Compliance with a Gluten Free Diet
Cross Contamination
11/13/2020
The Reliability Of Oat In Gluten – Free Diet
12/26/2020
Compliance with a Gluten Free Diet
Most Published
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Although the symptoms of desert can vary…
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Celiac disease is an intestinal absorption problem…
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What Should Be Done After a Celiac…
Celiac disease can occur when the body develops a reaction against gluten in genetically susceptible individuals (1,3). Today, the only known and confirmed treatment of celiac disease is a lifelong gluten-free diet (3,6). The main purpose of the gluten-free diet is; To treat health problems that occur in gluten-related diseases (2,3). Today, the most well-known gluten-related disease; While the diagnosis frequency of celiac disease is increasing, its prevalence in the general population is estimated to be around 1% (1).
The Importance of Compliance with Diet
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Since celiac disease affects the digestive system, it generally gives classic symptoms such as abdominal pain, diarrhea, vomiting and gas problems (3,5). In addition, malabsorption, weight loss, vitamin-mineral deficiencies, bone resorption, anemia, skin problems, bone-joint pain, growth retardation, and liver disorders (3,5,10). The gluten-free diet plays a major role in the recovery of these complications.
Celiac patients should start dieting immediately after diagnosis (4,6). With the initiation of diet, gluten is removed from the body and recovery begins from the second day (4,17). With the initiation of gluten-free diet, pre-diagnosis damage and absorption center; Absorption improves gradually as the small intestinal villi begin to heal (3,4,6). For this reason, strict adherence to the gluten-free diet is very important to significantly improve the complications of celiac disease that are seen before the gluten-free diet (4).
What Happens if a Gluten-Free Diet is Not Adhered to?
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The benefits of a gluten-free diet in celiac patients are certain. However, it can be difficult for many people with celiac disease to adapt to the diet (4).Gluten complex is frequently used in the food industry because it retains air, facilitates cooking, adds textural properties to products, and develops many other properties (9). This situation makes it difficult for celiac patients to adapt to the diet (9).Especially with early diagnosis of celiac disease in childhood; Gluten-free diet is vital to prevent growth retardation, decreased bone mineral density, and other complications (5,7,8). In a study, it was found that the rate of compliance with the gluten-free diet was 74% in pediatric (0-18 years old) celiac patients (7). It was observed that children consumed gluten-containing products again when they saw that the symptoms disappear after following the gluten-free diet for a while (7). The main reason for disrupting the diet is their friend environment or not being fully aware of the situation (7). It has been observed that many complications such as abdominal pain and diarrhea recurred with the deterioration of the diet (4,7,8). It is known that following a diet in a disease is more difficult than using drugs or exercising (9). This situation is clearly seen in celiac patients.
Factors such as cross-contamination, economic difficulty, out-of-home eating habits, and social environment are some of the factors that make it difficult to comply with diet (9). Adherence to diet in individuals with celiac disease; It directly affects the individual’s social life, work or school life and quality of life.The most common reason for persistent symptoms in individuals with celiac disease; unwittingly or willingly taking gluten into the body (9). Studies have found that adults consciously consume gluten when they have difficulty complying with the diet (4). In a study on dietary adherence rates of celiac disease patients in Turkey, after the diagnosis of celiac disease, gluten applied in general compliance with diet it was found to be 64.4% (4). While dietary compliance is expected to be 100% in diseases treated with diet, a rate of 64.4% remains low. It is of great importance that all celiac patients follow a gluten-free diet after diagnosis.
Complications gradually improve in celiac patients who adhere to a gluten-free diet frequently. It was observed that symptoms seen in more than 90% of celiac patients who applied a gluten-free diet for at least 1 year from the diagnosis improved and the quality of life increased (11,12).The risk of health problems increases in people with celiac disease who are not treated or who do not follow their diet. Physical symptoms such as diarrhea and abdominal pain begin to reappear first as celiac patients disrupt their diet or do not comply with their diet (17). With the progression of gluten exposure, the small intestine begins to be damaged (8). Absorption is prevented with damage to the small intestine (4,6,8). Deficiency of other vitamins and minerals, especially iron and B12, begins to be seen (13,14). The risk of osteoporosis increases with inhibition of absorption (15). Continuous exposure to gluten in the future has been observed to increase the risk of non-Hodgkin lymphoma, small intestine cancer and death (3,4,9,16).
