The gluten-free diet and its current application in coeliac disease and dermatitis herpetiformis

Abstract

Background: A gluten-free diet (GFD) is currently the only available therapy for coeliac disease (CD).

Objectives: We aim to review the literature on the GFD, the gluten content in naturally gluten-free (GF) and commercially available GF food, standards and legislation concerning the gluten content of foods, and the vitamins and mineral content of a GFD.

Methods: We carried out a PubMed search for the following terms: Gluten, GFD and food, education, vitamins, minerals, calcium, Codex wheat starch and oats. Relevant papers were reviewed and for each topic a consensus among the authors was obtained.

Conclusion: Patients with CD should avoid gluten and maintain a balanced diet to ensure an adequate intake of nutrients, vitamins, fibre and calcium. A GFD improves symptoms in most patients with CD. The practicalities of this however, are difficult, as (i) many processed foods are contaminated with gluten, (ii) staple GF foods are not widely available, and (iii) the GF substitutes are often expensive. Furthermore, (iv) the restrictions of the diet may adversely affect social interactions and quality of life. The inclusion of oats and wheat starch in the diet remains controversial.

Keywords: Coeliac disease; dermatitis herpetiformis; gluten free; gluten-free diet; parts per million.

Figure 1.

Classification of grains: Toxic grains for coeliac patients include bread wheat, durum wheat (used in pasta), spelt wheat, polonicum (Polish wheat), Kamut, monoccum (einkorn), farro, triticale (a cross between wheat and rye), and many other wild grass. They all belong to the Hordeae or Triticeae family. The grasses not in Triticeae are classified as safe (rice, corn, various millets, ragi, teff, oats). Protein sequence between the major wheat gliadin proteins and oat avenins indicates relative closeness of wheat and oats. From: Kasarda DD 2003. Celiac disease and safe grains. http://wheat.pw.usda.gov/ggpages/topics/celiac.vs.grains.html with the permission of the author.