Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies

Abstract

A lifelong gluten-free diet (GFD) is the only treatment for celiac disease and other gluten-related disorders. Nevertheless, strict adherence to the GFD is often challenging due to concerns about social isolation, risk of gluten contaminations, high cost, poor quality and the taste of gluten-free products. Moreover, although the GFD is effective in achieving mucosal healing, it may lead to dietary imbalances due to nutrient deficiencies over a long period of time. To overcome these issues, several gluten-free wheat flours have been developed to create products that closely resemble their gluten-containing counterparts. Furthermore, given the critical importance of adhering to the GFD, it becomes essential to promote adherence and monitor possible voluntary or involuntary transgressions. Various methods, including clinical assessment, questionnaires, serology for celiac disease, duodenal biopsies and the detection of Gluten Immunogenic Peptides (GIPs) are employed for this purpose, but none are considered entirely satisfactory. Since adherence to the GFD poses challenges, alternative therapies should be implemented in the coming years to improve treatment efficacy and the quality of life of patients with celiac disease. The aim of this narrative review is to explore current knowledge of the GFD and investigate its future perspectives, focusing on technology advancements, follow-up strategies and insights into a rapidly changing future.

Utilizing Telemedicine Applications in Celiac Disease and Other Gluten-Free-Diet-Dependent Conditions: Insights from the COVID-19 Pandemic

“…The only proven method for treating CD patients’ symptoms, returning their immune systems to normal, as well as the normalization of serological markers and healing their intestinal mucosa, is a life-long gluten-free diet (GFD) [ 9 , 14 , 61 , 62 , 63 , 64 ].…”

Celiac Disease, Gluten-Free Diet and Metabolic Dysfunction-Associated Steatotic Liver Disease

“…Gluten-free wheat flour has proven to be the best solution, showing superior nutritional profiles compared to traditional glutenfree alternatives. These powders usually have a high protein content, good amino acid profiles, and provide enough dietary fiber [110]. Other fake grain flours, such as amaranth, chickpea, chia, and quinoa, have also become popular.…”

“…Other fake grain flours, such as amaranth, chickpea, chia, and quinoa, have also become popular. These pseudocereals are free of gluten proteins and provide high-quality protein, cholesterol-lowering, and glycemic control effects, as well as enough carbohydrates [110,111]. Testing for micronutrient deficiencies like iron, folic acid, vitamin D, vitamin B6, and B12 in newly diagnosed CD patients and after following a GFD will raise awareness of the possibility that some patients need specific supplementation [4].…”

“…Patient-specific dietary advice should help CD-MASLD patients maintain an appropriate nutritional intake and reduce the risk of long-term liver-related events. Some of the key recommendations to improve diets include increased consumption of naturally gluten-free foods such as vegetables, fruits, legumes, nuts, seeds, and pseudocereals; choosing the right sources and amounts of good carbohydrates and proteins; and using gluten-free products enriched with micronutrients and vitamins (Figure 2) [110,116]. An ongoing exploration of the correlation between CD, GFD, and MASLD will allow enhanced comprehension and more adequate management of these significant and often associated health issues.…”