Role of dietary gluten in development of celiac disease and type I diabetes: management beyond gluten-free diet

: Gluten triggers celiac disease (CD) and type I diabetes in genetically predisposed population of human leukocyte antigen DQ2/DQ8+ and associates with disorders such as schizophrenia and autism. Application of a strict gluten-free diet is the only well-established treatment for patients with CD, whereas the treatment for patients with celiac type I diabetes may be depend on the timing and frequency of the diet. The application of a gluten-free diet in patients with CD may contribute to the development of metabolic syndrome and nonalcoholic fatty liver disease and may also lead to a high glycemic index, low fiber diet and micronutrient deficiencies. The alteration of copper bioavailability (either deficient or excess or aberrant coordination) may contribute to the onset and progress of related pathologies. Therefore, nutrient intake for patients on a gluten-free diet should be the focus of future research work. Other gluten-based therapies have been rising with more interest such as enzymatic pretreatment of gluten, oral enzyme supplements to digest dietary gluten and gluten removal by breeding wheat varieties with reduced or deleted gluten toxic, the development of polymeric binders to prevent gluten induced pathology.