A gluten-free diet (GFD) is a diet that completely excludes gluten, a mixture of proteins found in wheat and related grains, including barley, rye, oats, and all of their species and hybrids (such as spelled, kamut, and triticale). The inclusion of wheat in a gluten-free diet is still controversial, and may depend on wheat cultivars and frequent cross-contamination with other gluten-containing cereals.
Gluten causes health problems for those with gluten-related disorders, including celiac disease (CD), non-celiac gluten sensitivity (NCGS), gluten ataxia, dermatitis herpetiformis (DH), and wheat allergy. In these people, the gluten-free diet is shown as an effective treatment, but some studies show that about 79% of people with celiac disease experience incomplete recovery of the small intestine, despite a strict gluten-free diet. This is mainly due to unintentional gluten intake. People with poor basic education and an understanding of gluten-free diets often believe they follow a strict diet but make the usual mistakes.
In addition, a gluten-free diet can, at least in some cases, improve gastrointestinal or systemic symptoms in diseases such as irritable bowel syndrome, rheumatoid arthritis, multiple sclerosis or HIV enteropathy, among others. Gluten-free diets have also been promoted as an alternative treatment for people with autism, but the current evidence for their efficacy in making changes in autism symptoms is limited and weak.
Gluten protein has low nutritional and biological value, and grains containing gluten are not important in human diet. However, unbalanced food choices and incorrect choice of fault-free replacement products can lead to nutritional deficiencies. Substituting flour from whole wheat or other gluten-free cereals with gluten-free starch in commercial products can lead to lower essential nutrient intake, such as iron and vitamin B. Some gluten-free commercial replacement products are not enriched or enriched as their gluten-containing counterparts, and often have a greater lipid/carbohydrate content. Children very often consume this product excessively, such as snacks and biscuits. Nutritional complications can be prevented with proper dietary education.
Gluten-free diets should primarily be based on natural gluten-free foods with good micro and macro nutritional balance: meat, fish, eggs, milk and dairy products, beans, nuts, fruits, vegetables, potatoes, rice, and corn is all the right components of such a diet. If commercially prepared, a gluten-free replacement product is used, selecting enriched or fortified with vitamins and minerals is preferred. Pseudocereals (quinoa, amaranth, and buckwheat) and some minor cereals are healthy alternatives to these prepared products and have high biological and nutritional value.
Video Gluten-free diet
The reason behind diet adoption
Celiac disease
Celiac disease (CD) is a chronic, immune-mediated, and especially intestinal process, caused by the consumption of wheat, barley, rye and derivatives, which appear in people who are genetically predisposed from all ages. CDs are not only gastrointestinal diseases, as they can affect multiple organs and cause various non-gastrointestinal symptoms, and most importantly, may be often completely asymptomatic. An additional difficulty for diagnosis is the fact that serological markers (anti-tissue transglutaminase [TG2]) are not always present and many people with celiac may have minor mucosal lesions, without intestinal villous atrophy.
CD affects about 1-2% of the general population worldwide and continues to increase, but most cases remain unrecognized, undiagnosed and untreated, exposing patients to the risk of long-term complications. People may suffer severe symptoms of illness and have been subjected to extensive investigations for years before a proper diagnosis is achieved. Untreated CDs can cause malabsorption, decreased quality of life, iron deficiency, osteoporosis, obstetric complications (stillbirth, intrauterine growth restriction, premature birth, low birth weight, and small to gestational age), increased risk of intestinal lymphoma and more mortality big. CD is associated with several autoimmune diseases, such as type 1 diabetes mellitus, thyroiditis, gluten ataxia, psoriasis, vitiligo, autoimmune hepatitis, herpetiform dermatitis, primary sclerosis kolangitis, and more.
CDs with "classic symptoms", which include gastrointestinal manifestations such as chronic diarrhea and abdominal distension, malabsorption, loss of appetite, and growth disorders, are currently the most common form of presentation of the disease and affect mainly in young children who are generally younger than two year. age.
CDs with "non-classic symptoms" are the most common type of clinical and occur in older children (more than 2 years), adolescents and adults. It is characterized by mild or even absent gastrointestinal symptoms and a broad spectrum of non-intestinal manifestations that may involve every organ of the body, and very often may be asymptomatic in children (at least in 43% of cases) and adults..
Following a lifelong gluten-free diet is the only medically accepted treatment for people with celiac disease.
