The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes

Abstract

The gluten-free diet (GFD) remains a complex paradigm in managing celiac disease (CeD) in children and adults, and there are many reasons why GFD adherence should be strict to improve outcomes. However, this is a challenging task for patients, since they need to have access to quality healthcare resources that facilitate optimal GFD adherence. Understanding the strengths and weaknesses of the GFD, tackling coexisting nutritional deficiencies, and dealing with complex situations, such as seronegative CeD or non-responsive CeD, all require the involvement of a multidisciplinary team. The short- and long-term follow-up of CeD patients should preferably be performed by a combined Gastroenterology and Nutrition service with well-defined quality standards and the multidisciplinary involvement of physicians, nurses, dietitians, and psychologists. Nutritional advice and counseling by an experienced dietitian can reduce the costs associated with long-term follow-up of CeD patients. Likewise, psychological interventions may be essential in specific scenarios where implementing and sustaining a lifelong GFD can cause a significant psychological burden for patients. This manuscript aims to provide guidelines to improve clinical practice in the follow-up and monitoring of CeD patients and provide information on the nutritional risks of an ill-advised GFD. Clinicians, biochemists, food technologists, dietitians, and psychologists with a global view of the disease have been involved in its writing.

Policy Brief: Celiac disease in Chilean children: Implementation of a practical guide on gluten-free diet for caregivers and educators, a contrast with other countries in the region.

“…Los resultados son similares en el resto de los países latinoamericanos, pues existen pocas revisiones sistemáticas y el problema es el mismo, una vez diagnosticada hay pocos profesionales expertos que sepan diseñar una dietoterapia adecuada, poca información sobre los alimentos libres de gluten, su preparación y altos costos de estos. Todo esto puede ser todo un reto en la población infantil, pues ya están sujetos a un diagnóstico tardío y la desinformación por parte de los cuidadores lleva a la búsqueda de recomendaciones erróneas permaneciendo así la mala adherencia a la dieta la cual es fundamental, creando un mayor riesgo de ingesta insuficiente de nutrientes necesarios en su alimentación (Simón et al, 2023).…”

Global Approach to Follow-Up of Celiac Disease

“…Actually, people who suffer from CD report limitations when eating outside, constant worry about gluten, continuous planning, feeling different, emotional pressure or coping with symptoms. Right after diagnosis, many patients feel anger, fear, shame, rage and sadness [120], but after some time on a GFD, the situation might normalize, and they begin to feel control over the situation and feel good, their health-related QoL being improved [121,122]. However, as gluten avoidance is essential for people with CD, there is also concern that "extreme vigilance" to a strict GFD may increase symptoms such as anxiety, stress and fatigue and therefore reduce their QoL.…”

“…These tools serve as essential elements when trying to mitigate the impact of CD at any age. Moreover, the emphasis on social support contributes significantly to the development of awareness, fostering optimal long-term adherence to a GFD [122].…”

A flour composite mixture for gluten-free confectionery

“…A significant shortcoming of available gluten-free products is their low protein content and high levels of fat and salt. To comply with recommendations regarding nutrition, it is necessary to develop the products and change the recipe [1].…”