Gluten-free Diet - Tough Alley in Torrid Time

Abstract

Dietitians play a pivotal role in the education, follow-up and navigation of the gluten-free diet for patients affected by celiac disease. Since gluten withdrawal is the cornerstone of celiac disease therapy, and since various future therapeutic strategies, are not yet on the market, the patients relay heavily on the registered dietitian nutritionists (RDNs) advice and service to cope with the gluten-free diet tough alley. Unfortunately, gluten withdrawal, nowadays, represent also a torrid time. The actual surge in incidence, wheat content, gluten intake, celiac disease-related T-cell stimulatory epitopes in wheat, usage in the processed food industries, nutritional deficiencies, changing phenotype and the fact that gluten is potentially detrimental to humankind health, make the RDNs role more complex, difficult and challenging. The present review expands on the gluten-free diet related tough alley in torrid time, which the registered dietitian nutritionists are facing when dealing with gluten-sensitive patients.

Navigating the Gluten-Free Boom: The Dark Side of Gluten Free Diet

“…More so, dietary modification, including GFD in gluten related conditions, may be associated with pathological eating practices (80). Compliance with GFD is a tough alley (28), associated with major changes in daily lifestyle routine and activities and eating habits, many times stressful and difficult to accept (81, 82). The underlying mechanisms that induce those psycho-social-behavioral disorders, while on GFD, are not understood.…”

“…Taking into account the tough alley and the contemporary torrid times in complying with a strict GFD (28), sincere and practical efforts should be implemented to close the gaps. Following are some suggestions to avoid the detrimental effect of GF product consumption toward a more personalized nutrition, tailored to the individual needs.…”

“…Asking a patient to abstain from a most-common food in their diet, often eaten in some form multiple times per day, is an extremely challenging directive fraught with non-compliance absent expert on-going advice. Early and effective consultation with a gluten knowledgeable, food labeling skilled, Dietitian, Nutritionist or Health Coach (28), increasing the intake of pseudo-cereals, polyphenol-rich fruits and vegetables, encouraging natural GF foods, focused efforts on rebuilding a balanced non-inflammatory microbiome, increasing the patient's education on the disease evolvement, GF products and follow ups, in order to improve adherence and establish a healthy balanced diet (6, 47, 49, 50, 92) is of essential nature in reducing the increased risk of morbidity and mortality. Very important is the physician-dietitian-patient trustful relationship and the team communication for the patient's successful recovery and adherence to the dietary restriction.…”

“…For the newly evolved entity of non-celiac gluten sensitivity, GFD might alleviate their symptoms, though, the pathophysiological pathways, offending environmental factors, strict diagnostic criteria and therapeutic nutrient withdrawal policy, are far from being resolved (23–25). The diagnostic criteria for CD and its related extra-intestinal manifestations (26, 27) are quite clear and the recommended gluten avoidance is obvious, but the lifelong restriction is a bumpy road (28, 29). The difficulties in following GFD and the reasons for poor patient's compliance were summarized recently (28, 29).…”

“…The diagnostic criteria for CD and its related extra-intestinal manifestations (26, 27) are quite clear and the recommended gluten avoidance is obvious, but the lifelong restriction is a bumpy road (28, 29). The difficulties in following GFD and the reasons for poor patient's compliance were summarized recently (28, 29). Gluten is considered as a universal food additive as a thickener, flavor enhancer, filler, emulsifier, or texture modifier in many processed food products (6, 30).…”