International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
Open Access
Journal Browser
International Journal of Celiac Disease. 2017, 5(2), 50-55
DOI: 10.12691/ijcd-5-2-4
Open AccessArticle

Gluten-free Diet - Tough Alley in Torrid Time

Lerner Aaron1, 2, and Matthias Torsten2

1B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

2AESKU.KIPP Institute, Wendelsheim, Germany

Pub. Date: June 02, 2017

Cite this paper:
Lerner Aaron and Matthias Torsten. Gluten-free Diet - Tough Alley in Torrid Time. International Journal of Celiac Disease. 2017; 5(2):50-55. doi: 10.12691/ijcd-5-2-4


Dietitians play a pivotal role in the education, follow-up and navigation of the gluten-free diet for patients affected by celiac disease. Since gluten withdrawal is the cornerstone of celiac disease therapy, and since various future therapeutic strategies, are not yet on the market, the patients relay heavily on the registered dietitian nutritionists (RDNs) advice and service to cope with the gluten-free diet tough alley. Unfortunately, gluten withdrawal, nowadays, represent also a torrid time. The actual surge in incidence, wheat content, gluten intake, celiac disease-related T-cell stimulatory epitopes in wheat, usage in the processed food industries, nutritional deficiencies, changing phenotype and the fact that gluten is potentially detrimental to humankind health, make the RDNs role more complex, difficult and challenging. The present review expands on the gluten-free diet related tough alley in torrid time, which the registered dietitian nutritionists are facing when dealing with gluten-sensitive patients.

gluten-free diet celiac disease dietitians compliance adherence

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Lerner A. New therapeutic strategies for celiac disease. Autoimmun Rev. 2010; 9:144-7.
[2]  Tidwell D, Bomba A. Attitude of people with celiac disease towards dietitians and medical nutritional therapy. J Am Diet Assoc 2001; 101: A29.
[3]  Mahadev S, Simpson S, Lebwohl B, Lewis SK, Tennyson CA, Green PH. Is dietitian use associated with celiac disease outcomes? Nutrients. 2013; 5:1585-94.
[4]  Lamontagne P, West GE, Galibois I. Quebecers with celiac disease: analysis of dietary problems. Can J Diet Pract Res. 2001; 62:175-81.
[5]  Geiger J, Rhee Y, Stastny SN, Salafia EB. Celiac Disease and the Gluten-free Diet: Registered Dietitian Nutritionists’ Self-reported Knowledge Varies. International J of Celiac Disease. 2017, 5(2).
[6]  McNally SL, Donohue MC, Newton KP, Ogletree SP, Conner KK, Ingegneri SE, Kagnoff MF. Can consumers trust web-based information about celiac disease? Accuracy, comprehensiveness, transparency, and readability of information on the internet. Interact J Med Res. 2012; 1:e1.
[7]  Cameron BDMA (2008). Celiac Disease: Internet Resources.
[8]  Stanley M. (2013).
[9]  Guiu L. (2017).
[10]  aussiecoeliac (2015).
[11]  Megan (2012).
[12]  Boyce B. Nutrition apps: opportunities to guide patients and grow your career. J Acad Nutr Diet. 2014; 114:13-5.
[13]  Meyer KG, Fasshauer M, Nebel IT, Paschke R. Comparative analysis of conventional training and a computer-based interactive training program for celiac disease patients. Patient Educ Couns. 2004; 54:353-60.
[14]  Niewinski MM.Advances in celiac disease and gluten-free diet. J Am Diet Assoc. 2008; 108:661-72.
[15]  Meeuwisse GW. Round table discussion. Diagnostic criteria in coeliac disease. Acta Paediatr. 1970; 59:461-63.
[16]  Ludvigsson JF, Leffler DA, Bai J et al. The Oslo definitions for coeliac disease and related terms. Gut. 2013 Jan; 62(1): 43-52.
[17]  Picarelli A, Borghini R, Donato G, Di Tola M, Boccabella C, Isonne C, Giordano M, Di Cristofano C, Romeo F, Di Cioccio G, Marcheggiano A, Villanacci V, Tiberti A. Weaknesses of histological analysis in celiac disease diagnosis: new possible scenarios. Scand J Gastroenterol. 2014; 49:1318-24.
[18]  Lerner A, Matthias T. Intraepithelial lymphocyte normal cut-off level in celiac disease: The debate continues. Internat J Celiac Dis.2016; 4:4-6.
[19]  Marsh MN. “It's Counting That Counts.” Internation J of Celiac Dis 2016; 4:1-3.
[20]  Peña AS. Counting Intraepithelial Lymphocytes. Immunohistochemistry and Flow Cytometer are Necessary New Steps in the Diagnosis of Celiac Disease. Internation J of Celiac Dis. 2016; 4:7-8.
[21]  Akobeng AK, Thomas AG. Systematic review: tolerable amount of gluten for people with coeliac disease. Aliment Pharmacol Ther. 2008; 27:1044-52.
[22]  Gibert A, Kruizinga AG, Neuhold S, Houben GF, Canela MA, Fasano A, Catassi C. Might gluten traces in wheat substitutes pose a risk in patients with celiac disease? A population-based probabilistic approach to risk estimation. Am J Clin Nutr. 2013; 97:109-16.
[23]  Gibert A, Espadaler M, Angel Canela M, Sánchez A, Vaqué C, Rafecas M. Consumption of gluten-free products: should the threshold value for trace amounts of gluten be at 20, 100 or 200 p.p.m.? Eur J Gastroenterol Hepatol. 2006; 18:1187-95.
[24]  Collin P, Thorell L, Kaukinen K, Mäki M. The safe threshold for gluten contamination in gluten-free products. Can trace amounts be accepted in the treatment of coeliac disease? Aliment Pharmacol Ther. 2004; 19:1277-83.
[25]  Biagi F, Campanella J, Martucci S, Pezzimenti D, Ciclitira PJ, Ellis HJ, Corazza GR. A milligram of gluten a day keeps the mucosal recovery away: a case report. Nutr Rev. 2004; 62:360-3.
[26]  Collin P, Mäki M, Kaukinen K. It is the compliance, not milligrams of gluten that is essential in the treatment of celiac disease. Nutr Rev. 2004; 62:490
[27]  Lerner A, Jeremias P, Matthias T. Outside of Normal Limits: False Positive/Negative Anti TG2 Autoantibodies. Internat J Celiac Disease, 2015; 3:87-90.
[28]  Lauria L, Spinelli A, Cairella G, Censi L, Nardone P, Buoncristiano M; 2012 Group OKkio alla SALUTE. Dietary habits among children aged 8-9 years in Italy. Ann Ist Super Sanita. 2015; 51:371-81.
[29]  Lerner-Geva L, Bar-Zvi E, Levitan G, Boyko V, Reichman B, Pinhas-Hamiel O. An intervention for improving the lifestyle habits of kindergarten children in Israel: a cluster-randomised controlled trial investigation. Public Health Nutr. 2015; 18:1537-44.
[30]  Eliyah Livshits O, Shauol R, Reifen R, Matthias T, Lerner A. Can Celiac Disease Present Along With Childhood Obesity? International Journal of Celiac Disease. 2017; 5:19-23.
[31]  Moreno LA, Gottrand F, Huybrechts I, Ruiz JR, González-Gross M, DeHenauw S; HELENA Study Group. Nutrition and lifestyle in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Adv Nutr. 2014; 5: 615S-623S.
[32]  Olsson C, Hörnell A, Ivarsson A, Sydner YM. The everyday life of adolescent coeliacs: issues of importance for compliance with the gluten-free diet. J Hum Nutr Diet. 2008; 21:359-67.
[33]  Casella S, Zanini B, Lanzarotto F, Villanacci V, Ricci C, Lanzini A. Celiac disease in elderly adults: clinical, serological, and histological characteristics and the effect of a gluten-free diet. J Am Geriatr Soc. 2012; 60:1064-9.
[34]  Vilppula A, Kaukinen K, Luostarinen L, Krekelä I, Patrikainen H, Valve R, et al. Clinical benefit of gluten-free diet in screen-detected older celiac disease patients. BMC Gastroenterol. 2011; 11:136.
[35]  Lerner A, Matthias T. Increased knowledge and awareness of celiac disease will benefit the elderly. Intern. J of Celiac Dis. 2015; 3:112-114.
[36]  Lerner A, Jeremias P, Matthias T. The world incidence and prevalence of autoimmune diseases is increasing: A review. Internat J Celiac Disease. 2015; 3:151-155.
[37]  Lerner A, Jermias P, Matthias T. The world incidence of celiac disease is increasing: a review. Internat. J. Of Recent Scient. Res. 2015; 7:5491-5496.
[38]  Lerner A, Matthias T. Possible association between celiac disease and bacterial transglutaminase in food processing: a hypothesis. Nutr Rev. 2015; 73:544-552.
[39]  Lerner A, Matthias T. Changes in intestinal tight junction permeability associated with industrial food additives explain the rising incidence of autoimmune disease. Autoimmun Rev. 2015; 14:479-89.
[40]  Matthias T, Jeremias P, Neidhöfer S, Lerner A. The industrial food additive microbial transglutaminase, mimics the tissue transglutaminase and is immunogenic in celiac disease patients. Autoimmun Rev, 2016; 15:1111-1119.
[41]  Lerner A, Matthias T. Multiple food additives enhance human chronic diseases. SOJ Microbiology&Infectious Dis. 2016; 4:1-2.
[42]  Lerner A, Matthias T. Are Microbial Enzymes Used Safe in the Processed Food Industries? Food and Bioprocess Technology, 2016; 9: 2125-2126
[43]  Lerner A, Matthias T. Don’t forget the exogenous microbial transglutaminases: it is immunogenic and potentially pathogenic. Biophysics, 2016; 3:529-535.
[44]  Lerner A, Aminov R, Matthias T. Intestinal dysbiotic transglutaminases are potential environmental drivers of systemic autoimmunogenesis. Frontiers in Microbiology, 2017; 8; article 66.
[45]  Lerner A, Matthias T. Extraintestinal manifestations of CD: Common pathways in the gut-remote organs’ axes. Internat J Celiac Dis. 2017; 5:24-27.
[46]  Van den Broeck HC, de Jong HC, Salentijn EMJ, et al. Presence of celiac disease epitopes in modern and old hexaploid wheat varieties: wheat breeding may have contributed to increased prevalence of celiac disease. Theor Appl Genet. 2010; 121:1527-39.
[47]  Molberg O, Uhlen AK, Flaete NS, et al. Mapping of gluten T-cell epitopes in the bread wheat ancestors: implications for celiac disease. Gastroenterology 2005; 128:393-401.
[48]  Lerner A. Balanced polymorphism: a survival advantage in celiac disease. Editorial. Med Hypotheses, 2011; 77:1-2.
[49]  Lerner A. The last two millennias eco-catastrophes are the driving forces for the potential genetic advantage mechanisms in celiac disease. Med Hypotheses. 2011; 77:773-6.
[50]  Greco L. From the neolithic revolution to gluten intolerance: benefits and problems associated with the cultivation of wheat. J Pediatr Gastroenterol Nutr. 1997; 24:S14-6.
[51]  Branski D, Ashkenazy A, Freier S, Lerner A, Dinari G et al. Extraintestinal manifestations and associated disorders of celiac disease. In: “Gluten-Sensitive Enteropathy”. Front Gastrointest Res. Eds. Branski D, Rozen P, Kagnoff MF. Karger, Basel. pp. 164-175. 1992.
[52]  Lauret E, Rodrigo L. Celiac Disease and Autoimmune-Associated Conditions Biomed Res Int. 2013; 2013: 127589.
[53]  Cárdenas-Roldán J, Rojas-Villarraga A, Anaya JM. How do autoimmune diseases cluster in families? A systematic review and meta-analysis BMC Med. 2013; 11: 73.
[54]  Haimi M, Lerner A. Nutritional Deficencies in the pediatric age group in a multicultural developed country- Israel. World Journal of Clinical Cases. 2014; 2:120-125.
[55]  Lerner A, Gruener N, Iancu TC. Serum carnitine levels in coeliac disease. Gut 1993; 34:933-935.
[56]  Lerner A, Shapira Y, Agmon-Levin N, , Pacht A, Ben-Ami Shor D, López Hoyos M, Sanchez-Castanon M, Shoenfeld Y. The clinical significance of 25OH-vitamin D status in celiac disease. Crit Rev Allerg Immunol. 2012; 42:322-330.
[57]  Abbasi N, Allameh SF. Extra intestinal manifestations of celiac disease and associated disorders. Internat J Celiac Dis. 2017; 5:1-9.
[58]  Lerner A, Matthias T. Extraintestinal manifestations of CD: Common pathways in the gut-remote organs’ axes. Internat J Celiac Dis. 2017; 5:24-27.
[59]  Case S. The gluten-free diet: How to provide effective education and resources. Gastroenterol 2005; 128:s128-134.
[60]  Theethira TG, Dennis M. Celiac disease and the gluten-free diet: consequences and recommendations for improvement. Dig Dis. 2015; 33:175-82.
[61]  Kupper C. Dietary guidelines and implementation for celiac disease. Gastroenterology. 2005; 128(4 Suppl 1):S121-7.
[62]  Pietzak MM. Follow-up of patients with celiac disease: achieving compliance with treatment. Gastroenterology. 2005; 128 (4 Suppl 1): S135-41.