Non-celiac gluten sensitivity
The non-celiac gluten sensitivity (NCGS) is described as a condition of some of the improved symptoms when switching to a gluten-free diet, after celiac disease and wheat allergy are excluded. People with NCGS may develop gastrointestinal symptoms, which are similar to irritable bowel syndrome (IBS) or various nonongastrointestinal symptoms.
Gastrointestinal symptoms may include any of the following: abdominal pain, bloating, bowel habit disorders (either diarrhea or constipation), nausea, aerophagia, gastroesophageal reflux disease, and aphthous stomatitis. Extra-intestinal symptoms, said to be the only manifestation of NCGS in the absence of gastrointestinal symptoms, have been suggested, but remain controversial. These include: headaches, migraines, "foggy thoughts", fatigue, fibromyalgia, joint and muscle pain, numb legs or arms, tingling extremities, dermatitis (eczema or skin rash), atopic disorders such as asthma, rhinitis, other allergies, depression, anxiety, iron deficiency anemia, folate deficiency or autoimmune disease. NCGS has also been controversially involved in several neuropsychiatric disorders, including schizophrenia, eating disorders, autism, peripheral neuropathy, ataxia and attention deficit hyperactivity disorder (ADHD). Above 20% of people with NCGS have IgE-mediated allergies to one or more inhalants, food or metals, among which the most common are mites, graminaceae, parietaria, cats or dogs, clams and nickel. About 35% of people with NCGS suffer from other food intolerances, especially lactose intolerance.
The pathogenesis of NCGS is not well understood. It is hypothesized that gluten, like celiac disease, is the cause of NCGS. Many recent studies on NCGS aim to determine which agents trigger a response in people with NCGS: the extent to which gluten, FODMAP, ATI (vegetable proteins present in gluten- staining cereals and gluten) or wheat agglutinins are involved. For this reason, NCGS is a controversial syndrome and some authors are still questioning it. In a double-blind placebo-controlled trial (DBPC) by Biesiekierski et al. In some people with irritable bowel syndrome (IBS), the authors found no difference between gluten or placebo groups and the NCGS concept as a questionable syndrome. However, this study appears to have incorrect design errors and participant selection, which may mask the true effects of gluten reintroduction. In a May 2015 review published in Gastroenterology, Fasano et al. concluded that in addition to gluten, ATI and FODMAP present in gluten, wheat, barley, rye, and its derivatives play a role in the development of symptomatic NCGS. ATI, which is against proteolytic digestion, may be a congenital immune inducer in people with celiac or NCGS disease. FODMAPs cause mild wheat intolerance at most, which is mainly confined to gastrointestinal symptoms.
After the exclusion of celiac disease and wheat allergy, the next step to the diagnosis and treatment of NCGS is to start a strict gluten-free diet to assess whether symptoms improve or heal completely. This can occur within days until the start of GFD week, but improvement may also be due to a non-specific placebo response. Recommendations may resemble those for celiac disease, for strict and nourished diets, without violations. The degree of gluten cross contamination tolerated by people with NCGS is unclear but there is some evidence that they may present with symptoms even after small amounts of consumption. Not yet known whether NCGS is a permanent or temporary condition. A gluten reintroduction trial to observe any reaction after 1-2 years of a strict gluten free diet may be possible.
The subgroup of people with NCGS may not improve by eating commercially available gluten free products, which are usually rich in preservatives and additives, since chemical additives (such as sulfites, glutamate, nitrates and benzoates) may have a role in generating the functional gastrointestinal symptoms of the NCGS. These people can benefit from a diet with a low content of preservatives and additives.
NCGS, which may be immune-mediated, now appears to be more common than celiac disease, with a prevalence rate between 0.5-13% in the general population.
Wheat allergy
People can also experience the adverse effects of wheat as a result of wheat allergy. Gastrointestinal symptoms of wheat allergy are similar to celiac disease and non-celiac gluten sensitivity, but there are different intervals between wheat exposure and onset of symptoms. Wheat allergies have a rapid onset (from minute to hour) after the consumption of wheat-containing foods and can become anaphylactic.
Management of wheat allergy consists of a complete withdrawal of foods containing wheat and cereals containing gluten. Nevertheless, some people with wheat allergy can tolerate barley, rye or oats.
Gluten Ataxia
Gluten ataxia is an autoimmune disease triggered by gluten consumption. With gluten ataxia, damage occurs in the cerebellum, the center of the brain balance that controls coordination and complex movements such as walking, talking and swallowing, with the loss of Purkinje cells. People with gluten ataxia usually show a disorder of style or incoordination and tremor in the upper extremity. Nystagmus which is triggered by views and other ocular signs of cerebellar dysfunction is common. Myoclonus, palatal tremor, and opsoclonus-myoclonus may also appear.
