As proteínas do glúten apresentam um baixo valor nutricional e biológico e os grãos que contêm glúten não são essenciais para os seres humanos.[9] Porém, uma seleção desbalanceada de alimentos e uma escolha incorreta de produtos sem glúten na alimentação podem levar a deficiências nutricionais. A substituição de cereais contendo glúten por farinhas sem glúten em produtos comerciais tradicionalmente produzidos com trigo ou outros cereais contendo glúten pode levar a uma menor ingestão de alguns nutrientes, como ferro e vitaminas do complexo B. Alguns produtos sem glúten vendidos no mercado não são enriquecidos/fortificados como os alimentos similares com glúten e, frequentemente, apresentam maior teor de lipídios e carboidratos. As complicações nutricionais podem ser prevenidas por uma correta educação dietética.[2]
Uma dieta sem glúten deve ser baseada, naturalmente, em alimentos sem glúten com um bom equilíbrio de micro e macronutrientes. Carne, peixe, ovos, legumes, castanhas, frutas, vegetais, batatas, arroz e mandioca são todos apropriados. Se produtos sem glúten comercialmente preparados forem utilizados, é preferível que se escolham formas enriquecidas ou fortificadas com vitaminas e minerais.[2] Além disso, uma alternativa saudável a esses produtos são os pseudocereais (como a quinoa, o amaranto e o trigo sarraceno) e outros cereais menores, que têm um alto valor nutricional e biológico.[2][9]
Apesar de serem altamente recomendadas para celíacos, as dietas sem glúten têm sido alvo de estudos. Uma recente pesquisa descobriu que pessoas que adotaram dieta glúten free possuíam níveis mais elevados de mercúrio e arsênico decorrente da contaminação dos campos de produção de arroz (principal substituto do glúten).[10]
↑ abcdefgPenagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV (18 de novembro de 2013). «Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet». Nutrients. 5 (11): 4553–65. PMC3847748. PMID24253052. doi:10.3390/nu5114553. For CD patients on GFD, the nutritional complications are likely to be caused by the poor nutritional quality of the GFPs mentioned above and by the incorrect alimentary choices of CD patients. (...) the limited choice of food products in the diet of children with CD induces a high consumption of packaged GFPs, such as snacks and biscuits. (..) It has been shown that some commercially available GFPs have a lower content of folates, iron and B vitamins or are not consistently enriched/fortified compared to their gluten containing counterparts. (...) The first step towards a balanced diet starts from early education on CD and GFD, possibly provided by a skilled dietitian and/or by a physician with expert knowledge in CD. (...) It is advisable to prefer consumption of naturally GF foods, since it has been shown that they are more balanced and complete under both the macro- and micro-nutrient point of view. In fact, these foods are considered to have a higher nutritional value in terms of energy provision, lipid composition and vitamin content as opposed to the commercially purified GF products. Within the range of naturally GF foods, it is preferable to consume those rich in iron and folic acid, such as leafy vegetables, legumes, fish and meat. During explanation of naturally GF foods to patients, it is a good approach for healthcare professionals to bear in mind the local food habits and recipes of each country. This may provide tailored dietary advice, improving acceptance and compliance to GFD. Furthermore, increasing awareness on the availability of the local naturally GF foods may help promote their consumption, resulting in a more balanced and economically advantageous diet. Indeed, these aspects should always be addressed during dietary counseling. With regards to the commercially purified GFPs, it is recommended to pay special attention to the labeling and chemical composition. (...) Increasing awareness on the possible nutritional deficiencies associated with GFD may help healthcare professionals and families tackle the issue by starting from early education on GFD and clear dietary advice on how to choose the most appropriate gluten-free foods.
↑Mulder CJ, van Wanrooij RL, Bakker SF, Wierdsma N, Bouma G (2013). «Gluten-free diet in gluten-related disorders». Dig Dis. (Review). 31 (1): 57–62. PMID23797124. doi:10.1159/000347180. The only treatment for CD, dermatitis herpetiformis (DH) and gluten ataxia is lifelong adherence to a GFD.
↑Hischenhuber C, Crevel R, Jarry B, Mäki M, Moneret-Vautrin DA, Romano A, Troncone R, Ward R (1 de março de 2006). «Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease». Aliment Pharmacol Ther. 23 (5): 559–75. PMID16480395. doi:10.1111/j.1365-2036.2006.02768.x. For both wheat allergy and coeliac disease the dietary avoidance of wheat and other gluten-containing cereals is the only effective treatment.
↑Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE (junho de 2015). «Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders». Best Pract Res Clin Gastroenterol. 29 (3): 477–91. PMID26060112. doi:10.1016/j.bpg.2015.04.006. A recently proposed approach to NCGS diagnosis is an objective improvement of gastrointestinal symptoms and extra-intestinal manifestations assessed through a rating scale before and after GFD. Although a standardized symptom rating scale is not yet applied worldwide, a recent study indicated that a decrease of the global symptom score higher than 50% after GFD can be regarded as confirmatory of NCGS (Table 1) [53]. (…) After the confirmation of NCGS diagnosis, according to the previously mentioned work-up, patients are advized to start with a GFD [49].
↑El-Chammas K, Danner E (junho de 2011). «Gluten-free diet in nonceliac disease». Nutr Clin Pract (Review). 26 (3): 294–9. PMID21586414. doi:10.1177/0884533611405538. The prescription of a GFD has been recommended for patients with IBS-like symptoms without histologic evidence of CD and who have positive IgA tTG antibodies or have the at-risk haplotypes DQ2 or DQ8.46 (…) Historically, a GFD was occasionally used in the management of multiple sclerosis (MS), because anecdotal reports indicated a positive effect (reversal of symptoms) of a GFD in MS patients. (…) what has been demonstrated so far is that a glutenfree vegan diet for 1 year significantly reduced disease activity and levels of antibodies to β-lactoglobulin and gliadin in patients with RA. (...) The beneficial effect of a GFD on diarrhea and weight gain in patients with HIV enteropathy has been demonstrated in a few case series. Treatment with a GFD has been observed to decrease the frequency of diarrhea and thus allow weight gain.84 (IBS=irritable bowel syndrome; RA=rheumatoid arthritis; GFD=gluten-free diet)
