Adverse Effects of Gluten-free Diets

In celiac disease, treatment with a gluten-free diet is highly effective for management of clinical features, particularly resolution of diarrhea and weight loss. In children, normalization of growth results. In adult celiacs with iron deficiency anemia, complete normalization of iron levels and resolution of anemia may occur with a gluten-free diet alone. In addition, the small intestinal mucosa responds to restriction of dietary gluten and, eventually, in the vast majority, complete histological recovery occurs. Although effective in celiac disease, the gluten-free diet has been increasingly used in clinical conditions unrelated to celiac disease. Unfortunately, gluten-free diets may have significant negative effects with evidence for development of nutrient deficiencies, an increased risk for obesity particularly in children, and measurable evidence for the accumulation of several heavy metals in blood and urine. Although longer term studies are still needed, caution must be advised in the use of gluten-free diets for non-celiac disorders including those based solely on patient-reported gluten sensitivity