Assessing US Registered Dietitians Knowledge and Perceptions of a Gluten-Free Diet: A Mixed Methods Approach

Abstract Background The practice of gluten-free diets is on the rise, evidenced by the increase in gluten-free sales from $2.8 billion in 2015 to a projected $7.6 billion in 2020. People with celiac disease and non-celiac gluten sensitivity are required to avoid gluten containing products. It is important that registered dietitians are knowledgeable about this topic due to the prevalence and popularity of the gluten-free diet by those with or without celiac disease or non-celiac gluten sensitivity. Methods A mixed methods approach using qualitative (focus group) was used to generate topics for a quantitative (survey) that assessed knowledge and perceptions of a gluten-free diet from a representative sample of 508 registered dietitians.ResultsOver 18% of respondents incorrectly identified gluten as a carbohydrate. Additionally, less than 80% of RDs correctly identified the presence or absence of gluten in semolina, spelt, kamut, and buckwheat. Regarding perceptions of a gluten-free diet, participants reported that the public is not aware of what gluten is, a gluten-free diet is not appropriate for the general public or weight loss, and the gluten-free diet is a fad when used outside of celiac disease and nonceliac gluten sensitivity.ConclusionsThere is a need for improved education of a gluten-free diet in the areas of sources of gluten, labeling, and gluten-related disorders among Registered Dietitians.

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The Relationship of Perceived Health Benefits and Information Sources to Following a Gluten-Free Diet Among People Without Celiac Disease or Non-Celiac Gluten Sensitivity

Current Developments in Nutrition ◽

10.1093/cdn/nzaa051_001 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 704-704

Author(s):

Kristina Arslain ◽

Pratiksha Baishya ◽

Christopher Gustafson ◽

Devin Rose

Keyword(s):

Celiac Disease ◽

Information Sources ◽

Agricultural Research ◽

Health Benefits ◽

Perceived Health ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free ◽

Relationship Of ◽

The Relationship

Abstract Objectives The gluten-free diet (GFD) has been adopted by many people who do not have Celiac disease or non-Celiac gluten sensitivity, but no studies examine the relationship of perceived health benefits of, and the sources that recommend trying, the GFD to the decision to follow the diet. Methods We surveyed a large, nationally representative sample of 3051 US residents about their attitudes, perceptions, and experiences with the GFD. Logistic regression was used to compare respondents who had no diagnosed need for a GFD but were currently avoiding or had avoided gluten previously (GF-Consumer) to the consumers that had never tried a GFD. Results Over one-fifth of our respondents were GF-Consumers. Beliefs that “a gluten-reduced diet is healthier for people than a full-gluten containing diet” (OR 1.55; P < 0.01), that “gluten-free products are generally more nutritious than their gluten-containing variant” (OR 1.53; P < 0.01) and that a GFD can help clear acne (OR 1.44; P < 0.01) were all positively associated with trying a GFD. The most influential source that suggested the diet was oneself who learned about a GFD through personal research (OR 3.35; P < 0.01). This was followed by “family member or friend” (OR 2.68; P < 0.01) and “healthcare center or health professional (doctor, dietitian, etc.)” (OR 2.10; P < 0.01). Conclusions Positive, but scientifically unsubstantiated, beliefs about the benefits of the GFD were strongly associated with trying a GF diet. Both conventional and unconventional sources of information about the GFD were positively associated with following the diet. These findings about beliefs and information sources highlight potential barriers to the promotion of scientifically based nutritional recommendations to consumers. Funding Sources University of Nebraska Agricultural Research Division Innovation Fund for Wheat/Cereal Crops.

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A109 CELIAC DISEASE IS A RARE CAUSE OF BENIGN DUODENAL STRICTURE

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.108 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 126-127

Author(s):

I Balubaid ◽

N Khanna

Keyword(s):

