Pharmacology Book





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Gluten-Free Diet

Aka: Gluten-Free Diet, Gluten Content in Food, Gluten Containing Foods, Gluten in Medications
  1. Indications
    1. Celiac Sprue
  2. Precautions
    1. Gluten is prevalent in food products
    2. Read all food labels carefully
    3. Glutens may be unexpectedly present in products
      1. Food additives, emulsifiers or stabilizers
      2. Soy sauce (True tamari sauce contains no wheat)
    4. Gluten free diet is intended for those with Celiac Sprue
      1. Avoiding gluten for those without Celiac Sprue is not based on medical evidence
      2. Whole grains (in contrast to refined grains) are part of a Healthy Diet
      3. Gluten intake is not associated with Coronary Artery Disease
        1. Lebwhol (2017) BMJ 357:j1892 [PubMed]
    5. Medications may contain small amounts of gluten (<0.5 mg/dose)
      1. Glutens may be present in the form of pregelatinized starch, Sodium starch glycolate, dextrin, dextrate
      2. The rare small amount of Gluten in Medications is unlikely to cause adverse effects, even in Celiac Sprue
      3. Celiac Sprue patients can typically tolerate 50 mg/day of gluten, well above what may be in medications
      4. (2019) presc lett 26(6)
  3. Management: Food to avoid
    1. Wheat (and kamut, semolina, spelt and triticale)
    2. Rye
    3. Barley (and malt)
    4. Beers, Lagers, Ales, and Stouts
  4. Management: Foods allowed (do not contain gluten)
    1. Foods marked with gluten-free symbol
    2. Amaranth
    3. Corn
    4. Rice
    5. Buckwheat
    6. Potato
    7. Soybean
    8. Sorghum
    9. Millet
    10. Quinoa
    11. Tapioca flours
    12. Teff
    13. Wine, Liqueurs, whiskey, brandy and most ciders
    14. Oats (if specifically labeled as gluten-free, and not contaminated with wheat, rye or barley)
  5. Management: Flour Alternatives
    1. Non-Gluten cereal grains above on the allowable list
    2. Legumes (e.g. chickpeas, Kidney beans, lentils, soybeans)
    3. Nuts (e.g. almonds, cashews, hazelnuts, walnuts)
    4. Seeds (e.g. flax, sunflower, pumpkin)
    5. Tubers (e.g. arrowroot, jicama, potato, tapioca)
  6. Resources
    1. Don Wiss's Gluten-free Links
    2. Gluten Free Casein Free Diet (GFCF Diet)
  7. References
    1. Kupper (2005) Gastroenterology 128: S121-7 [PubMed]
    2. Green (2007) N Engl J Med 357(17): 1731-43 [PubMed]

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