title: Celiac disease: understanding the gluten-free diet.
abstract: OBJECTIVE
  The only effective and safe treatment of celiac disease (CD) continues being strict exclusion of gluten for life, the so-called gluten-free diet (GFD). Although this treatment is highly successful, following strict GFD poses difficulties to patients in family, social and working contexts, deteriorating his/her quality of life. We aimed to review main characteristics of GFD with special emphasis on factors that may interfere with adherence to it.
  
  
  METHODS
  We conducted a search of various databases, such as PubMed, Google Scholar, Embase, and Scielo, with focus on key words such as "gluten-free diet", "celiac disease", "gluten" and "gluten-free diet adherence". Available literature has not reached definitive conclusions on the exact amount of gluten that is harmless to celiac patients, although international agreements establish cutoff points for gluten-free products and advise the use of clinical assessment to tailor the diet according to individual needs. Following GFD must include eliminating gluten as ingredient as well as hidden component and potential cross contamination in foods. There are numerous grains to substitute wheat but composition of most gluten-free products tends to include only a small number of them, especially rice. The diet must be not only free of gluten but also healthy to avoid nutrient, vitamins and minerals deficiencies or excess. Overweight/obesity frequency has increased among celiac patients so weight gain deserves attention during follow up. Nutritional education by a trained nutritionist is of great relevance to achieve long-term satisfactory health status and good compliance.
  
  
  CONCLUSIONS
  A balanced GFD should be based on a combination of naturally gluten-free foods and certified processed gluten-free products. How to measure and improve adherence to GFD is still controversial and deserves further study.
authors.affiliation: Department of Nutrition, Faculty of Medicine, University of Chile, Av. Independencia 1027, Independencia, Santiago, Chile. kbascunan@med.uchile.cl.
authors.forename: Karla A
authors.initials: KA
authors.lastname: Bascuñán
authors.affiliation: Laboratory of Gastroenterology, Institute of Nutrition and Food Technology, INTA, University of Chile, Independencia, Chile.
authors.forename: María Catalina
authors.initials: MC
authors.lastname: Vespa
authors.affiliation: Laboratory of Gastroenterology, Institute of Nutrition and Food Technology, INTA, University of Chile, Independencia, Chile.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Araya
mesh_terms: D002446:Celiac Disease / Q000178:diet therapy*; D055050:Diet, Gluten-Free; D000072001:Diet, Healthy; D005506:Food Contamination; D005983:Glutens / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007413:Intestinal Mucosa; D007421:Intestine, Small; D008019:Life Style; D052756:Nutritional Sciences / Q000193:education; D009752:Nutritional Status; D010349:Patient Compliance; D010353:Patient Education as Topic; D011788:Quality of Life; D015430:Weight Gain
chemical_list: D005983:Glutens
keywords: Adherence to diet; Celiac disease; Gluten; Gluten-free diet