Conclusion
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Gluten-free diet in individuals with celiac disease; It has many benefits, such as reducing clinical symptoms, preventing small intestine damage, allowing the small intestine to absorb nutrients properly, reducing the risk of osteoporosis and cancer. If the gluten-free diet is not followed, these situations may worsen and progress in the opposite direction. Social life and quality of life are negatively affected in celiac patients who do not comply with a gluten-free diet. This situation may bring some psychological disturbances in the future.Looking at all of these, celiac patients need to stick to their diet as much as possible and choose the right gluten-free food sources.
Dietician Can KOCAKURT
REFERENCES
ALPAT, İ., & BİLGİN, G. D. (2018). GLUTEN-FREE DIET: TREND OR TREATMENT METHOD? INTERNATIONAL JOURNAL OF REFEREED NUTRITION STUDIES, 83-116.
Al-Toma, A., Volta, U., Auricchio, R., Castillejo, G., Sanders, D. S., Cellier, C.,. . . Lundin, K. E. (2019). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Europen Gastroenterology Journal, 583-613.
Aydın, Ö., Kahramanoğlu-Aksoy, E., Akpınar, M. Y., & Göktaş, Z. (2019). Compliance of Adult Celiac Patients with Gluten Free Diet. Nutrition and Diet Journal, 51-58.
MINISTRY, T. S. (2017). Metabolism and Celiac. General Directorate of Public Health: https://hsgm.saglik.gov.tr/tr/metabolizma-ve-colyak/%C3%A7%C3%B6lyak- symptoms ,tan%C4%B1s%C4%B1-ve-kompluluklar% C4% B1.html retrieved from
Bascuñán, K. A., Vespa, M. C., & Araya, M. (2017). Celiac disease: understanding the gluten-free diet. European journal of nutrition, 449-459.
Benjamin Lebwohl MD, P. D. (2018). Coeliac disease. THE LANCET, 70-81.
Casellas, F., Rodrigo, L., Lucendo, A. J., Fernández-Bañares, F., Molina-Infante, J., Vivas, S.,. . . López-Vivancos, J. (2015). Benefit on health-related quality of life of adherence to gluten-free diet in adult patients with celiac disease. Revista española de enfermedades Digestiva: organo oficial de la Sociedad Española de Patología Digestiva, 196-201.
Catassi, C., Fabiani, E., Corrao, G., Barbato, M., Renzo, A. D., Carella, A. M.,. . . Guariso, G. (2002). Risk of non-Hodgkin lymphoma in celiac disease. Journal of the American Medical Association, 1413-1419.
Czaja-Bulsa, G., & Bulsa, M. (2018). Adherence to Gluten-Free Diet in Children with Celiac Disease. Nutrients.
García-Manzanares, A., & Lucendo, A. J. (2011). Nutritional and dietary aspects of celiac disease. Nutrition in clinical practice, 163-173.
Jericho, H., Sansotta, N., & Guandalini, S. (2017). Extraintestinal Manifestations of Celiac Disease: Effectiveness of the Gluten-Free Diet. Journal of pediatric gastroenterology and nutrition, 75-79.
Makovicky, P., Makovicky, P., Caja, F., Rimarova, K., Samasca, G., & Vannucci, L. (2020). Celiac disease and gluten-free diet: past, present, and future. Gastroenterology and hepatology from bed to bench, 1-7.
Murray, J. A., Watson, T., & Beverlee Clearman, F. M. (2004). Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. The American journal of clinical nutrition, 669-673.
Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). AMERICAN COLLEGE OF GASTROENTEROLOGY CLINICAL GUIDELINE: DIAGNOSIS AND MANAGEMENT OF CELIAC DISEASE. The American journal of gastroenterology, 656-677.
Saturni, L., Ferretti, G., & Bacchett, T. (2010). The Gluten-Free Diet: Safety and Nutritional Quality. Nutrients, 16-34.
Stefano, M. D., Mengoli, C., Bergonzi, M., & Corazza, G. R. (2013). Bone Mass and Mineral Metabolism Alterations in Adult Celiac Disease: Pathophysiology and Clinical Approach. Nutrients, 4786-4799.
