Journal Information
Vol. 85. Issue 3.
Pages 373-374 (July - September 2020)
Vol. 85. Issue 3.
Pages 373-374 (July - September 2020)
Letter to the Editor
DOI: 10.1016/j.rgmxen.2020.04.003
Open Access
Impact of a gluten-free diet on patients with celiac disease, nonceliac gluten sensitivity, and asymptomatic controls. A need for healthier gluten-free foods
El impacto de la dieta libre de gluten en pacientes con enfermedad celíaca, sensibilidad al gluten no celíaca y controles asintomáticos. La necesidad de alimentos libres de gluten más sanos
Visits
...
A. Viscido
Corresponding author
angelo.viscido@univaq.it

Corresponding author at: Departmento de Vida, Salud y Ciencias del Medio Ambiente, Universidad de L’Aquila, L’Aquila, Piazzale Salvatore Tommasi 1, L’Aquila 67100, Italy. Tel +39 086 243 4746.
, G. Latella
Unidad de Gastroenterología, Departamento de Vida, Salud y Ciencias del Medio Ambiente, Universidad de L’Aquila, L’Aquila, Italy
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
Dear Editors,

We read the recently published editorial “Impact of a gluten-free diet on patients with celiac disease, nonceliac gluten sensitivity, and asymptomatic controls” with great interest.1 In that editorial, Dr. Coss-Adame emphasizes the value of the prospective study by Remes-Troche et al.,2 for being the first investigation showing that a gluten-free diet (GFD) can determine metabolic abnormalities, not only in patients with celiac disease (CD), but also in those with nonceliac gluten sensitivity (NCGS), a condition that is generally considered free from complications.

The study demonstrated that both patients with CD and those with NCGS have a statistically similar increased risk of developing metabolic syndrome (MS), non-alcoholic fatty liver disease (NAFLD), and obesity, after only 6 months on a GFD. For example, the increase in the presence of MS was 20% in patients with CD and 15% in patients with NCGS. It is noteworthy that those numbers could be higher, as follow-up continues, given that the highest rates of metabolic alterations in patients with CD on a GFD have been found to present after 5–10 years on the diet.3

In addition to joining Coss-Adame in congratulating Remes-Troche et al. on their original demonstration, we wish to comment on the association between the development of metabolic abnormalities and the implementation of a GFD, in patients with CD and patients with NCGS.

In celiac patients, the exclusion of gluten from the diet prompts the healing of the intestinal mucosa, although some gastrointestinal tract defects can persist.4 Thus, increasing intestinal absorption capacity may be responsible for the development of metabolic disorders. However, patients with NCGS should have normal intestinal absorption, most likely meaning the development of metabolic abnormalities in that group of patients is associated with other mechanisms. It could be speculated that the GFD itself was responsible for the development of metabolic disorders.5 There is evidence that the GFD is an unbalanced diet, with multiple nutritional deficiencies and a high glycemic index. With respect to their gluten-containing equivalents, gluten-free foods are deficient in proteins, fiber, folate, iron, potassium, and zinc, whereas they have an excess of fat, carbohydrates, sugars, and sodium. Growing evidence indicates that the GFD needs to be improved by lowering fats and calories and including more adequate levels of fibers, proteins, electrolytes, vitamins, and other micronutrients. 5 A concomitant factor for the development of metabolic alterations in NCGS after a GFD could derive from the remission of dyspeptic symptoms, possibly resulting in excessive food intake.

No matter what the mechanisms leading to metabolic alterations from a GFD are, it is important to underline that MS, NAFLD, and obesity are established risk factors for cardiovascular disease and diabetes.

In conclusion, we agree with the suggestion of Coss-Adame to inform patients about the metabolic risks associated with a GFD, prescribe an appropriate diet to suit individual needs, and provide preventive cardiovascular surveillance for patients on a GFD.

Financial disclosure

No financial support was received in relation to this article.

Conflict of interest

The authors declare that they have no conflict of interest.

References
[1]
E. Coss-Adame.
Impact of a gluten-free diet on patients with celiac disease, nonceliac gluten sensitivity, and asymptomatic controls.
Rev Gastroenterol Mex., (2020),
[2]
J.M. Remes-Troche, O.J. Cobos-Quevedo, X. Rivera-Gutiérrez, et al.
Metabolic effects in patients with celiac disease, patients with nonceliac gluten sensitivity, and asymptomatic controls, after six months of a gluten-free diet.
Rev Gastroenterol Mex., (2019),
[3]
A. Ciccone, D. Gabrieli, R. Cardinale, et al.
Metabolic alterations in celiac disease occurring after following a gluten-free diet.
Digestion., 100 (2019), pp. 262-268
[4]
D. Gabrieli, F. Ciccone, A. Capannolo, et al.
Subtypes of chronic gastritis in patients with celiac disease before and after gluten-free diet.
United Eur Gastroenterol J., 5 (2017), pp. 805-810
[5]
V. Melini, F. Melini.
Gluten-free diet: Gaps and needs for a healthier diet.

Please cite this article as: Viscido A, Latella G. El impacto de la dieta libre de gluten en pacientes con enfermedad celíaca, sensibilidad al gluten no celíaca y controles asintomáticos. La necesidad de alimentos libres de gluten más sanos. Revista de Gastroenterología de México. 2020;85:373–374.

Copyright © 2020. Asociación Mexicana de Gastroenterología
Idiomas
Revista de Gastroenterología de México

Subscribe to our newsletter

Article options
Tools
es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.