Gluten Free Diet

Ventenilla-Zulaybar
History of Gluten Free Diet
250 AD - Greek physician named Aretaeus of
Cappadocia correlated an unnamed disease with
the patients disease and referred it as koliakos
(suffering in the bowels)

1843 Stanislas Tanchou claimed that cancer
rates are correlated with intake of grains

Today gluten consumption in patients with
Celiac disease may lead to atrophy of small
intestines

Definition
Gluten compromised of proteins (gliadin,
glutenin), predominantly found in cereal
grains such as wheat, rye, and barley

Celiac Disease intolerance to gluten; may
lead to destruction and atrophy of the small
intestine villi
Characteristics
Gluten free diets
Avoidance of any
product made from
wheat, barley, rye,
and oats





May include:
meat
fish
fruit and vegetables
rice
Potatoes
Lentils
Gluten free softdrinks

Usage
Adults and children must follow strict gluten-
free diet
Follow up endoscopy golden standard to
confirm clinical remission and dietary
compliance
Literature Review
1. Gluten-Free Diet and Quality of Life in Celiac Disease

Gabriel Samasca, Genel Sur, Julia Lupan, Diana Deleanu

Research Institute for Gastroenterology and Liver diseases, Shasheed Beheshti University of
Medical Sciences and Health Services

Gastroenterology and Hepatology from Bed to Bench. May 28, 2014: 139-143

2. Assessment of the Response to Gluten-Free Diet in an Iraqi Population with Celiac
Disease. A Histological and Serological Follow-up Study

Muhammed Osman, Balsam Taha, Ghada Al Duboni

Department of Pathology, Faculty of Medicine and Defence Health, University Pertahanan
Malaysia, Kem Sungai Besi, Kula Lumpur, Malaysia

Archives of Medical Science. May 12, 2014; 10(2); 294-299

Recommendations for Gluten-free
Diet in Patients with Celiac Disease

Follow up endoscopy and biopsies (after 4-6
mos)
Health education
Serological testing (normalize: 6-12 mos)
anti-gliadin antibodies(AGA)
anti-endomysial antibodies(EMA)
anti-tissue transglutaminase antibodies(tTG)

Scientific Evidence of Effectiveness
Taha and Duboni (2014)
increasing body weight, body mass index, fat
mass, bone mass, triceps skinfold thickness, and
nutritional and biochemical status including iron
absorption
though small bowel histology does improve
following a gluten-free diet, the small bowel does
not generally normalize within 12 months
Positive effects more in adults than in children by
the end of +/- 1 month of gluten free diet
May vary on different populations
Scientific Evidence of Effectiveness
Samsca et al. (2014)
gluten free diet positive effects were observed in
celiac disease patients: increase in body mass
index, higher energy intakes, reducing adiposity
gain, moderates the risk of the associated
complications
Impracticality and lack of knowledge leads to
decrease in adherence to gluten free diet
Recommended to find other alternative for
management of celiac disease
Possible Harm/ARDs that May Occur
with the Use of Gluten-Free Diet
Side effects (negative):
Constipation (loss of fiber in diet)
Increase cholesterol level
Decrease caloric intake
Weight changes
Nutritional deficiencies (B vitamins, calcium, iron,
zinc, magnesium, and fiber)
Decrease normal flora in intestine
(Bifidobacterium and Lactobacillus )
Symptom confusion (influx of unfamiliar foods)


Side effects (positive):
Relief of: abdominal pain, bloating, diarrhea,
vomiting and constipation with gluten
consumption.

Contraindications: severe vitamin deficiencies,
low caloric intake and high cholesterol level

Drug Interactions:
Gluten free medications



Reference
Peter Green, director, Celiac Disease Center,
Columbia University.
Celiac Disease Center at Columbia University,
"Frequently Asked Questions."
National Digestive Diseases Clearinghouse,
"Celiac Disease."
Kupper, C. Gastroenterology, April 2005; vol 128:
pp S121-7.
Lee, A. Journal of Human Nutrition and Dietetics,
October 2007; vol 20: pp 423-30.



Hallert C, Grant C, Grehn S, et al. Evidence of poor
vitamin status in celiac patients on a gluten-free
diet for 10 years. Alimentary Pharmacolology &
Therapeutics 2002;16:1333-1339.
Gluten-Free Diet Guide for Families. Children's
Digestive Health and Nutrition Foundation/North
American Society of Pediatric Gastroenterology,
Hepatology and Nutrition.
Mariani P, Viti M, Montouri M, et al. The gluten-
free diet: a nutritional risk factor for adolescents
with celiac disease? Journal of Pediatric
Gastroenterology and Nutrition 1998;27:519-523.