Does the popular "gluten-free diet" really work for people with rheumatism?

*For medical professionals to read and reference blindly following the crowd is really bad! When chatting with many doctors and friends recently, they said that they were about to be asked "crazy" by some patients in the outpatient clinic, and they were all asking patients with rheumatism whether gluten-free diet is useful? To be honest, Jiemei's first reaction when she heard the gluten diet thought it was the "bran" of the wheat grain, the rough outer skin that is discarded during the wheat processing
.

In fact, bran exists before wheat is processed into flour, and gluten exists in refined white flour from wheat
.

 The gluten diet is not actually a mystery.
The essence of gluten is the gliadin and glutenin in wheat foods
.

In fact, the most common food gluten is a good companion for Liangpi - gluten is actually a food composed of gluten after wheat flour has been washed with water to remove the starch
.

Gluten is widely found in barley, oats, rye and other wheat foods, and the content of wheat is particularly high.
In wheat flour, high-gluten flour has the highest gluten content
.

This means that not only common pasta such as noodles, steamed buns, flower rolls, steamed buns, dumplings, but also wheat flour-based snacks such as bread, biscuits, cakes, egg tarts, and sachima are all gluten-containing foods
.

Some barley- and rye-based beers or soy sauces may also contain gluten
.

Some fried food, although the main ingredient is not wheat food, but in order to keep the taste crisp, the surface is likely to be coated with a layer of batter or bread crumbs, so it becomes a gluten-containing food
.

 Gluten free = healthier? In recent years, the gluten-free diet has become popular.
The so-called "gluten-free" means that the diet does not contain wheat, barley, rye and other gluten-containing raw materials
.

Among the grains, rice, corn, millet, soybeans, beans, and potatoes are gluten-free, and buckwheat and quinoa are also gluten-free
.

The "Special Dietary Standards for Gluten-Intolerant People" issued by the International Codex Alimentarius Commission (CAC) stipulates that gluten-free foods refer to gluten-free or gluten-free foods with a gluten content of less than 20 mg/kg, including naturally gluten-free foods (such as legumes).
, fruits and vegetables, unprocessed meat, fish, eggs, and dairy products) and gluten alternatives to cereals [1]
.

The limit requirements for gluten-free foods in the European Union, the United States, and Canada are consistent with the CAC regulations [2].
Argentina’s limit of gluten in gluten-free foods is 10 mg/kg, while China currently has no relevant regulations for gluten-free foods.
standard
.

 The gluten-free diet was originally a therapeutic diet for celiac disease or people with gluten allergies, but in recent years, more and more studies have found its role in other diseases, such as intestinal inflammatory diseases, arthritis, Kidney disease can also be treated or improved
.

Later, even autism, depression, systemic lupus erythematosus, type 1 diabetes, psoriasis and other intractable diseases have been linked to the gluten-free diet (many advocates, lack of clinical evidence)
.

Now some businesses are in a good mood.
As long as the supermarket is marked "gluten-free", it means health! Let many people blindly follow suit
.

 However, is this really the case? Is a gluten-free diet really good for people with rheumatism? Is a gluten-free diet good for people with rheumatism? not necessarily! Rheumatoid Arthritis Gluten is a gut-derived antigen and an immune trigger for celiac disease and rheumatoid arthritis.
Systemic immune responses in celiac disease can occur outside the gut, and gut-derived antigens are key The promoter of rheumatoid arthritis is also a factor of immune disorders in rheumatoid arthritis.
These common immune mechanisms can lead to the simultaneous incidence of rheumatoid arthritis and celiac disease [3]
.

Although the benefit of a gluten-free diet for patients with rheumatoid arthritis is still inconclusive, there is evidence that a 1-year gluten-free vegan diet can significantly reduce beta-microglobulin and gluten resistance in patients with rheumatoid arthritis Plasma antibody levels thereby reduce the disease activity of rheumatoid arthritis [4]
.

A randomized study of 66 patients with rheumatoid arthritis showed that a gluten-free vegan diet reduced levels of low-density lipoprotein and oxidized low-density lipoprotein and improved natural atherosclerotic protection against phosphorylcholine Antibodies, with potential anti-atherosclerotic and anti-inflammatory effects [5], since the gluten-free diet has not been studied alone in rheumatoid arthritis, it is too early to conclude that it is beneficial in this setting
.

 Systemic lupus erythematosus Celiac disease is associated with a variety of autoimmune diseases and is rare in systemic lupus erythematosus, but there are still case reports
.

A gluten-free diet is essential if a patient with systemic lupus erythematosus has coeliac disease
.

If a patient does not have celiac disease, eating gluten-containing foods generally has no effect on the condition
.

 Psoriatic arthritis Psoriatic arthritis and celiac disease are both autoimmune diseases
.

Studies have shown that people with psoriatic arthritis are more likely to develop celiac disease and may benefit from a gluten-free diet, but the sample size it collected was limited and informative
.

An observational study of new-onset patients found no association between gluten intake and the risk of developing psoriasis and psoriatic arthritis
.

Therefore, more robust controlled studies with large sample sizes are needed to demonstrate the relationship between gluten-free diets and psoriasis
.

At the same time, we Chinese have fewer gluten allergies than Westerners
.

Therefore, whether to go on a gluten-free diet depends on whether the patient is allergic to gluten
.

