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  • Jefferson Adams
    Jefferson Adams

    How Good is Your Gluten-free Diet?

    Reviewed and edited by a celiac disease expert.

      Are you fully gluten-free? How do you know?


    Caption: Can your doctor do more to monitor your gluten-free diet? Photo: CC--Wellness PC

    Celiac.com 12/08/2016 - People with celiac disease are supposed to follow a strict lifelong gluten-free diet. Celiac patients should receive regular follow-up dietary interviews and blood tests to make sure that they are successfully following the diet.

    However, none of these methods offer an accurate measure of dietary compliance. The only way to know for sure, is to test. A team of researchers recently set out to evaluate the measurement of gluten immunogenic peptides (GIP) in stools as a marker of gluten-free diet adherence in celiac patients and compare it with traditional methods of gluten-free diet monitoring.

    The team conducted a prospective, nonrandomized, multi-center study including 188 celiac patients on gluten-free diet and 84 healthy controls. Subjects were given a dietary questionnaire and fecal GIP quantified by enzyme-linked immunosorbent assay (ELISA). They simultaneously measured serological anti-tissue transglutaminase (anti-tTG) IgA and anti-deamidated gliadin peptide (anti-DGP) IgA antibodies.

    A total of 56 of the 188 celiac patients, about 30 percent, had detectable GIP levels in stools. There was significant association between age and GIP in stools that revealed increasing dietary transgressions with advancing age. Nearly forty percent occurred in in subjects 13 years of age or older, with 60% occurring in men 13 years of age or older.

    The team found no connection between fecal GIP and dietary questionnaire or anti-tTG antibodies. However, they did spot a connection between GIP and anti-DGP antibodies, with seven of the 53 GIP stool-positive patients testing positive for anti-DGP.

    The detection of gluten peptides in stool samples shows the limits of traditional methods for monitoring a gluten-free diet in celiac patients. The GIP ELISA provides direct and quantitative assessment of gluten exposure soon after consumption, and might improve diagnosis and clinical management of non-responsive celiac disease and refractory celiac disease.

    Basically, doctors need to take a much more hands on role in monitoring celiac patients who are following gluten-free diets.

    Source:

    The research team included Isabel Comino PhD1, Fernando Fernández-Bañares MD, PhD2, María Esteve MD, PhD2, Luís Ortigosa MD, PhD3, Gemma Castillejo MD, PhD4, Blanca Fambuena MS5, Carmen Ribes-Koninckx MD, PhD6, Carlos Sierra MD, PhD7, Alfonso Rodríguez-Herrera MD, PhD8, José Carlos Salazar MD9, Ángel Caunedo MD10, J M Marugán-Miguelsanz MD, PhD11, José Antonio Garrote MD, PhD12, Santiago Vivas MD, PhD13, Oreste lo Iacono MD, PhD14, Alejandro Nuñez BSc13, Luis Vaquero MD, PhD13, Ana María Vegas MD12, Laura Crespo MD12, Luis Fernández-Salazar MD, PhD11, Eduardo Arranz MD, PhD11, Victoria Alejandra Jiménez-García MD10, Marco Antonio Montes-Cano MD, PhD15, Beatriz Espín MD, PhD9, Ana Galera MD8, Justo Valverde MD8, Francisco José Girón MD7, Miguel Bolonio MSc6, Antonio Millán MD, PhD5, Francesc Martínez Cerezo 4, César Guajardo MD3, José Ramón Alberto MD3, Mercé Rosinach MD, PhD2, Verónica Segura BSc1, Francisco León MD, PhD16, Jorge Marinich PhD17, Alba Muñoz-Suano PhD17, Manuel Romero-Gómez MD, PhD5, Ángel Cebolla PhD17 and Carolina Sousa PhD1

    They are variously affiliated with the Department of Microbiology and Parasitology, Faculty of Pharmacy, University of Seville, Seville, Spain; the Department of Gastroenterology, Hospital Universitari Mutua Terrassa, and CIBERehd, Terrassa, Barcelona, Spain; the Pediatric Gastroenterology, Hospital Universitario Nuestra Señora de La Candelaria, Tenerife, Spain; Pediatric Gastroenterology, Hospital Universitari de Sant Joan de Reus, IISPV, URV, Reus, Spain; the Unit for the Clinical Management of Digestive Diseases and CIBERehd and Gastroenterology and Nutrition Unit, Hospital Universitario Virgen de Valme, Seville, Spain; the Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario y Politécnico La Fe, Celiac Disease and Digestive Inmunopatology Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; the Pediatric Gastroenterology and Nutrition Unit, Hospital Materno-Infantil, Malaga, Spain; the Gastroenterology and Nutrition Unit, Instituto Hispalense de Pediatría, Seville, Spain; the Servicio de Gastroenterología Pediátrica, Hospital Universitario Virgen del Rocío, Seville, Spain; the Hospital Universitario Virgen Macarena, Seville, Spain; the Mucosal Immunology Laboratory, Instituto de Biología y Genética Molecular (IBGM), University of Valladolid, CSIC and Gastroenterology Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; the Clinical Analysis and Pediatrics, Hospital Universitario Río Hortega, Valladolid, Spain; the Servicio de Aparato Digestivo, Hospital Universitario de Leon, Leon, Spain; the Sección de Aparato Digestivo, Hospital del Tajo, Madrid, Spain; the Servicio de Inmunología, CIBER de Epidemiología y Salud Pública, Hospital Universitario Virgen del Rocío/IBiS/CSIC/Universidad de Sevilla, Seville, Spain; with Celimmune, Bethesda, Maryland, USA, and with Biomedal SL, Seville, Spain


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    Never mind the doctors taking a better on-hands approach... the organizations to which these doctors are attached, i.e. HMO´s, also should require participation as well. They do a good job requiring diabetics to test on a regular basis as a way regulate a patients health. The same should be required for celiacs.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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