Gluten-Free Diet for Fashion or Necessity? Review with New Speculations on Irritable Bowel Syndrome-like Disorders

Overview

Journal Nutrients

Date 2024 Dec 17

PMID 39683629

Authors

Raffaele Borghini

Alessia Spagnuolo

Giuseppe Donato

Giovanni Borghini

Affiliations

Soon will be listed here.

Abstract

Nowadays, the gluten-free diet (GFD) has become much more than the dietary treatment for celiac disease. Due to its presumed beneficial effects even in non-celiac subjects, it has become a new fashion statement and it is promoted by some healthcare professionals, social media and marketing strategists. On the other hand, regardless of a proper medical indication, a GFD may present side effects, such as poor palatability, high costs and socio-psychological adversities. Moreover, it can be an obstacle to correct clinical practice and may induce nutritional deficiency due to a low-quality diet. In addition, a GFD can trigger or exacerbate many irritable bowel syndrome (IBS)-like disorders in predisposed subjects: reactivity to dietary nickel, the increased consumption of FODMAP-rich foods and histamine intolerance seem to frequently play a relevant role. The possible intersections between high-risk foods in these categories of patients, as well as the possible overlaps among IBS-like disorders during GFD, are described. In conclusion, it is advisable to undergo a careful clinical evaluation by a gastroenterologist and a nutritionist (in some cases, also a psychotherapist) before starting and during a GFD, because both benefits and risks are possible. It is also important to take into account IBS-like disorders that can be exacerbated by a GFD and that are still underestimated today.

References

Comas-Baste O, Sanchez-Perez S, Veciana-Nogues M, Latorre-Moratalla M, Vidal-Carou M . Histamine Intolerance: The Current State of the Art. Biomolecules. 2020; 10(8). PMC: 7463562. DOI: 10.3390/biom10081181. View

Marino M, Casale R, Borghini R, Di Nardi S, Donato G, Angeloni A . The effects of modified versus unmodified wheat gluten administration in patients with celiac disease. Int Immunopharmacol. 2017; 47:1-8. DOI: 10.1016/j.intimp.2017.03.012. View

Caio G, Volta U, Sapone A, Leffler D, De Giorgio R, Catassi C . Celiac disease: a comprehensive current review. BMC Med. 2019; 17(1):142. PMC: 6647104. DOI: 10.1186/s12916-019-1380-z. View

Pietzak M . Follow-up of patients with celiac disease: achieving compliance with treatment. Gastroenterology. 2005; 128(4 Suppl 1):S135-41. DOI: 10.1053/j.gastro.2005.02.025. View

Staudacher H, Gibson P . How healthy is a gluten-free diet?. Br J Nutr. 2015; 114(10):1539-41. DOI: 10.1017/S000711451500330X. View

Trovato C, Oliva S, Pietropaoli N, Pignataro M, Berni S, Tancredi A . A new double immunohistochemistry method to detect mucosal anti-transglutaminase IgA deposits in coeliac children. Dig Liver Dis. 2021; 54(2):200-206. DOI: 10.1016/j.dld.2021.11.006. View

Chey W, Chang V, Hoellrich C, Lee K, Lubkin M, Corcoran D . Mega-Cecum: An Unrecognized Cause of Symptoms in Some Female Patients with Uro-Gynecological Symptoms and Severe Slow Transit Constipation. Dig Dis Sci. 2016; 62(1):217-223. DOI: 10.1007/s10620-016-4392-y. View

Miglietta S, Borghini R, Relucenti M, Sorrentino V, Chen R, Li X . New Insights into Intestinal Permeability in Irritable Bowel Syndrome-Like Disorders: Histological and Ultrastructural Findings of Duodenal Biopsies. Cells. 2021; 10(10). PMC: 8533783. DOI: 10.3390/cells10102593. View

Exposito Miranda M, Garcia-Valdes L, Espigares-Rodriguez E, Leno-Duran E, Requena P . Non-celiac gluten sensitivity: Clinical presentation, etiology and differential diagnosis. Gastroenterol Hepatol. 2022; 46(7):562-571. DOI: 10.1016/j.gastrohep.2022.10.001. View

10.

Husby S, Koletzko S, Korponay-Szabo I, Kurppa K, Mearin M, Ribes-Koninckx C . European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr. 2019; 70(1):141-156. DOI: 10.1097/MPG.0000000000002497. View

11.

Wang J, Yang P, Zhang L, Hou X . A Low-FODMAP Diet Improves the Global Symptoms and Bowel Habits of Adult IBS Patients: A Systematic Review and Meta-Analysis. Front Nutr. 2021; 8:683191. PMC: 8417072. DOI: 10.3389/fnut.2021.683191. View

12.

Koochakpoor G, Salari-Moghaddam A, Keshteli A, Esmaillzadeh A, Adibi P . Association of Coffee and Caffeine Intake With Irritable Bowel Syndrome in Adults. Front Nutr. 2021; 8:632469. PMC: 8241212. DOI: 10.3389/fnut.2021.632469. View

13.

Lindfors K, Ciacci C, Kurppa K, Lundin K, Makharia G, Mearin M . Coeliac disease. Nat Rev Dis Primers. 2019; 5(1):3. DOI: 10.1038/s41572-018-0054-z. View

14.

Surdea-Blaga T, Baban A, Dumitrascu D . Psychosocial determinants of irritable bowel syndrome. World J Gastroenterol. 2012; 18(7):616-26. PMC: 3281218. DOI: 10.3748/wjg.v18.i7.616. View

15.

Palmieri B, Vadala M, Laurino C . Gluten-free diet in non-celiac patients: beliefs, truths, advantages and disadvantages. Minerva Gastroenterol Dietol. 2018; 65(2):153-162. DOI: 10.23736/S1121-421X.18.02519-9. View

16.

Roszkowska A, Pawlicka M, Mroczek A, Balabuszek K, Nieradko-Iwanicka B . Non-Celiac Gluten Sensitivity: A Review. Medicina (Kaunas). 2019; 55(6). PMC: 6630947. DOI: 10.3390/medicina55060222. View

17.

Perez-Cabral I, Bernal-Mercado A, Islas-Rubio A, Suarez-Jimenez G, Robles-Garcia M, Puebla-Duarte A . Exploring Dietary Interventions in Autism Spectrum Disorder. Foods. 2024; 13(18). PMC: 11431671. DOI: 10.3390/foods13183010. View

18.

Lusetti F, Schiepatti A, Scalvini D, Maimaris S, Biagi F . Efficacy of a Low-FODMAP Diet for Coeliac Patients with Persistent IBS-like Symptoms despite a Gluten-Free Diet: A Systematic Review. Nutrients. 2024; 16(7). PMC: 11013587. DOI: 10.3390/nu16071094. View

19.

Hrubisko M, Danis R, Huorka M, Wawruch M . Histamine Intolerance-The More We Know the Less We Know. A Review. Nutrients. 2021; 13(7). PMC: 8308327. DOI: 10.3390/nu13072228. View

20.

Haider M, Al Sbihi A, Reddy S, Green P . Prevalence of malignant neoplasms in celiac disease patients - a nationwide United States population-based study. World J Clin Oncol. 2024; 15(8):1048-1060. PMC: 11346075. DOI: 10.5306/wjco.v15.i8.1048. View