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Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1892 (Published 02 May 2017) Cite this as: BMJ 2017;357:j1892

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Re: Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study

Dear Editor,

Lebwohl et al. [1], articulately describe why gluten free diets among people without coeliac disease should be discouraged, since this could result in reduced consumption of whole grains, which may in turn affect cardiovascular risk. However, this should not undermine the importance of a gluten free diet for people with coeliac disease whereby the ingestion of gluten not only results in villous damage but increases the risk of malabsorption, anaemia, osteoporosis and slight increase in malignancies. [2]

At a time when prescriptions of gluten free products are under review it is essential to consider the impact this would have on people with coeliac disease. Our own research based on data collected in the West Midlands (in press) revealed that there was significantly (P<0.001) better adherence to a gluten free diet by patients who received gluten free food on prescription compared to patients who did not (n=143). Furthermore work by Hall et al. [3] has shown that intentional gluten consumption was significantly lower in people who received gluten free food on prescription.

Although the current trends for a gluten free diet in people without coeliac disease is ill advised, prescriptions for gluten free food for people with coeliac disease remain key for dietary adherence and managing short and long term symptoms of the disease.

References
1. Lebwohl, B, Cao Y, Zong G, Hu FB. Green HR et al. (2017), Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ 2017;357:j1892
2. Mooney P, Hadjivassiliou M, Sanders DS. Clinical review—coeliac disease. BMJ 2014;348:g1561.
3. Hall NJ, Rubin GP, Charnock A. Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey. Appetite 2013; 356: 56-62. doi:10.1016/j.appet.2013.04.016 pmid:23623778.OpenUrl

Competing interests: The authors have previously received a Dr Schar Institute Nutrition Award

03 May 2017
Sue L Reeves
Principal Lecturer
Humayun Muhammad, Yvonne Jeanes
University of Roehampton
London, SW15 4JD