Weight Loss ◽

Celiac Disease ◽

Case Reports ◽

Balloon Dilation ◽

Gluten Free Diet ◽

Gluten Free ◽

Early Satiety ◽

Ulcer Disease ◽

Duodenal Stricture ◽

H Pylori

Abstract Background Benign duodenal stricture is an uncommon problem encountered by gastroenterologists. The most common cause is peptic ulcer disease (PUD). With the diagnosis and eradication of H. Pylori, early diagnosis of PUD and the use of PPIs to treat upper gastrointestinal inflammation, the incidence of benign duodenal stricture has dramatically decreased. Patients with duodenal stricture may present with early satiety, nausea, vomiting and weight loss. We present the case of a man with a refractory web-like stricture in the second part of the duodenum (D2) caused by Celiac disease. Aims To describe a rare endoscopic finding in a patient with Celiac disease Methods Case report with literature review Results We present a case of a 64 year old male was referred for consideration of duodenal stenting of a refractory stricture in the second part of the duodenum D2. The patient had a 1 year history of abdominal pain, early satiety and weight loss (10 lbs). He also reported intermittent episodes of diarrhea. Investigations included a CT scan of the abdomen which showed a stricture at the level of proximal D2 described as a “duodenal band”. Previous attempts at balloon dilation had not resulted in prolonged symptomatic or endoscopic improvement. Testing for H. Pylori was negative and he did not use NSAIDs. Upper endoscopy was performed to assess the stricture prior to consideration of stenting. This showed a tight web-like stricture in proximal D2. The stricture was balloon dilated up to 16.5 mm, enabling the endoscope to pass beyond it. The mucosa in D2 was atrophic with flattening of the folds and scalloping. There was no inflammation seen. Biopsies from D2 revealed moderate villous blunting and intraepithelial lymphocytosis. Celiac serology testing was abnormal, with an anti-tTG Ab level of 32 RU/ml which confirmed the diagnosis of Celiac disease. The balloon dilation and gluten-free diet resulted in resolution of his symptoms. Follow up endoscopy revealed normalization of his duodenal folds and biopsies. In addition, anti-tTG Ab level was normalized. Although stricture improved with prolonged patency, he still has mild recurrence of his stricture requiring balloon dilation on an annual basis. Conclusions This case describes a very uncommon complication of Celiac disease. The likely pathophysiology involves inflammation and potentially ulceration from Celiac disease, resulting in a benign stricture. There have been a few case reports describing duodenal strictures as a complication of Celiac disease. Treatment involves a gluten-free diet and endoscopic therapy. More severe cases of obstruction would likely require surgical intervention. In our case, the gluten-free diet and balloon dilation were successful and duodenal stenting was not necessary. Given the possibility of Celiac disease as a cause of duodenal stricture, it would be reasonable to biopsy D2 and check anti-tTG Ab in cases of duodenal stricture. Funding Agencies None

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Metabolic effects in patients with celiac disease, patients with nonceliac gluten sensitivity, and asymptomatic controls, after six months of a gluten-free diet

Revista de Gastroenterología de México (English Edition) ◽

10.1016/j.rgmxen.2019.02.011 ◽

2020 ◽

Vol 85 (2) ◽

pp. 109-117 ◽

Cited By ~ 1

Author(s):

J.M. Remes-Troche ◽

O. De J. Cobos-Quevedo ◽

X. Rivera-Gutiérrez ◽

G. Hernández ◽

E. de la Cruz-Patiño ◽

...

Keyword(s):

Celiac Disease ◽

Gluten Free Diet ◽

Metabolic Effects ◽

Gluten Sensitivity ◽

Gluten Free

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Impact of a gluten-free diet on patients with celiac disease, nonceliac gluten sensitivity, and asymptomatic controls. A need for healthier gluten-free foods

Revista de Gastroenterología de México (English Edition) ◽

10.1016/j.rgmxen.2020.04.003 ◽

2020 ◽

Vol 85 (3) ◽

pp. 373-374

Author(s):

A. Viscido ◽

G. Latella

Keyword(s):

Celiac Disease ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free

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Management of Nonceliac Gluten Sensitivity by Gastroenterology Specialists: Data from an Italian Survey

BioMed Research International ◽

10.1155/2015/530136 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Federica Branchi ◽

Francesca Ferretti ◽

Lorenzo Norsa ◽

Leda Roncoroni ◽

Dario Conte ◽

...

Keyword(s):

Medical Education ◽

Celiac Disease ◽

Therapeutic Approach ◽

Gluten Free Diet ◽

Gluten Sensitivity ◽

Gluten Free ◽

Outpatient Services ◽

Italian Survey ◽

Correct Definition ◽

Definition Of

Background and Aim. Nonceliac gluten sensitivity is syndrome characterized by symptoms disappearing after a gluten-free diet. Its existence is still argument of discussion among specialists. Our aim was to evaluate the knowledge about nonceliac gluten sensitivity among gastroenterology specialists.Methods. During October 2013 a questionnaire was sent through a medical newsletter to Italian gastroenterologists. Twelve questions investigated their knowledge on nonceliac gluten sensitivity, including their diagnostic and therapeutic approach.Results. A total of 212 gastroenterologists filled in the questionnaire. The 98.6% were aware of the existence of a syndrome called “nonceliac gluten sensitivity” and 77% believe in its existence. However, only 56% gave a correct definition of the term. The majority of specialists diagnosed gluten sensitive patients and the number of diagnoses was not statistically different from that of celiac disease. Moreover, a gluten-free diet was prescribed by 64% of the specialists and among them the 73% noted an increase of gluten sensitive patients attending their outpatient services.Conclusions. Our study indicated that most of the specialists recognize nonceliac gluten sensitivity and prescribe gluten-free diet, although 44% of the specialists are not able to give its correct definition; underlining the necessity of medical education on this topic is needed.

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Motility Alterations in Celiac Disease and Non-Celiac Gluten Sensitivity

Digestive Diseases ◽

10.1159/000371400 ◽

2015 ◽

Vol 33 (2) ◽

pp. 200-207 ◽

Cited By ~ 8

Author(s):

Maria Ines Pinto-Sanchez ◽

Premysl Bercik ◽

Elena F. Verdu

Keyword(s):

Celiac Disease ◽

Functional Characterization ◽

Disease Process ◽

Gastrointestinal Transit ◽

Gluten Free Diet ◽

Low Grade ◽

Gluten Sensitivity ◽

Gluten Free ◽

Gliadin Antibodies ◽

Before And After

Regulation of gut motility is complex and involves neuromuscular, immune and environmental mechanisms. It is well established that patients with celiac disease (CD) often display gut dysmotility. Studies have shown the presence of disturbed esophageal motility, altered gastric emptying, and dysmotility of the small intestine, gallbladder and colon in untreated CD. Most of these motor abnormalities resolve after a strict gluten-free diet, suggesting that mechanisms related to the inflammatory condition and disease process are responsible for the motor dysfunction. Motility abnormalities are also a hallmark of functional bowel disorders such as irritable bowel syndrome (IBS), where it has been proposed as underlying mechanism for symptom generation (diarrhea, constipation, bloating). Non-celiac gluten sensitivity (NCGS) is a poorly defined entity, mostly self-diagnosed, that presents clinically with IBS symptoms in the absence of specific celiac markers. Patients with NCGS are believed to react symptomatically to wheat components, and some studies have proposed the presence of low-grade inflammation in these patients. There is little information regarding the functional characterization of these patients before and after a gluten-free diet. A study suggested the presence of altered gastrointestinal transit in NCGS patients who also have a high prevalence of nonspecific anti-gliadin antibodies. Results of an ongoing clinical study in NCGS patients with positive anti-gliadin antibodies before and after a gluten-free diet will be discussed. Elucidating the mechanisms for symptom generation in NCGS patients is important to find new therapeutic alternatives to the burden of imposing a strict gluten-free diet in patients who do not have CD.

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The Gluten-Free Diet for Celiac Disease and Beyond

Nutrients ◽

10.3390/nu13113993 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3993

Author(s):

Bara Aljada ◽

Ahmed Zohni ◽

Wael El-Matary

Keyword(s):

Celiac Disease ◽

Dermatitis Herpetiformis ◽

Cognitive Disorders ◽

Gluten Free Diet ◽

Nutritional Deficiencies ◽

Gluten Sensitivity ◽

Gluten Free ◽

Immune Mediated ◽

The Brain

The gluten-free diet (GFD) has gained popularity beyond its main medical indication as the treatment for gluten-induced immune-mediated disorders such as celiac disease (CD), dermatitis herpetiformis, gluten ataxia, wheat allergy, and non-celiac gluten sensitivity. However, the diet carries some disadvantages such as elevated costs, nutritional deficiencies, and social and psychological barriers. The present work aims to review indications, proven benefits, and adverse events of a gluten-free diet. Close follow-up with patients following the diet is recommended. More data is needed to assess the effectiveness of the diet in managing mental and cognitive disorders and to establish a connection between the brain and gluten.

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