Wahab, P. J., Meijer, J. W., & Mulder, C. J. (2002). Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery. American journal of clinical pathology, 459-463.
COMPLIANCE WITH A GLUTEN FREE DIET
Celiac disease can occur when the body develops a reaction against gluten in genetically susceptible individuals (1,3). Today, the only known and confirmed treatment of celiac disease is a lifelong gluten-free diet (3,6). The main purpose of the gluten-free diet is; To treat health problems that occur in gluten-related diseases (2,3). Today, the most well-known gluten-related disease; While the diagnosis frequency of celiac disease is increasing, its prevalence in the general population is estimated to be around 1% (1).
The Importance of Compliance with Diet
Since celiac disease affects the digestive system, it generally gives classic symptoms such as abdominal pain, diarrhea, vomiting and gas problems (3,5). In addition, malabsorption, weight loss, vitamin-mineral deficiencies, bone resorption, anemia, skin problems, bone-joint pain, growth retardation, and liver disorders (3,5,10). The gluten-free diet plays a major role in the recovery of these complications.
Celiac patients should start dieting immediately after diagnosis (4,6). With the initiation of diet, gluten is removed from the body and recovery begins from the second day (4,17). With the initiation of gluten-free diet, pre-diagnosis damage and absorption center; Absorption improves gradually as the small intestinal villi begin to heal (3,4,6). For this reason, strict adherence to the gluten-free diet is very important to significantly improve the complications of celiac disease that are seen before the gluten-free diet (4).
What Happens if a Gluten-Free Diet is Not Adhered to?
The benefits of a gluten-free diet in celiac patients are certain. However, it can be difficult for many people with celiac disease to adapt to the diet (4).Gluten complex is frequently used in the food industry because it retains air, facilitates cooking, adds textural properties to products, and develops many other properties (9). This situation makes it difficult for celiac patients to adapt to the diet (9).Especially with early diagnosis of celiac disease in childhood; Gluten-free diet is vital to prevent growth retardation, decreased bone mineral density, and other complications (5,7,8). In a study, it was found that the rate of compliance with the gluten-free diet was 74% in pediatric (0-18 years old) celiac patients (7). It was observed that children consumed gluten-containing products again when they saw that the symptoms disappear after following the gluten-free diet for a while (7). The main reason for disrupting the diet is their friend environment or not being fully aware of the situation (7). It has been observed that many complications such as abdominal pain and diarrhea recurred with the deterioration of the diet (4,7,8). It is known that following a diet in a disease is more difficult than using drugs or exercising (9). This situation is clearly seen in celiac patients.
Factors such as cross-contamination, economic difficulty, out-of-home eating habits, and social environment are some of the factors that make it difficult to comply with diet (9). Adherence to diet in individuals with celiac disease; It directly affects the individual’s social life, work or school life and quality of life.The most common reason for persistent symptoms in individuals with celiac disease; unwittingly or willingly taking gluten into the body (9). Studies have found that adults consciously consume gluten when they have difficulty complying with the diet (4). In a study on dietary adherence rates of celiac disease patients in Turkey, after the diagnosis of celiac disease, gluten applied in general compliance with diet it was found to be 64.4% (4). While dietary compliance is expected to be 100% in diseases treated with diet, a rate of 64.4% remains low. It is of great importance that all celiac patients follow a gluten-free diet after diagnosis.
Complications gradually improve in celiac patients who adhere to a gluten-free diet frequently. It was observed that symptoms seen in more than 90% of celiac patients who applied a gluten-free diet for at least 1 year from the diagnosis improved and the quality of life increased (11,12).The risk of health problems increases in people with celiac disease who are not treated or who do not follow their diet. Physical symptoms such as diarrhea and abdominal pain begin to reappear first as celiac patients disrupt their diet or do not comply with their diet (17). With the progression of gluten exposure, the small intestine begins to be damaged (8). Absorption is prevented with damage to the small intestine (4,6,8). Deficiency of other vitamins and minerals, especially iron and B12, begins to be seen (13,14). The risk of osteoporosis increases with inhibition of absorption (15). Continuous exposure to gluten in the future has been observed to increase the risk of non-Hodgkin lymphoma, small intestine cancer and death (3,4,9,16).
