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- The authors of this systematic review evaluated the nutritional quality of the gluten-free (GF) diet used in the management of celiac disease (CD). As the GF diet excludes many fiber-rich foods, such as grains, there is a lack of fiber. In addition, there are insufficient quantities of many micronutrients, notably vitamin D, vitamin B12, and folate. Levels of iron, zinc, magnesium, and calcium are also inadequate. In addition, macronutrient intake was reportedly inadequate due to a poor choice of GF foods. Many GF meals contained a higher content of saturated and hydrogenated fatty acids and foods often associated with an increased glycemic index.
- While a GF diet is necessary to effectively treat CD, the nutritional quality of the foods consumed should be evaluated. Patients need to be educated about appropriate food choices.
Abstract
BACKGROUND & AIMS
The only available treatment for celiac disease (CD) is lifelong adherence to gluten free (GF)-diet. However, GF-diet may lead to possible nutrient unbalance resulting in improper nutritional quality of diet. The aim of this study is to evaluate the nutritional quality of GF-diet.
RESULTS
GF-diet was found to be poor in alimentary fiber due in particular to the necessary avoidance of several kinds of foods naturally rich in fiber (i.e. grain) and the low content of fiber of GF product that are usually made with starches and/or refined flours. Micronutrients are also found to be poor, in particular Vit. D, Vit. B12 and folate, in addition to some minerals such as iron, zinc, magnesium and calcium. Moreover, an inadequate macronutrient intake was reported related above all to the focus on the avoidance of gluten that often leaving back the importance of nutritional quality of the choice. In particular, it was found a higher content of both saturated and hydrogenated fatty acids and an increase in the glycemic index and glycemic load of the meal.
CONCLUSIONS
Despite the GF-diet is necessary in celiac disease treatment and the attention is on gluten avoidance, the evaluation of nutritional quality of the diet must be considered. Moreover, educational strategies based on the relationship between nutrients and food and human health could be developed to optimize the therapeutic approach in celiac patients.
With the growing popularity of removing gluten from the diet, it is important to be aware of the common deficiencies associated with this eating pattern.
This literature review found that the most common deficiency of a gluten-free diet was fiber. Eating gluten-free often reduces high-fiber grains from the diet. Additionally, gluten-free products are made from starch and processed flours that are void of fiber. As a grain is processed to remove gluten, the outer fibrous coat is removed, leaving a starchy sugary flour that has a higher glycemic index that can lead to weight gain. Quinoa and amaranth are two grains that are void of gluten but high in fiber and nutrients, particularly folate. Patients should be encouraged to eat them in their natural, unprocessed state.
The most common vitamin deficiencies seen in a gluten-free diet involve B12, folate, and vitamin D. Consider checking levels of these vitamins in patients on a gluten-free diet.
The most common mineral deficiencies are magnesium, calcium, zinc, and iron. Gluten-free grains are generally low in magnesium compared with those that are gluten-rich.
Compared with non–gluten free diets, gluten-free diets are higher in simple carbohydrates and saturated fat, with a greater total calorie content.
The paper summarizes its findings with this table: