MANAGEMENT OF GS
The hallmark treatment for GS, regardless of its causative factor, is a strict gluten-free diet (GFD). For patients with CD, a 100% GFD is recommended for life. It is not yet known whether this lifelong duration is necessary for those with NCGS and WA, or if there is a safe threshold in these patients for gluten consumption. It is helpful for patients to keep a food diary, noting what they eat and how that affects the appearance or attenuation of symptoms.
Transitioning to a gluten-free lifestyle can be confusing, frustrating, and expensive for patients. Removing gluten from the diet is also challenging, as wheat is the predominant grain consumed in this country. Barley and rye (less so oats) also contain gluten, leaving limited alternatives, like amaranth, corn, quinoa, rice, and tapioca. Unlike CD and NCGS, WA requires only elimination of wheat-containing products; thus, it may not be necessary for affected patients to avoid barley and rye.1,4
Extensive patient education is important for success. Referral to a knowledgeable nutritionist is ideal but not always practical. Lists of foods to avoid on a gluten-free diet are readily available, but important points should be stressed, including how to read food labels. For example, the term wheat-free does not mean gluten-free (see Table 2).1,17 As of August 2014, the food industry, by law, can only claim a product is “gluten-free” if it contains no more than 20 parts per million (ppm) of gluten.1
Due to malabsorption issues, it is recommended that patients with CD be monitored for micronutrient deficiencies (ie, iron, B1, B6, B12, and zinc), and osteopenia/osteoporosis (dual-energy x-ray absorptiometry [DEXA] at the time of diagnosis) and be offered fertility counseling. What patients with GS need most of all are informed, caring providers to help guide them through diagnosis and treatment.6,13
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