Conclusion
Gluten-free diet in individuals with celiac disease; It has many benefits, such as reducing clinical symptoms, preventing small intestine damage, allowing the small intestine to absorb nutrients properly, reducing the risk of osteoporosis and cancer. If the gluten-free diet is not followed, these situations may worsen and progress in the opposite direction. Social life and quality of life are negatively affected in celiac patients who do not comply with a gluten-free diet. This situation may bring some psychological disturbances in the future.Looking at all of these, celiac patients need to stick to their diet as much as possible and choose the right gluten-free food sources.
Dietician Can KOCAKURT
REFERENCES
ALPAT, İ., & BİLGİN, G. D. (2018). GLUTEN-FREE DIET: TREND OR TREATMENT METHOD? INTERNATIONAL JOURNAL OF REFEREED NUTRITION STUDIES, 83-116.
Al-Toma, A., Volta, U., Auricchio, R., Castillejo, G., Sanders, D. S., Cellier, C.,. . . Lundin, K. E. (2019). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Europen Gastroenterology Journal, 583-613.
Aydın, Ö., Kahramanoğlu-Aksoy, E., Akpınar, M. Y., & Göktaş, Z. (2019). Compliance of Adult Celiac Patients with Gluten Free Diet. Nutrition and Diet Journal, 51-58.
MINISTRY, T. S. (2017). Metabolism and Celiac. General Directorate of Public Health: https://hsgm.saglik.gov.tr/tr/metabolizma-ve-colyak/%C3%A7%C3%B6lyak- symptoms ,tan%C4%B1s%C4%B1-ve-kompluluklar% C4% B1.html retrieved from
Bascuñán, K. A., Vespa, M. C., & Araya, M. (2017). Celiac disease: understanding the gluten-free diet. European journal of nutrition, 449-459.
Benjamin Lebwohl MD, P. D. (2018). Coeliac disease. THE LANCET, 70-81.
Casellas, F., Rodrigo, L., Lucendo, A. J., Fernández-Bañares, F., Molina-Infante, J., Vivas, S.,. . . López-Vivancos, J. (2015). Benefit on health-related quality of life of adherence to gluten-free diet in adult patients with celiac disease. Revista española de enfermedades Digestiva: organo oficial de la Sociedad Española de Patología Digestiva, 196-201.
Catassi, C., Fabiani, E., Corrao, G., Barbato, M., Renzo, A. D., Carella, A. M.,. . . Guariso, G. (2002). Risk of non-Hodgkin lymphoma in celiac disease. Journal of the American Medical Association, 1413-1419.
Czaja-Bulsa, G., & Bulsa, M. (2018). Adherence to Gluten-Free Diet in Children with Celiac Disease. Nutrients.
García-Manzanares, A., & Lucendo, A. J. (2011). Nutritional and dietary aspects of celiac disease. Nutrition in clinical practice, 163-173.
Jericho, H., Sansotta, N., & Guandalini, S. (2017). Extraintestinal Manifestations of Celiac Disease: Effectiveness of the Gluten-Free Diet. Journal of pediatric gastroenterology and nutrition, 75-79.
Makovicky, P., Makovicky, P., Caja, F., Rimarova, K., Samasca, G., & Vannucci, L. (2020). Celiac disease and gluten-free diet: past, present, and future. Gastroenterology and hepatology from bed to bench, 1-7.
Murray, J. A., Watson, T., & Beverlee Clearman, F. M. (2004). Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. The American journal of clinical nutrition, 669-673.
Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). AMERICAN COLLEGE OF GASTROENTEROLOGY CLINICAL GUIDELINE: DIAGNOSIS AND MANAGEMENT OF CELIAC DISEASE. The American journal of gastroenterology, 656-677.
Saturni, L., Ferretti, G., & Bacchett, T. (2010). The Gluten-Free Diet: Safety and Nutritional Quality. Nutrients, 16-34.
Stefano, M. D., Mengoli, C., Bergonzi, M., & Corazza, G. R. (2013). Bone Mass and Mineral Metabolism Alterations in Adult Celiac Disease: Pathophysiology and Clinical Approach. Nutrients, 4786-4799.
Wahab, P. J., Meijer, J. W., & Mulder, C. J. (2002). Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery. American journal of clinical pathology, 459-463.
