The gluten-free diet and its current application in coeliac disease and dermatitis herpetiformis.
BACKGROUND
A gluten-free diet (GFD) is currently the only available therapy for coeliac disease (CD).


OBJECTIVE
We aim to review the literature on the GFD, the gluten content in naturally gluten-free (GF) and commercially available GF food, standards and legislation concerning the gluten content of foods, and the vitamins and mineral content of a GFD.


METHODS
We carried out a PubMed search for the following terms: Gluten, GFD and food, education, vitamins, minerals, calcium, Codex wheat starch and oats. Relevant papers were reviewed and for each topic a consensus among the authors was obtained.


CONCLUSIONS
Patients with CD should avoid gluten and maintain a balanced diet to ensure an adequate intake of nutrients, vitamins, fibre and calcium. A GFD improves symptoms in most patients with CD. The practicalities of this however, are difficult, as (i) many processed foods are contaminated with gluten, (ii) staple GF foods are not widely available, and (iii) the GF substitutes are often expensive. Furthermore, (iv) the restrictions of the diet may adversely affect social interactions and quality of life. The inclusion of oats and wheat starch in the diet remains controversial.
Department of Medicine and Surgery, Gastroenterology, University of Salerno, Italy.
Carolina
C
Ciacci
Department of Gastroenterology, Division of Diabetes and Nutritional Sciences, Kings College London; The Rayne Institute, St Thomas Hospital, London, UK.
Paul
P
Ciclitira
Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Trust; Royal Hallamshire Hospital, Sheffield, UK.
Marios
M
Hadjivassiliou
School of Medicine, University of Tampere and Department of Internal Medicine, Tampere University Hospital and Department of Internal Medicine, Seinäjoki Central Hospital, Finland.
Katri
K
Kaukinen
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and Department of Pediatrics, Örebro University Hospital, Sweden.
Jonas F
JF
Ludvigsson
Coeliac UK, High Wycombe, Buckinghamshire, UK.
Norma
N
McGough
Gastroenterology and Liver Unit, Royal Hallamshire Hospital & University of Sheffield, Sheffield, UK.
David S
DS
Sanders
Cambridge Intestinal Unit, Addenbrooke's Hospital, Cambridge, UK.
Jeremy
J
Woodward
Department of Dermatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Jonathan N
JN
Leonard
Department of Gastroenterology, University Hospital Llandough, Cardiff, UK.
Gillian L
GL
Swift
Coeliac disease; dermatitis herpetiformis; gluten free; gluten-free diet; parts per million