritional complications can be prevented by a correct dietary education.
A gluten free-diet should be mainly based on naturally gluten-free foods with a good balance of micro and macro nutrients. Meat, fish, eggs, legumes, nuts, fruits, vegetables, potatoes, rice, maize are all appropriate. If commercially prepared gluten-free replacement products are used, it is preferable to choose those are enriched or fortified with vitamins and minerals. Furthermore, a healthy alternative to these products are pseudocereals (such as quinoa, amaranth, and buckwheat) and other minor cereals, which have high biological and nutritional value.
Coeliac disease spelled celiac disease in North America, is an autoimmune disorder of the small intestine that happens in genetically predisposed people of all ages from middle infancy onward. Symptoms include chronic diarrhoea, failure to thrive (in children) and fatigue, but these could be absent, and symptoms in other organ systems have been described. A growing percentage of diagnoses are being made in asymptomatic persons because of increased screening. Coeliac disease is attributable to a reaction to gliadin, a prolamin (gluten protein) found in wheat and similar proteins found in the crops of the tribe Triticeae (which includes other cultivars such as barley and rye). Upon exposure to gliadin and certain other prolamins, the enzyme tissue transglutaminase modifies the protein and the immune system cross-reacts with the small-bowel tissue, causing an inflammatory reaction. That leads to a truncating of the villi lining the small intestine (called villous atrophy). This interferes with the absorption of nutrients, since the intestinal villi are responsible for absorption. The only known effective treatment is a lifelong gluten-free diet. While the disease is caused by a reaction to wheat proteins, it's not the same as wheat allergy.
Severe coeliac disease leads to the characteristic symptoms of pale, loose and greasy stool (steatorrhoea), weight-loss or failure to gain weight (in young children). Individuals with milder coeliac disease may have symptoms that are much more subtle and occur in other organs instead of the bowel itself. Finally, it is possible to have coeliac disease without any symptoms whatsoever. Many adults with subtle disease have only fatigue or anaemia.
Wheat subspecies (such as spelt, semolina and durum) and related species like barley, rye, triticale and Kamut also induce symptoms of coeliac disease. A small minority of coeliac sufferers also react to oats. It is most probable that oats produce symptoms due to cross contamination with other grains in the fields or in the distribution channels. Generally, oats are therefore not recommended. Other cereals like maize (corn), quinoa, millet, sorghum, teff, amaranth, buckwheat, rice and wild rice are safe for patients to consume. Non-cereal carbohydrate-rich foods such as potatoes and bananas do not contain gluten and do not trigger symptoms.
There are a number of tests that can be utilized to help in diagnosis. The extent of symptoms may determine the order of the tests, but all tests lose their usefulness if the patient is already taking a gluten-free diet plan. Intestinal damage begins to heal within weeks of gluten being removed from the diet and antibody levels decline over months. For those who have already started on a gluten-free diet, it may be required to perform a re-challenge with some gluten-containing food in a single meal each day over 2-6 weeks before repeating the investigations.