COMPLIANCE WITH A GLUTEN FREE DIET
Celiac disease can occur when the body develops a reaction against gluten in genetically susceptible individuals (1,3). Today, the only known and confirmed treatment of celiac disease is a lifelong gluten-free diet (3,6). The main purpose of the gluten-free diet is; To treat health problems that occur in gluten-related diseases (2,3). Today, the most well-known gluten-related disease; While the diagnosis frequency of celiac disease is increasing, its prevalence in the general population is estimated to be around 1% (1).
The Importance of Compliance with Diet
Since celiac disease affects the digestive system, it generally gives classic symptoms such as abdominal pain, diarrhea, vomiting and gas problems (3,5). In addition, malabsorption, weight loss, vitamin-mineral deficiencies, bone resorption, anemia, skin problems, bone-joint pain, growth retardation, and liver disorders (3,5,10). The gluten-free diet plays a major role in the recovery of these complications.
Celiac patients should start dieting immediately after diagnosis (4,6). With the initiation of diet, gluten is removed from the body and recovery begins from the second day (4,17). With the initiation of gluten-free diet, pre-diagnosis damage and absorption center; Absorption improves gradually as the small intestinal villi begin to heal (3,4,6). For this reason, strict adherence to the gluten-free diet is very important to significantly improve the complications of celiac disease that are seen before the gluten-free diet (4).
What Happens if a Gluten-Free Diet is Not Adhered to?
The benefits of a gluten-free diet in celiac patients are certain. However, it can be difficult for many people with celiac disease to adapt to the diet (4).Gluten complex is frequently used in the food industry because it retains air, facilitates cooking, adds textural properties to products, and develops many other properties (9). This situation makes it difficult for celiac patients to adapt to the diet (9).Especially with early diagnosis of celiac disease in childhood; Gluten-free diet is vital to prevent growth retardation, decreased bone mineral density, and other complications (5,7,8). In a study, it was found that the rate of compliance with the gluten-free diet was 74% in pediatric (0-18 years old) celiac patients (7). It was observed that children consumed gluten-containing products again when they saw that the symptoms disappear after following the gluten-free diet for a while (7). The main reason for disrupting the diet is their friend environment or not being fully aware of the situation (7). It has been observed that many complications such as abdominal pain and diarrhea recurred with the deterioration of the diet (4,7,8). It is known that following a diet in a disease is more difficult than using drugs or exercising (9). This situation is clearly seen in celiac patients.
Factors such as cross-contamination, economic difficulty, out-of-home eating habits, and social environment are some of the factors that make it difficult to comply with diet (9). Adherence to diet in individuals with celiac disease; It directly affects the individual’s social life, work or school life and quality of life.The most common reason for persistent symptoms in individuals with celiac disease; unwittingly or willingly taking gluten into the body (9). Studies have found that adults consciously consume gluten when they have difficulty complying with the diet (4). In a study on dietary adherence rates of celiac disease patients in Turkey, after the diagnosis of celiac disease, gluten applied in general compliance with diet it was found to be 64.4% (4). While dietary compliance is expected to be 100% in diseases treated with diet, a rate of 64.4% remains low. It is of great importance that all celiac patients follow a gluten-free diet after diagnosis.
Complications gradually improve in celiac patients who adhere to a gluten-free diet frequently. It was observed that symptoms seen in more than 90% of celiac patients who applied a gluten-free diet for at least 1 year from the diagnosis improved and the quality of life increased (11,12).The risk of health problems increases in people with celiac disease who are not treated or who do not follow their diet. Physical symptoms such as diarrhea and abdominal pain begin to reappear first as celiac patients disrupt their diet or do not comply with their diet (17). With the progression of gluten exposure, the small intestine begins to be damaged (8). Absorption is prevented with damage to the small intestine (4,6,8). Deficiency of other vitamins and minerals, especially iron and B12, begins to be seen (13,14). The risk of osteoporosis increases with inhibition of absorption (15). Continuous exposure to gluten in the future has been observed to increase the risk of non-Hodgkin lymphoma, small intestine cancer and death (3,4,9,16).
