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

Lerner, Aaron; O’Bryan, Thomas; Tenbusch, Matthias

doi:10.3389/fped.2019.00414

Cited by 49 publications

(56 citation statements)

References 90 publications

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“…It is not clear which of these targets should be considered as the primary or secondary endpoint of GFD for CD patients towards their long-term prognosis [6]. Although safe and efficient, GFD is very restrictive, resulting as a burden on social life and quality of life (for both patients and caregivers) [7][8][9][10] and frequently with poor compliance [11][12][13]. Moreover, the clinical response to inadvertent or voluntary gluten ingestion by treated CD patients can be very heterogeneous, ranging from gastroenteritislike pictures to no symptoms [3,14].…”

Section: Introductionmentioning

confidence: 99%

Safety of occasional ingestion of gluten in patients with celiac disease: a real-life study

Elli

Bascuñán

Lernia

et al. 2020

BMC Med

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Background: Gluten-free diet (GFD) decreases the quality of life of celiac disease (CD) patients, who frequently ask to occasionally ingest gluten-containing food. We evaluated CD patients reporting voluntary and occasional transgressions to their GFD. Methods: From October 2017 to September 2018, the patients reporting occasional and voluntary gluten ingestion (GFD-noncompliant) were prospectively enrolled. These patients underwent clinical examination, blood tests, duodenal biopsy, capsule enteroscopy (CE), and a validated food-frequency questionnaire (FFQ) assessing the frequency and quantity of gluten intake. Mortality was calculated and compared to the general population. A group of patients on strict GFD (GFD-adherent) acted as controls. Results: One thousand three hundred seventy-eight CD patients were evaluated during the study period. One hundred nine (8%) reported occasional (weekly or monthly) voluntary ingestion of gluten. The mean gluten intake was 185.2 ± 336.9 g/year, and the duration of their incorrect GFD was 8.6 ± 6.9 years. Among the noncompliant patients, 57% did not present any histological alteration; furthermore, the Marsh score profile was not different between compliant and noncompliant patients. Seventy percent did not present any alteration at CE. Seventy-five percent of patients reported no gastrointestinal symptoms after gluten ingestion. Twenty-three percent of patients in the GFD-noncompliant group presented positive tTG-IgA. No association was found between gluten intake, clinical symptoms, and biomarkers. Mortality was not different between the groups and the general population. Conclusions: Our results are that in a real-life scenario, a group of CD patients on long-term gluten intake showed no significant clinical symptoms or small bowel damage, thus suggesting that a degree of tolerance towards gluten consumption can be reached.

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Section: Introductionmentioning

confidence: 99%

Safety of occasional ingestion of gluten in patients with celiac disease: a real-life study

Elli

Bascuñán

Lernia

et al. 2020

BMC Med

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“…In the last few years, the nutritional profile of gluten-free food products has been increasingly questioned within the scientific community. The nutritional quality of the gluten-free food products currently available on the market is inadequate -low protein contents and high fat, sugar and salt contents-compared to equivalent gluten-containing products [52][53][54]. Data from studies on gluten-free foods have indicated that there is a need to lower fat and calories and to include more fibers, proteins, electrolytes, vitamins, and other micronutrients.…”

Section: Discussionmentioning

confidence: 99%

Celiac Disease, Gluten-Free Diet, and Metabolic and Liver Disorders

et al. 2020

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Celiac disease (CD) is a chronic autoimmune enteropathy triggered by the ingestion of gluten in genetically predisposed individuals. At the time of diagnosis, the frequency of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis in individuals with CD appears to be similar to that of the general population, although a lower body mass index and a lower rate of hypercholesterolemia and type 2 diabetes mellitus are observed at diagnosis in CD patients. The effect of a gluten-free diet (GFD) in individuals with these liver and metabolic disorders is still a matter of debate. The aim of this study was to investigate the links between a GFD and metabolic/liver disorders in CD patients. A systematic electronic search of the literature from January 2009 to December 2019 was performed using Medline, Web of Science, Scopus, and the Cochrane Library. Only papers written in English concerning metabolic and liver disorders in adult patients with CD were included. Out of 1195 citations, 14 eligible studies were identified. Increases in the frequency of NAFLD, weight gain, and alterations of the lipid profile suggest that important changes happen in celiac patients on a GFD, though the physiopathology of these conditions is unclear. Although a GFD is the only effective treatment available for CD, liver function, body weight, and metabolic and nutritional profiles should be monitored in patients on a GFD.

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“…On the other hand, many patients remain symptomatic and have ongoing low-grade enteric inflammation, despite gluten withdrawal. Admittedly, in contrast, gluten has its known side effects [46], but GFD also has a dark side [47].…”

Section: Celiac Disease In a Nutshellmentioning

confidence: 99%

Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease

Lerner¹,

Tenbusch²

2020

IJMS

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Microbial transglutaminase (mTG) is a survival factor for microbes, but yeasts, fungi, and plants also produce transglutaminase. mTG is a cross-linker that is heavily consumed as a protein glue in multiple processed food industries. According to the manufacturers' claims, microbial transglutaminase and its cross-linked products are safe, i.e., nonallergenic, nonimmunogenic, and nonpathogenic. The regulatory authorities declare it as "generally recognized as safe" for public users. However, scientific observations are accumulating concerning its undesirable effects on human health. Functionally, mTG imitates its family member, tissue transglutaminase, which is the autoantigen of celiac disease. Both these transglutaminases mediate cross-linked complexes, which are immunogenic in celiac patients. The enzyme enhances intestinal permeability, suppresses mechanical (mucus) and immunological (anti phagocytic) enteric protective barriers, stimulates luminal bacterial growth, and augments the uptake of gliadin peptide. mTG and gliadin molecules are cotranscytosed through the enterocytes and deposited subepithelially. Moreover, mucosal dendritic cell surface transglutaminase induces gliadin endocytosis, and the enzyme-treated wheat products are immunoreactive in CD patients. The present review summarizes and updates the potentially detrimental effects of mTG, aiming to stimulate scientific and regulatory debates on its safety, to protect the public from the enzyme's unwanted effects.

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

Cited by 49 publications

References 90 publications

Safety of occasional ingestion of gluten in patients with celiac disease: a real-life study

Safety of occasional ingestion of gluten in patients with celiac disease: a real-life study

Celiac Disease, Gluten-Free Diet, and Metabolic and Liver Disorders

Processed Food Additive Microbial Transglutaminase and Its Cross-Linked Gliadin Complexes Are Potential Public Health Concerns in Celiac Disease

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