 Although the role of gluten-free diets in rheumatism is currently controversial, in 2021 the French Society of Rheumatology recommends that gluten-free diets should not be recommended as a method of controlling chronic inflammatory rheumatic disease activity in the absence of a diagnosis of celiac disease
.

The challenges of gluten-free diet to health At the same time, long-term adherence to gluten-free diet not only affects the quality of life of patients, but also leads to the deficiency of micronutrients such as iron and zinc, accumulation of heavy metals, and causes obesity, abnormal metabolism,
etc.

 Unbalanced nutrition Patel et al.
[6] found that because some gluten-free foods have higher fat and calorie density than general foods, long-term adherence to a gluten-free diet will result in the enrichment of body fat and protein
.

Studies by Segura et al.
[7] have shown that gluten-free foods are high in total fat and saturated fat, which may also cause problems such as malnutrition in healthy people
.

Long-term adherence to a gluten-free diet often results in an unbalanced nutritional intake
.

 Heavy Metal Accumulation Due to gluten-free diet consumers generally increase the intake of rice and fish, both of which are potential sources of heavy metals, and studies have shown that long-term adherence to a gluten-free diet can cause heavy metals in human blood and tissues.
accumulation
in.

A prospective study in Italy showed that after excluding the possibility of direct intake of heavy metals, blood mercury levels in patients who adhered to a gluten-free diet were almost four times higher than those in a normal diet [8]
.

Raehsler et al.
[9] found that after controlling for factors such as age, gender, race and smoking status, the levels of arsenic in urine and mercury, lead and cadmium in blood of patients with celiac disease who adhered to a gluten-free diet were also significantly higher than those without Groups on a gluten-free diet
.

All in all, long-term gluten-free diet can lead to the accumulation of heavy metals in the body and endanger the health of patients
.

 Increased disease risk Some scholars have pointed out that a gluten-free diet is associated with an increased risk of metabolic syndrome and obesity
.

In addition, a gluten-free diet also has an impact on the gut microbiota and immune function in healthy adults.
It inhibits the growth of bifidobacteria, lactobacilli, and Enterobacteriaceae, causes changes in gut microbial diversity, and reduces gut immunity.
It can cause a series of gastrointestinal diseases [10]
.

The above studies all show that long-term gluten-free diet may increase the risk of certain diseases, so it is worth thinking about whether healthy people choose gluten-free diet, and developing safer and healthier gluten-free food will definitely become a new research direction.

.

 CONCLUSIONS Although gluten-free diets are currently popular, the health benefits of gluten-free diets remain controversial unless there is clear evidence
.

Except for gluten-sensitive people such as celiac disease who need a gluten-free diet, the general population and people with gluten-free rheumatism do not need a gluten-free diet
.

 References [1] CXS 118-1979 Standard for foods for special dietary use for persons intolerant to gluten [S].
[2] Fan Bei, Zheng Miao, Tian Yaqiong, et al.
Current status of regulations and standards for gluten allergens in foreign food and its Enlightenment to my country[J].
Agricultural Engineering Technology, 2010, (12): 14-17.
[3]Warjri SB, Ete T, Beyong T, et al.
Coeliac Disease With Rheumatoid Arthritis: An Unusual Association.
Gastroenterology Res.
2015.
8(1): 167-168.
[4]El-Chammas K, Danner E.
Gluten-free diet in nonceliac disease.
Nutr Clin Pract.
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26(3): 294-9.
[5]Elkan AC , Sjöberg B, Kolsrud B, Ringertz B, Hafström I, Frostegård J.
Gluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized study.
Arthritis Res Ther.
2008 .
10(2): R34[6]Patel NK, Lacy BE.
Another reason to avoid the gluten-free fad[J].
Clin Gastroenterol H, 2018, 16(2): 1-2.
[7]Segura MEM,Rosell CM.
Chemical composition and starch digestibility of different gluten-free breads [J].
Plant Foods Hum Nutr, 2011, 66(3): 224-230.
[8]Elli L, Rossi V, Conte D, et al.
Increased Mercury levels in patients with celiac disease following a gluten-free regimen [J].
Gastroenterology Res Pract, 2015.
[9]Raehsler SL, Marietta EV, Murray, JA, et al.
Accumulation of heavy metals in people on a gluten-free diet [J].
Clin Gastroenterol H, 2018, 16(2): 244-251.
[10]Sanz Y.
Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans [J].
Gut Microbes, 2010, 1(3): 135-137.
Increased mercury levels in patients with celiac disease following a gluten-free regimen [J].
Gastroenterology Res Pract, 2015.
[9]Raehsler SL, Marietta EV, Murray, JA, et al.
Accumulation of heavy metals in people on a gluten- free diet [J].
Clin Gastroenterol H, 2018, 16(2): 244-251.
[10]Sanz Y.
Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans [J].
Gut Microbes , 2010, 1(3): 135-137.
Increased mercury levels in patients with celiac disease following a gluten-free regimen [J].
Gastroenterology Res Pract, 2015.
[9]Raehsler SL, Marietta EV, Murray, JA, et al.
Accumulation of heavy metals in people on a gluten- free diet [J].
Clin Gastroenterol H, 2018, 16(2): 244-251.
[10]Sanz Y.
Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans [J].
Gut Microbes , 2010, 1(3): 135-137.