Early diagnosis and treatment with a gluten-free diet can increase ataxia and prevent its development. The effectiveness of treatment depends on the time elapsed since the onset of ataxia until diagnosis, because the death of neurons in the cerebellum due to exposure to gluten can not be changed.
The attachment of gluten ataxia to 40% of unknown origin ataxia and 15% of all ataxia. Less than 10% of people with gluten ataxia present with gastrointestinal symptoms, but about 40% have bowel damage.
As a fad diet
Since the beginning of the 21st century, the gluten-free diet has become the most popular trendy fashion diet in the United States and other countries. Physicians around the world have been challenged by more and more people who do not have celiac disease or wheat allergy, with digestive or extra-digestive symptoms that increase the removal of wheat/gluten from the diet. Many of these people started a gluten-free diet with their own, without ever being evaluated before. Other reasons that contribute to this trend are the publication of several books that demonstrate gluten and lead to the causes of type 2 diabetes, weight gain and obesity, and a wide list of diseases ranging from depression and anxiety to arthritis and autism. The most impacting book is the Grain Brain: The Surprising Truth about Wheat, Carbohydrates, and Sugar - Your Brain Mute Killer, by American neurologist David Perlmutter, published in September 2013. Another book that has a big impact is Belly Wheat: Reduce Wheat, Lose Weight, and Find Your Way Back to Health , by cardiologist William Davis, referring to wheat as a "chronic poison" and becoming a New York Times > bestsellers in a month of publication in 2011. Gluten-free diets have been recommended and followed by many celebrities to lose weight, such as Miley Cyrus, Gwyneth Paltrow, and Kourtney Kardashian, and are used by some professional athletes, who believe diet can increase energy and health. It became popular in the US, because the popularity of low-carbohydrate diets faded.
Estimates show that by 2014, 30% of people in the United States and Australia consume gluten-free foods, with an ever-increasing number, calculated from a survey that by 2016 about 100 million Americans will consume gluten-free products. Data from the Nielsen survey of 2015 to 30,000 adults in 60 countries worldwide concluded that 21% of people prefer to buy gluten-free foods, becoming the highest interest among the younger generation. In the United States, it is estimated that more than half of people who buy gluten-free food do not have a clear reaction to gluten, and they do it "because they think it will help them lose weight, because they seem to feel better or because they are mistaken believe that they are sensitive to gluten. "Although gluten is highly reactive immunologically and humans do not seem to evolve to digest it properly, gluten-free diets are not a healthy option for the general population, other than people suffering from gluten-related disorders or other associated conditions that improve with diet gluten-free in some cases, such as irritable bowel syndrome and certain autoimmune and neurologic disorders. No published experimental evidence to support that gluten-free diet contributes to weight loss.
In a May 2015 review published in Gastroenterology , Fasano et al. concludes that, although there is a clear "fashion component" to the recent rise in the popularity of gluten-free diets, there is also a growing and unquestioned evidence of the presence of non-sheath gluten sensitivity.
The popularity of a gluten-free diet is detrimental to the people who actually need to eliminate gluten for medical reasons. The server issued an assessment, believing that it was just a fad, which caused them not to take the necessary precautions in food handling to avoid gluten cross-contamination. "In other words, customers who order gluten-free food that is washed with gluten-filled beer basically makes a mockery of a serious problem". Even many professionals in the medical field think that a gluten-free diet is just a fad. On the other hand, the popularity of gluten-free diets has increased the availability of commercial gluten-free replacement products and gluten-free grains.
Gluten-free commercial replacement products, such as gluten-free cakes, are more expensive than those containing gluten, so purchasing increases the financial burden. They are also typically higher in calories, fat, and sugar, and lower in dietary fiber. In less developed countries, wheat can represent an important source of protein, because it is an important part of diet in the form of bread, noodles, bulgur, couscous, and other products.
Healthcare professionals advise against a gluten-free diet as a form of self-diagnosis, since tests for celiac disease can only be believed if the person has taken gluten recently. There is consensus in the medical community that one should consult a doctor before undergoing a gluten-free diet, so that a medical professional can accurately test for celiac disease or health problems caused by gluten.
Although popularly used as an alternative treatment for people with autism, there is no good evidence that a gluten-free diet is beneficial in reducing symptoms of autism.