Conclusion
Gluten-free diet in individuals with celiac disease; It has many benefits, such as reducing clinical symptoms, preventing small intestine damage, allowing the small intestine to absorb nutrients properly, reducing the risk of osteoporosis and cancer. If the gluten-free diet is not followed, these situations may worsen and progress in the opposite direction. Social life and quality of life are negatively affected in celiac patients who do not comply with a gluten-free diet. This situation may bring some psychological disturbances in the future.Looking at all of these, celiac patients need to stick to their diet as much as possible and choose the right gluten-free food sources. Dietician Can KOCAKURT
REFERENCES
ALPAT, İ., & BİLGİN, G. D. (2018). GLUTEN-FREE DIET: TREND OR TREATMENT METHOD? INTERNATIONAL JOURNAL OF REFEREED NUTRITION STUDIES, 83-116.
Al-Toma, A., Volta, U., Auricchio, R., Castillejo, G., Sanders, D. S., Cellier, C.,. . . Lundin, K. E. (2019). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten-related disorders. United Europen Gastroenterology Journal, 583-613.
Aydın, Ö., Kahramanoğlu-Aksoy, E., Akpınar, M. Y., & Göktaş, Z. (2019). Compliance of Adult Celiac Patients with Gluten Free Diet. Nutrition and Diet Journal, 51-58.
MINISTRY, T. S. (2017). Metabolism and Celiac. General Directorate of Public Health: https://hsgm.saglik.gov.tr/tr/metabolizma-ve-colyak/%C3%A7%C3%B6lyak- symptoms ,tan%C4%B1s%C4%B1-ve-kompluluklar% C4% B1.html retrieved from
Bascuñán, K. A., Vespa, M. C., & Araya, M. (2017). Celiac disease: understanding the gluten-free diet. European journal of nutrition, 449-459.
Benjamin Lebwohl MD, P. D. (2018). Coeliac disease. THE LANCET, 70-81.
Casellas, F., Rodrigo, L., Lucendo, A. J., Fernández-Bañares, F., Molina-Infante, J., Vivas, S.,. . . López-Vivancos, J. (2015). Benefit on health-related quality of life of adherence to gluten-free diet in adult patients with celiac disease. Revista española de enfermedades Digestiva: organo oficial de la Sociedad Española de Patología Digestiva, 196-201.
Catassi, C., Fabiani, E., Corrao, G., Barbato, M., Renzo, A. D., Carella, A. M.,. . . Guariso, G. (2002). Risk of non-Hodgkin lymphoma in celiac disease. Journal of the American Medical Association, 1413-1419.
Czaja-Bulsa, G., & Bulsa, M. (2018). Adherence to Gluten-Free Diet in Children with Celiac Disease. Nutrients.
García-Manzanares, A., & Lucendo, A. J. (2011). Nutritional and dietary aspects of celiac disease. Nutrition in clinical practice, 163-173.
Jericho, H., Sansotta, N., & Guandalini, S. (2017). Extraintestinal Manifestations of Celiac Disease: Effectiveness of the Gluten-Free Diet. Journal of pediatric gastroenterology and nutrition, 75-79.
Makovicky, P., Makovicky, P., Caja, F., Rimarova, K., Samasca, G., & Vannucci, L. (2020). Celiac disease and gluten-free diet: past, present, and future. Gastroenterology and hepatology from bed to bench, 1-7.
Murray, J. A., Watson, T., & Beverlee Clearman, F. M. (2004). Effect of a gluten-free diet on gastrointestinal symptoms in celiac disease. The American journal of clinical nutrition, 669-673.
Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). AMERICAN COLLEGE OF GASTROENTEROLOGY CLINICAL GUIDELINE: DIAGNOSIS AND MANAGEMENT OF CELIAC DISEASE. The American journal of gastroenterology, 656-677.
Saturni, L., Ferretti, G., & Bacchett, T. (2010). The Gluten-Free Diet: Safety and Nutritional Quality. Nutrients, 16-34.
Stefano, M. D., Mengoli, C., Bergonzi, M., & Corazza, G. R. (2013). Bone Mass and Mineral Metabolism Alterations in Adult Celiac Disease: Pathophysiology and Clinical Approach. Nutrients, 4786-4799.
Wahab, P. J., Meijer, J. W., & Mulder, C. J. (2002). Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery. American journal of clinical pathology, 459-463.
