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Medically reviewed on January 30, A gluten-free diet is a meal plan that does not contain any gluten. Gluten is a protein found in wheat, rye, and barley. Gluten is found in many breads, pastas, cereals, cakes, pies, and cookies. Some vitamin supplements and medicines may also contain gluten. You need to follow this diet for the rest of your life if you have celiac disease, dermatitis herpetiformis, or non-celiac gluten sensitivity. Choose foods labeled as gluten-free.
You may be able to eat gluten-free oats, or you may be able to eat regular oats in small amounts. Ask your dietitian if oats are safe for you to eat. You may eat foods that are made with the following types of grains and starches:.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. CD is not only a gastrointestinal disease, because it may affect several organs and cause an extensive variety of non-gastrointestinal symptoms, and most importantly, it may often be completely asymptomatic.
Added difficulties for diagnosis are the fact that serological markers anti-tissue transglutaminase [TG2] are not always present  and many people with coeliac may have minor mucosal lesions, without atrophy of the intestinal villi. CD with "classic symptoms", which include gastrointestinal manifestations such as chronic diarrhoea and abdominal distention, malabsorption, loss of appetite, and impaired growth, is currently the least common presentation form of the disease and affects predominantly to small children generally younger than two years of age.
CD with "non-classic symptoms" is the most common clinical type and occurs in older children over 2 years old , adolescents and adults. Following a lifelong gluten-free diet is the only medically-accepted treatment for people with coeliac disease. Non-coeliac gluten sensitivity NCGS is described as a condition of multiple symptoms that improves when switching to a gluten-free diet, after coeliac disease and wheat allergy are excluded.
Gastrointestinal symptoms may include any of the following: The pathogenesis of NCGS is not yet well understood. It was hypothesized that gluten, as with coeliac disease, is the cause of NCGS. Nevertheless, this study seems to have design errors and an incorrect selection of participants, which could have masked the true effect of gluten reintroduction.
ATIs, which resist proteolytic digestion, may be the inducers of innate immunity in people with coeliac disease or NCGS. After exclusion of coeliac disease and wheat allergy,  the subsequent step for diagnosis and treatment of NCGS is to start a strict gluten-free diet to assess if symptoms improve or resolve completely.
This may occur within days to weeks of starting a GFD, but improvement may also be due to a non-specific, placebo response. A subgroup of people with NCGS may not improve by eating commercially available gluten-free products, which are usually rich of preservatives and additives, because chemical additives such as sulphites , glutamates , nitrates and benzoates might have a role in evoking functional gastrointestinal symptoms of NCGS.
These people may benefit from a diet with a low content of preservatives and additives. NCGS, which is possibly immune-mediated, now appears to be more common than coeliac disease,  with prevalence rates between 0.
People can also experience adverse effects of wheat as result of a wheat allergy. Wheat allergy has a fast onset from minutes to hours after the consumption of food containing wheat and could be anaphylaxis. The management of wheat allergy consists of complete withdrawal of any food containing wheat and other gluten-containing cereals. Gluten ataxia is an autoimmune disease triggered by the ingestion of gluten.
People with gluten ataxia usually present gait abnormality or incoordination and tremor of the upper limbs.
Gaze-evoked nystagmus and other ocular signs of cerebellar dysfunction are common. Myoclonus , palatal tremor, and opsoclonus-myoclonus may also appear.
Early diagnosis and treatment with a gluten-free diet can improve ataxia and prevent its progression. The effectiveness of the treatment depends on the elapsed time from the onset of the ataxia until diagnosis, because the death of neurons in the cerebellum as a result of gluten exposure is irreversible.
Since the beginning of the 21st century, the gluten-free diet has become the most popular fad diet in the United States and other countries.
Many of these persons began a gluten-free diet on their own, without having been previously evaluated. In a review of May published in Gastroenterology , Fasano et al. The popularity of the gluten-free diet is hurting people who actually need to eliminate gluten due to medical reasons. The servers are issuing judgments, believing that it is simply a fad, which is leading to them not taking the necessary precautions in the handling of the food to avoid gluten cross-contamination.
Gluten-free commercial replacement products, such as gluten-free cakes, are more expensive than their gluten-containing counterparts, so their purchase adds a financial burden.
Healthcare professionals recommend against undertaking a gluten-free diet as a form of self-diagnosis ,  because tests for coeliac disease are reliable only if the person has been consuming gluten recently. There is a consensus in the medical community that people should consult a physician before going on a gluten-free diet, so that a medical professional can accurately test for coeliac disease or any other gluten-induced health issues.
Although popularly used as an alternative treatment for people with autism, there is no good evidence that a gluten-free diet is of benefit in reducing the symptoms of autism. A gluten-free diet is a diet that strictly excludes gluten, proteins present in wheat and all wheat varieties such as spelt and kamut , barley , rye , oat , and derivatives of these grains such as malt and triticale , and foods that may include them, or shared transportation or processing facilities with them.
Other grains, although gluten-free in themselves, may contain gluten by cross-contamination with gluten-containing cereals during grain harvesting, transporting, milling, storing, processing, handling or cooking. Processed foods commonly contain gluten as an additive as emulsifiers, thickeners, gelling agents, fillers, and coatings , so they would need specific labeling.
