Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY, 10032, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, 10032, USA.
Dig Dis Sci. 2019 Jul;64(7):1740-1747. doi: 10.1007/s10620-019-05663-x.
While the gluten-free diet (GFD) is the only known effective therapy for celiac disease, in recent years it has become increasingly popular in the USA and worldwide, with many believing it to be more "healthful" and others claiming that it has beneficial effects for health conditions, many extraintestinal, other than celiac disease. This review examines the evidence for use of the GFD in patients without celiac disease who self-report intestinal and/or extraintestinal symptoms (non-celiac gluten sensitivity), as well as for enhancement of athletic performance and treatment of autism, rheumatoid arthritis, and psychiatric disorders. Overall, the evidence for use of GFDs in conditions other than celiac disease is poor. Though non-celiac gluten sensitivity may ultimately emerge as a biomarker-defined condition, a large proportion of patients with apparent non-celiac gluten sensitivity have, after careful investigation, an alternative diagnosis. In light of this, and coupled with the potential physical and psychological harms associated with the avoidance of gluten, initiating a GFD should not be encouraged for people who have these other conditions or are seeking physical/athletic enhancement.
尽管无麸质饮食（GFD）是目前已知的治疗乳糜泻的唯一有效方法，但近年来，它在美国和全球范围内越来越受欢迎，许多人认为它更“健康”，而另一些人则声称它对除乳糜泻以外的许多肠外疾病有有益的影响。这篇综述探讨了在没有乳糜泻但自述有肠内和/或肠外症状（非乳糜泻麸质敏感）的患者中使用 GFD 的证据，以及在提高运动表现和治疗自闭症、类风湿关节炎和精神障碍方面的证据。总的来说，GFD 在除乳糜泻以外的疾病中的应用证据不足。虽然非乳糜泻麸质敏感最终可能会成为一种生物标志物定义的疾病，但在经过仔细调查后，相当一部分有明显非乳糜泻麸质敏感的患者会有其他替代诊断。有鉴于此，再加上避免食用麸质可能带来的身体和心理伤害，对于患有这些其他疾病或寻求身体/运动增强的人，不应鼓励他们采用 GFD。
