Gluten-free nutrition
Gluten-free diet as a therapy for gluten-related diseases
Regardless of whether coeliac disease or gluten/wheat sensitivity: After diagnosis of a gluten-related disorder (GRD), a gluten-free diet is the only possible therapy - albeit with varying degrees of stringency and persistence.
First the diagnosis, then gluten-free eating
The basic rule is: first the diagnosis, then the gluten-free diet therapy. On the one hand, gluten-free eating can falsify the results of the differential diagnosis of cereal and gluten-related diseases. In addition, the type of gluten-free diet differs depending on the diagnosis. In the case of the autoimmune disease coeliac disease, for example, the gluten-free diet must be absolute and permanent: Sufferers must not eat any foods containing gluten for the rest of their lives - even if they only contain traces of gluten. For patients with gluten/wheat sensitivity, however, the gluten-free diet can be limited in time.
| Celiac Disease | Gluten/Wheat Sensitivity | |
|---|---|---|
| Duration | Lifelong | Temporarily limited, at least one to two years |
| Special notes | Strictly gluten-free, no traces allowed | Afterwards, low-gluten may be sufficient |
Table: Gluten-free diet plan for coeliac disease or gluten/wheat sensitivity.
Gluten-free diet for coeliac disease
The only treatment for coeliac disease is a lifelong, strictly gluten-free diet. Dietary errors or non-compliance with a strict gluten-free diet increase the risk of developing complications of coeliac disease. Changing your diet after being diagnosed with coeliac disease is therefore a drastic change. A coeliac disease dietary consultation by an appropriately trained dietician with information on implementing a gluten-free diet can help those affected to cope with the disease. In the case of children, dietary training for the whole family is necessary - and friends and relatives as well as carers and teachers must also be informed in order to avoid dietary errors.
Dietary counselling in three stages has become established for coeliac disease:
Gluten-free diet for gluten / wheat sensitivity
Gluten / wheat sensitivity can also be treated with a gluten-free diet. Here too, it is important that the gluten-free diet is only started after diagnosis. In contrast to the strict recommendations for coeliac disease, patients with gluten/wheat sensitivity do not absolutely and for the rest of their lives have to eat gluten-free : After 6 to 8 weeks of strictly avoiding gluten, a gluten-reduced diet may be sufficient to prevent the symptoms from flaring up again. As the tolerable limit varies from person to person , an individually adapted, symptom-orientated gluten-free diet is recommended. To ensure that the changeover is successful, counselling and support from an appropriately trained nutritionist is strongly recommended.
Sources
- Felber J et al. Updated S2k guideline coeliac disease of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS), Z Gastroenterol 2022; 60: 790-856.
- Biagi F, Bianchi PI, Marchese A, et al. A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life. Br J Nutr. 2012;108(10):1884-1888. doi:10.1017/S0007114511007367.
- Hughey JJ, Ray BK, Lee AR, et al. Self-reported dietary adherence, disease-specific symptoms, and quality of life are associated with healthcare provider follow-up in celiac disease. BMC Gastroenterol. 2017;17(1):156. doi:10.1186/s12876-017-0713-7.
- Al-Toma A, Volta U, Auricchio R, Castillejo G, Sanders DS, Cellier C, Mulder CJ, Lundin KEA. European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019 Jun;7(5):583-613. doi: 10.1177/2050640619844125. Epub 2019 Apr 13. PMID: 31210940; PMCID: PMC6545713.