Maps Gluten-free diet
Eating gluten-free
Gluten-free diet is a diet that completely excludes gluten, the protein present in wheat (and all varieties of wheat as spelled and kamut), barley, rye, oats, and derivatives of grains such as malt and triticale, and foods that may include them , or share transportation or processing facilities with them. The inclusion of wheat in a gluten-free diet is still controversial. Oat toxicity in people with gluten-related disorders depends on the oats consumed by cultivars because toxic prolamin immunoreactivities differ among oat varieties. Furthermore, oats are often cross-contaminated with other gluten-containing cereals. Pure oat (labeled as "pure oat" or "gluten free oat") refers to wheat that is not contaminated with any of the other gluten-containing cereals. Some pure wheat cultivars can be a safe part of a gluten-free diet, which requires knowledge of the various grains used in food products for a gluten-free diet. Nevertheless, the long-term effects of pure wheat consumption remain unclear and further studies identify the cultivars used necessary before making a final recommendation on their inclusion in a gluten-free diet.
Other grains, although gluten-free in themselves, may contain gluten with cross-contamination with gluten-containing cereals during wheat harvest, transportation, grinding, storage, processing, handling or cooking.
Processed foods generally contain gluten as additives (as emulsifiers, thickeners, gelling agents, fillers, and coatings), so they require special labeling. Unexpected sources of gluten are, among other things, processed meats, vegetarian meat substitutes, re-processed seafood, stuffing, butter, seasonings, marinades, sauces, snacks, candies and ice cream.
Cross-contamination at home is also a consideration for those suffering from gluten-related disorders. There are many sources of cross-contamination, such as when family members prepare gluten-free and gluten-free meals on the same surface (counter tops, tables, etc.) or share unfilled equipment after use for preparing food. foods containing gluten (cutting boards, colanders, cutlery, etc.), kitchen utensils (toaster, cupboards, etc.) or certain packaged foods (butter, peanut butter, etc.).
Drugs and dietary supplements are made using excipients that may contain gluten.
Gluten-free diets include natural gluten-free foods, such as meat, fish, seafood, eggs, milk and dairy products, beans, nuts, fruits, vegetables, potatoes, pseudocereals (especially spinach, buckwheat, chia seeds, quinoa) certain grains of cereals (corn, rice, sorghum), minor cereals (including fonio, Job's tears, millet, teff, called "minor" cereals because they are "less common and grow only in some small areas of the world"), some other plant products (garut, mesquite flour, sago, tapioca) and products made from these gluten-free foods.
Risk
Unbalanced food choices and incorrect choice of wrong gluten-free replacement products can cause nutritional deficiencies. Replacing flour from whole wheat or gluten-free cereals with gluten-free starch in commercial products can lead to lower essential nutrient intake, such as iron and vitamin B and higher intake of sugars and saturated fats. Some gluten-free commercial replacement products are not enriched or enriched as their gluten-containing counterparts, and often have a greater lipid/carbohydrate content. Children very often consume this product excessively, such as snacks and biscuits. These nutritional complications can be prevented with proper dietary education. Pseudocereals (quinoa, amaranth, and buckwheat) and some minor cereals are healthy alternatives to these prepared products and have higher biological and nutritional value. Progress toward higher gluten-free bread products, enhanced for example in terms of fiber content and glycemic index, has been made by not using corn starch or other starch to replace flour. In this sense, for example an inulin fiber diet (which acts as a prebiotic) or quinoa or amaranth wholemeal has been a substitute for flour. Such substitutions are also found to produce better bread crust and texture. It is recommended that anyone starting a gluten-free diet check with a registered dietitian to ensure they get the required amount of key nutrients such as iron, calcium, fiber, thiamin, riboflavin, niacin and folate. Vitamins often contain gluten as a binding agent. Experts have suggested that it is important to always read the content labels of each product intended to be swallowed.
Up to 30% of people with known celiac disease often continue to experience or regrow the symptoms. Also, the lack of symptoms or negative blood antibody levels is not a reliable indicator of bowel recovery. Some studies show an incomplete recovery of the small intestine despite the tight gluten-free diet, and about 79% of these people have persistent villous atrophy. This lack of recovery is mainly due to unintentional gluten exposure. People with poor basic education and an understanding of gluten-free diets often believe that they actually follow the diet, but make the usual mistakes. In addition, some people often deliberately continue to eat gluten because of limited availability, lower self-esteem, higher prices, and inadequate labeling of gluten-free products. Noncompliance with the regimen is also affected by age at diagnosis (adolescents), ignorance of the consequences of lack of strict treatment and certain psychological factors. Ongoing gluten intake can cause severe disease complications, such as various types of cancer (both intestine and extra-intestinal) and osteoporosis.
