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Celiac disease and the gluten-free diet

At the 2022 Pediatric Academic Societies Meeting, Marisa Stahl, MD, MSCS, discussed how to separate the wheat from the chaff when it comes to the gluten epidemic.

“By the end of this session, I hope to describe the dynamic landscape of the gluten-free diet in the US, understand medical indications for a gluten-free diet, along with the risks and benefits of dietary intervention, and describe the diagnosis and management,” explained Marisa Stahl, MD,MSCS, assistant professor of pediatrics, the Digestive Health Institute at the Colorado Center for Celiac Disease in Aurora, at her session, “The gluten-free epidemic: myths and facts revealed.”

The gluten-free industry, with some $2 billion worth of products on the market, has been growing worldwide, Stahl noted. Gluten-free diets are no longer just for those with celiac disease (CD), either; 2 in 5 people who eat gluten-free do so because they believe it is better for their overall health. Medical indications for going gluten-free include food intolerances, allergy (wheat), and autoimmune disease (CD). As far as other autoimmune diseases, though, says Stahl, “There is little evidence to support a gluten-free diet for other autoimmune diseases.”

While many believe that a gluten-free diet is healthier, pediatric health care providers should share these facts with their patients: gluten-free diets are frequently higher in fat and sugar content; there is a risk of obesity and insulin resistance; and there are vitamin and nutrient deficiencies as a result of inadequate fiber intake.

For a patient who does have CD, however, the gluten-free diet is currently the only available treatment. Symptoms for this condition can be confusing, as they are wide-ranging and nonspecific, and include fatigue, anemia, headaches, brain fog, oral ulcers diarrhea, abdominal pain, and many more. Screening for diagnosis includes a gene or HLA-based screening (often expensive for patients), and the antibody-based screening (more common and less costly). To add to the murkiness of diagnosis, “Not all antibody positive tests mean your patient has CD,” remarks Stahl. “It could be a transient positivity, perhaps potential CD, infection, or a concurrent autoimmune disease.” Endoscopy can help make a solid determination. Besides strict adherence to a gluten-free diet, health care maintenance includes CBC, thyroid and vitamin D checks; gluten-free multivitamins; and vitamin D and iron supplementation when appropriate.

And while there are no other therapies on the market, there are several on the horizon: drugs currently being studied include latiglutenase, which can break down gluten in the stomach; larazotide a zonulin antagonist; and specific nanoparticles which can retrain the immune system.“The perceived burden [for CD] is high, and we need new treatments,” concluded Stahl.

Reference
Stahl M. The gluten-free epidemic: myths and facts revealed. PAS 2022. April 23, 2022. Denver, Colorado.