Unexpected sources of gluten are, among others, processed meat, vegetarian meat substitutes, reconstituted seafood, stuffings, butter, seasonings, marinades, dressings, confectionary, candies, and ice cream. Cross contamination in the home is also a consideration for those who suffer gluten-related disorders.
Medications and dietary supplements are made using excipients that may contain gluten. The gluten-free diet includes naturally gluten-free food, such as meat, fish, seafood , eggs, milk and dairy products , nuts , legumes , fruit, vegetables, potatoes , pseudocereals in particular amaranth , buckwheat , chia seed , quinoa , only certain cereal grains corn , rice, sorghum , minor cereals including fonio , Job's tears , millet , teff , called "minor" cereals as they are "less common and are only grown in a few small regions of the world" ,  some other plant products arrowroot , mesquite flour ,  sago ,  tapioca  and products made from these gluten-free foods.
An unbalanced selection of food and an incorrect choice of gluten-free replacement products may lead to nutritional deficiencies.
Replacing flour from wheat or other gluten-containing cereals with gluten-free flours in commercial products may lead to a lower intake of important nutrients, such as iron and B vitamins and a higher intake of sugars and saturated fats.
These nutritional complications can be prevented by a correct dietary education. In this aim, for example the dietary fibre inulin which acts as a prebiotic  or quinoa or amaranth wholemeal have been as substitute for part of the flour. Such substitution has been found to also yield improved crust and texture of bread. Vitamins often contain gluten as a binding agent. Experts have advised that it is important to always read the content label of any product that is intended to be swallowed.
Poor compliance with the regimen is also influenced by age at diagnosis adolescents , ignorance of the consequences of the lack of a strict treatment and certain psychological factors. The term gluten-free is generally used to indicate a supposed harmless level of gluten rather than a complete absence. Regulation of the label gluten-free varies by country. Most countries derive key provisions of their gluten-free labelling regulations from the Codex Alimentarius international standards for food labelling as a standard relating to the labelling of products as gluten-free.
It only applies to foods that would normally contain gluten. It categorizes gluten-free food as:. The Codex Standard specifies that the gluten-free claim must appear in the immediate proximity of the name of the product, to ensure visibility. There is no general agreement on the analytical method used to measure gluten in ingredients and food products. The European Union, World Health Organization, and Codex Alimentarius require reliable measurement of the wheat prolamins, gliadins rather than all-wheat proteins.
The Australian government recommends  that:. All food products must be clearly labelled whether they contain gluten or they are gluten-free.
The law does not establish a gluten threshold for the declaration of its absence. Health Canada considers that foods containing levels of gluten not exceeding 20 ppm as a result of contamination, meet the health and safety intent of section B. Labels for all food products sold in Canada must clearly identify the presence of gluten if it is present at a level greater than 10 ppm.
The EU European Commission delineates  the categories as:. All foods containing gluten as an ingredient must be labelled accordingly as gluten is defined as one of the 14 recognised EU allergens. Until anyone could use the gluten-free claim with no repercussion. After this was reported in the Chicago Tribune , the products continued to be sold.
The manufacturer has since replaced the batter used in its chicken nuggets. The Alcohol and Tobacco Tax and Trade Bureau published interim rules and proposed mandatory labelling for alcoholic products in Any food product that inherently does not contain gluten may use a gluten-free label where any unavoidable presence of gluten in the food bearing the claim in its labelling is below 20 ppm gluten.
From Wikipedia, the free encyclopedia. J Gastroenterol Hepatol Review. The gluten found in all of these grains has been identified as the component capable of triggering the immune-mediated disorder, coeliac disease. United European Gastroenterol J Review. Explicit use of et al. It is necessary to consider that oats include many varieties, containing various amino acid sequences and showing different immunoreactivities associated with toxic prolamins.
As a result, several studies have shown that the immunogenicity of oats varies depending on the cultivar consumed. Thus, it is essential to thoroughly study the variety of oats used in a food ingredient before including it in a gluten-free diet.
For CD patients on GFD, the nutritional complications are likely to be caused by the poor nutritional quality of the GFPs mentioned above and by the incorrect alimentary choices of CD patients. It is advisable to prefer consumption of naturally GF foods, since it has been shown that they are more balanced and complete under both the macro- and micro-nutrient point of view. In fact, these foods are considered to have a higher nutritional value in terms of energy provision, lipid composition and vitamin content as opposed to the commercially purified GF products.
Within the range of naturally GF foods, it is preferable to consume those rich in iron and folic acid, such as leafy vegetables, legumes, fish and meat. During explanation of naturally GF foods to patients, it is a good approach for healthcare professionals to bear in mind the local food habits and recipes of each country.
This may provide tailored dietary advice, improving acceptance and compliance to GFD. Furthermore, increasing awareness on the availability of the local naturally GF foods may help promote their consumption, resulting in a more balanced and economically advantageous diet.
Indeed, these aspects should always be addressed during dietary counseling. With regards to the commercially purified GFPs, it is recommended to pay special attention to the labeling and chemical composition.
Increasing awareness on the possible nutritional deficiencies associated with GFD may help healthcare professionals and families tackle the issue by starting from early education on GFD and clear dietary advice on how to choose the most appropriate gluten-free foods. The Need to Revisit the Issue". Can J Gastroenterol Hepatol Review. For both wheat allergy and coeliac disease the dietary avoidance of wheat and other gluten-containing cereals is the only effective treatment.
Best Pract Res Clin Gastroenterol.