Gluten-Free Diet

Why is important for celiac patients to follow a strict gluten-free diet?

Currently, the only treatment for celiac disease is to follow a strict, life-long gluten free diet. This treatment not only reduces the symptoms of the disease, but also prevents long-term complications such as nutritional deficiencies, low bone mineral density and other health problems such as repeated abortions. In this sense, patients with a damaged intestinal mucosa are 4.3 times more at risk of developing a non-Hodgkin lymphoma 10.

However, according to several studies, more than 45% of celiac patients still show intestinal damage even after following a gluten free diet for a year 8,9. Therefore, strict adherence to the diet is essential to ensure that full recovery of the intestinal mucosa is achieved. In fact, a lack of mucosal recovery is likely to be associated with failing to adhere to the gluten free diet, which can reach 54% in adult patients 6. However, a total exclusion of gluten from the diet is difficult because gluten is one of the most common ingredients in food 7. Therefore, to ensure a correct adherence to the gluten free diet is necessary a continuous monitoring.

How to monitor the gluten-free diet? – Biomedal’s products (iVYDAL In Vitro Diagnostics®)

Biomedal S.L. has developed and patented a new methodology to directly monitor gluten free diet compliance 11, including it in the products of the iVYDALIn Vitro Diagnostics® line. The technique is based on the identification of toxic gluten fractions (gluten immunogenic peptides, GIP) that remain resistant to gastrointestinal digestion and are eliminated in stool and urine. This new methodology directly ensures compliance with the gluten free diet and contributes to the recovery of the patient’s quality of life. Moreover, the iVYDAL line products help ensure correct diagnosis of celiac patients who do not respond to the gluten-free diet or the one known as refractory celiac disease, by identifying those patients that do not follow the diet correctly. This methodology has been recommended in the Protocol for the Early Diagnosis of Celiac Disease published by the Ministry of Health, Social Services and Equality of Spain.

Other methods for gluten free diet monitoring are ineffective and present certain disadvantages. They include dietary questionnaires (information is subjective and do not detect accidental gluten ingestion), serological markers (not sensitive 9 and may remain negative despite dietary transgressions) and biopsies. Despite being the “gold standard” for celiac disease monitoring, biopsies are invasive, subjective, highly expensive and very unpleasant for the patient.

Pros and cons of methods to assess adherence to a gluten free diet

Dietary and symptoms questionnaires

  • Subjective, often inaccurate information based on patients’ report.

  • The majority of transgressions are asymptomatic. The questionnaires can not detect them.

  • Voluntary and involuntary omissions.

  • Does not require specific technology.

Serology
.

  • Requires blood extraction.

  • Not sensitive to contamination or modest transgressions not suitable to assess adherence to a GFD.

  • Poor correlation with gut mucosal healing or symptoms.

  • Specific for diagnosis of celiac disease.

Biopsy
.

  • Invasive, costly and uncomfortable method.

  • High variability of interpretation among pathologists.

  • Detects mucosal damage which has already occurred, without the possibility of preventing it.

  • Direct assessment of mucosal recovery or damage.

GIP
.

  • Non-invasive. It only requires stool or urine samples.

  • High specificity and sensitivity for the detection of gluten intake.

  • Detects gluten intake instead of its consequences, enables immediate dietary habit modification.

  • GIP excretion varies among subjects.