Rules and labels
Gluten-free terms are generally used to denote harmless gluten levels rather than none at all. The exact level at which gluten is harmless is uncertain and controversial. A systematic review of 2008 tentatively concluded that consumption of less than 10 mg of gluten per day is unlikely to cause histologic abnormalities, although noted that some reliable research has been conducted.
The rules of gluten-free labels vary by country. Most countries enjoy the key provisions of their gluten-free labeling rules from the international Codex Alimentarius standard for food labeling as a standard relating to product labeling as gluten-free. This only applies to foods that usually contain gluten. Gluten-free is defined as 20 ppm (= 20 mg/kg) or less. It categorizes gluten-free foods such as:
- Gluten-free food with composition
- Food that has become gluten-free through special processing.
- Reduced gluten content, foods that include food products with between 20 and 100 ppm of gluten. The reduced gluten content is left to each country to be defined more specifically.
The Codex standard suggests the Mendez Immunoassay (ELISA) method associated with enzymes to show the presence of gluten, but allows for other relevant methods, such as DNA. The Codex standard specifies that gluten-free claims should arise in the immediate proximity of product names, to ensure visibility.
There is no general agreement on the analytical methods used to measure gluten in ingredients and food products. The ELISA method is designed to detect w-gliadins, but suffers from a setback that has no sensitivity to prolamin barley. The use of highly sensitive tests is mandatory to certify gluten-free food products. The European Union, World Health Organization, and Codex Alimentarius require reliable measurements of grain progarin, gliadin rather than wheat protein.
Australia
The Australian Government recommends that:
- gluten-free foods containing no detectable gluten (& lt; 3ppm) wheat or its products, cereals containing chopped gluten or its products
- food labeled low gluten claims resulting in a level of 20 mg of gluten per 100 g of food
Brazil
All food products should be clearly labeled whether they contain gluten or gluten free. Since April 2016, the possibility of cross-contamination is mandatory when the product does not intentionally add any food allergens or derivatives thereof, but Good Precautions and allergen control measures adopted are insufficient to prevent any unintended footprint.. When a product contains a cross-contamination warning with wheat, rye, barley, oats and its hybrid strain, a "gluten-containing" warning is mandatory. The law does not set a gluten threshold for its absence statements.
Canada
Health Canada considers that foods containing gluten levels not exceeding 20 ppm as a result of contamination, fulfill health and safety purposes of section B.24.018 of the Food and Drug Regulations when gluten-free claims are made. Any deliberate addition of gluten, even at low levels should be stated on the packaging and gluten-free claims would be considered wrong and misleading. Labels for all food products sold in Canada should clearly identify the presence of gluten if present at levels greater than 10 ppm.
European Union
EU European Commission describes categories as:
- gluten-free: 20 ppm or less gluten
- very low gluten food: 20-100ppm gluten.
All foods containing gluten as ingredients should be labeled in accordance with gluten defined as one of the 14 recognized EU allergens.
United States
Until 2012 anyone can use gluten-free claim without reaction. In 2008, Wellshire Farms chicken nuggets labeled gluten-free were purchased and samples were sent to a food allergy laboratory where they were found to contain gluten. Once this is reported in the Chicago Tribune , the product continues to be sold. Manufacturers have since replaced the dough used in chicken nuggets. The first US gluten-free labeling in Food Labeling and Consumer Protection Act (FALCPA) 2004. The Tax and Trade Bureau of Alcohol and Tobacco issued a provisional regulation and proposed mandatory labeling for alcohol products in 2006. The FDA issues their Final Rules on August 5, 2013 When food producers voluntarily choose to use gluten-free claims for a product, foods containing claims in their labels should not contain:
- a substance containing gluten-containing granules
- ingredients derived from unprocessed gluten-containing grains to remove gluten
- ingredients derived from gluten-containing grains, which have been processed to remove gluten but result in the presence of 20 ppm or more gluten in the diet. Any food product that claims to be gluten-free and also contains the term "wheat" in the ingredients list or in the "Wheat Grant" statement, should also include the "wheat * has been processed to enable this food to meet the FDA's requirements for gluten-free foods," near the statement ingredients.
Any food product that is inherently non-glutenable may use gluten-free labels in which any unavoidable gluten in foods containing claims in the label is below 20 ppm of gluten.
See also
- Gluten-free diet, casein free
- Special Carbohydrate Diet
- Paleolithic diet
- 2010 in food
References
Source of the article : Wikipedia
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