History:
Celiac disease first appeared in the medical literature in the 1880s (1). A British physician, Dr. Samuel Gee, suggested that the only treatment option is through diet, however, the exact diet was not known yet. He used thinly cut and well-toasted bread as his treatment, which did not work. In the 1920s Dr. Sidney Hass developed the banana diet to treat children with celiac disease, which worked because bananas do not contain gluten. However, it was not until 1941 when Willem-Karel Dicke, a Netherlands pediatrician, reported the gluten-free diet in his paper W K Dicke: A Simple Diet for Gee-Herter's Syndrome for the treatment of celiac disease (2). From 1934-1936 he was experimenting with a wheat-free diet, yet it was not until a mother reported that her child’s celiac disease improved rapidly and significantly if she removed the bread from the diet that alerted Dicke and led to the finding of a “bread-free diet”, and further, the gluten-free diet.
Purpose:
A diet for celiac disease (3): Celiac disease is a chronic, immune-mediated disease caused by the consumption of gluten. The immune system reacts to gluten leading to inflammation and damage in the linings of the small intestine. Classic symptoms include gastrointestinal manifestations such as diarrhea, bloating, fatigue, and malabsorption. Celiac disease may also present asymptomatically.
Non-celiac gluten sensitivity (3): This condition has multiple symptoms similar to that of celiac disease and improves when on a gluten-free diet, however, celiac disease and a wheat allergy have been ruled out.
Wheat allergy (3): Wheat is one of the eight most common food allergens. All forms of wheat contain gluten therefore individuals with a wheat allergy follow a gluten-free diet. While a wheat allergy may present with similar GI symptoms of celiac disease and non-celiac gluten sensitivity the onset of symptoms after exposure is typically within minutes to hours and may even cause anaphylaxis.
Gluten ataxia (3): This is an autoimmune disease triggered by the consumption of gluten, causing damage to the brain, specifically the cerebellum. Treatment with a gluten-free diet can improve ataxia and prevent its progression.
A fad diet: The gluten-free diet has become a very popular fad diet. An increasing number of people who do not have an issue eating gluten choose to follow a gluten-free diet for “general health.” Although it has become almost like a “dietary fashion,” the gluten-free diet without a medical diagnosis is not generally recommended.
General dietary practices:
Avoid all sources that contain gluten. People who follow a gluten-free diet must always read food labels, ingredient lists, and inform restaurants of their allergy.
Avoid:
Grains: wheat (Durum, Einkorn, Emmer, Kamut, Spelt), barley, Rye, Triticale.
Processed foods that contain gluten: beer, bread, cakes, pies, cereals, pasta, etc.
Hidden sources: deli meat, candy, soy sauce, sauces, nuts, chips, and french fries.
Some medications and supplements may use gluten as a binding agent.
Non-food items: some beauty products, toothpaste, chewing gum, etc.
Key concerns:
Fortified bread and cereals are a major source of B vitamins in the United States and through a gluten-free diet, there is a risk for nutrient deficiencies (3). Due to whole grains being a source of fiber there is also a risk for inadequate intake. Some gluten-free products may also have higher fat and sugar content than the original products that are being substituted. Gluten-free products are generally more expensive so following the diet long-term may add a financial burden. Accidental exposure to gluten is possible through cross-contamination, eating out at a restaurant, or because it is hidden within the food system and in cosmetics.
Further Resources:
Foundations: Celiac Disease Foundation
Apps
Books: Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case.
Websites:
**The information presented provides an overview of the diet along with credible resources to refer to in order to learn more. This is not intended to make any dietary recommendations, rather an education tool for our clients.**
Reference:
A Brief History of Celiac Disease. The University of Chicago Celiac Disease Center. https://www.cureceliacdisease.org/wp-content/uploads/SU07CeliacCtr.News_.pdf. Published 2007. Accessed July 26, 2020.
Mulder C. Pioneer in the gluten free diet: Willem-Karel Dicke 1905-1962, over 50 years of gluten free diet. Gut. 1993;34(4:1473-1475). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1374403/pdf/gut00562-0009.pdf. Accessed July 26, 2020.
The good news is that you don't have to go grain-free. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gluten-free-diet/art-20048530#:~:text=Purpose,a%20gluten%2Drelated%20medical%20condition. Published 2020. Accessed July 26, 2020.
