Clinical Nutrition, University of Chicago Medicine, Chicago, IL, USA.
Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA.
Curr Gastroenterol Rep. 2024 Aug;26(8):191-199. doi: 10.1007/s11894-024-00931-x. Epub 2024 Jun 12.
Celiac disease is a common chronic inflammatory condition of the small bowel triggered by gluten in wheat, rye and barley in the diet. Non-celiac gluten sensitivity presents with symptoms similar to celiac disease with the ingestion of gluten or other components of wheat. In this article, we review challenges presented by a gluten free diet for the treatment of both disorders.
Wheat is ubiquitous in the diet and medications/products. A registered dietitian is mandatory for patient education on the gluten free diet. Naturally gluten free foods provide a healthy diet for those with celiac disease. Whole grains labelled gluten free, including oats, are encouraged in the diet as refined grains may be deficient in fiber, protein, and micronutrients, particularly folate. Gluten contamination is the most common cause of persistent symptoms in celiac disease though shared equipment of food preparation may not be as large a problem as suspected. Most with celiac disease on a gluten free diet will fully recover and gain weight that poses a problem for those overweight to start. The gluten free diet may have a negative impact on quality of life for both celiac patients and their families. Those with hypervigilance of the gluten free diet and avoidance of dining out have the lowest quality of life. The gluten free diet is currently the only effective treatment for celiac disease. A registered dietitian is needed to educate patients on the complexity of the gluten free diet with a goal of healthy eating, maintaining a healthy weight, and avoiding disordered eating or diet hypervigilance; key to a good quality of life.
乳糜泻是一种常见的小肠慢性炎症性疾病，由饮食中的小麦、黑麦和大麦中的麸质触发。非乳糜泻麸质敏感性在摄入麸质或小麦的其他成分时出现与乳糜泻相似的症状。本文综述了无麸质饮食治疗这两种疾病所面临的挑战。
小麦在饮食和药物/产品中无处不在。注册营养师是对无麸质饮食进行患者教育的必要条件。对于乳糜泻患者来说，天然无麸质食物提供了健康的饮食。全谷物（包括燕麦）被标记为无麸质，鼓励在饮食中使用，因为精制谷物可能缺乏纤维、蛋白质和微量营养素，特别是叶酸。麸质污染是乳糜泻患者持续症状的最常见原因，尽管食物准备过程中使用共享设备可能不像怀疑的那样是一个大问题。大多数乳糜泻患者在接受无麸质饮食后会完全康复并增加体重，这对超重患者来说是一个问题。无麸质饮食可能会对乳糜泻患者及其家属的生活质量产生负面影响。那些对无麸质饮食高度警惕并避免外出就餐的人生活质量最低。无麸质饮食是目前治疗乳糜泻的唯一有效方法。需要注册营养师来教育患者无麸质饮食的复杂性，目标是健康饮食、保持健康体重、避免饮食失调或饮食过度警惕；这是提高生活质量的关键。
