无麸质饮食

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小麦

无麸质饮食(GFD)是沒有麸质飲食,麸质是一種在小麦大麦裸麥中有的蛋白質成份[1][2],這些物類及其雜交種(如斯佩耳特小麦[1]卡姆麥英语Khorasan wheat小黑麦[1][2])也都算在內。但无麸质饮食是否要將燕麦列入,此部份仍有爭議,燕麦中的燕麦蛋白(Avenin)對乳糜瀉患者是有毒的[2],毒性視栽培品种而定[3]。此外,燕麥也常會被含麩質的穀物交叉污染[2]

麸质造成的健康問題為麩質過敏症英语gluten-related disorders,包括了乳糜瀉非乳糜泻麸质敏感英语non-celiac gluten sensitivity麸質失調英语gluten ataxia皰疹樣皮炎英语dermatitis herpetiformis小麥過敏英语wheat allergy[4]。若有這些疾病,改用无麸质饮食是醫師建議且有效的治療方式[5][6][7]。此外,無麩質過敏的人一般是不需要吃无麸质饮食[8],不過在部份案例中,无麸质饮食可能可以改善一些疾病的消化道症狀或是整體症狀,這些疾病包括大腸激躁症類風濕性關節炎多发性硬化症HIV腸病等[9]

麸质蛋白質的營養成份及生物學價值較低,而含有麸质的穀類也不是人類飲食中所必需的[10]。不過若食物攝取不均衡,或是不正確的選用无麸质替代饮食,可能會造成營養不良。市售產品中用的無麸质麵粉其中像鐵質維生素B等重要元素的含量較低。有些無麸质產品沒有強化這些成份,而且脂質糖類的含量較高。小孩特別容易食用太多這類的製品,例如餅乾及點心。營養方面的問題可以透過正確的飲食教育預防[2]

无麸质饮食應該主要以天然的无麸质食物為基礎,而且在微量元素營養素之間有好的平衡。肉類、魚類、蛋、豆類、堅果、馬鈴薯、米及玉米都很合適,若使用商業販售的无麸质替代饮食,建議選用富有維生素及礦物質的饮食[2]。此外像蕎麥準穀物及其他雜糧也是很好的代替品[2][10]

相關條目[编辑]

參考資料[编辑]

  1. ^ 1.0 1.1 1.2 Tovoli F, Masi C, Guidetti E, Negrini G, Paterini P, Bolondi L. Clinical and diagnostic aspects of gluten related disorders. World J Clin Cases. Mar 16, 2015, 3 (3): 275–84. PMC 4360499. PMID 25789300. doi:10.12998/wjcc.v3.i3.275. 
  2. ^ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Penagini F, Dilillo D, Meneghin F, Mameli C, Fabiano V, Zuccotti GV. Gluten-free diet in children: an approach to a nutritionally adequate and balanced diet. Nutrients. Nov 18, 2013, 5 (11): 4553–65. PMC 3847748. PMID 24253052. doi:10.3390/nu5114553. For CD patients on GFD, the nutritional complications are likely to be caused by the poor nutritional quality of the GFPs mentioned above and by the incorrect alimentary choices of CD patients. (...) the limited choice of food products in the diet of children with CD induces a high consumption of packaged GFPs, such as snacks and biscuits. (..) It has been shown that some commercially available GFPs have a lower content of folates, iron and B vitamins or are not consistently enriched/fortified compared to their gluten containing counterparts. (...) The first step towards a balanced diet starts from early education on CD and GFD, possibly provided by a skilled dietitian and/or by a physician with expert knowledge in CD. (...) It is advisable to prefer consumption of naturally GF foods, since it has been shown that they are more balanced and complete under both the macro- and micro-nutrient point of view. In fact, these foods are considered to have a higher nutritional value in terms of energy provision, lipid composition and vitamin content as opposed to the commercially purified GF products. Within the range of naturally GF foods, it is preferable to consume those rich in iron and folic acid, such as leafy vegetables, legumes, fish and meat. During explanation of naturally GF foods to patients, it is a good approach for healthcare professionals to bear in mind the local food habits and recipes of each country. This may provide tailored dietary advice, improving acceptance and compliance to GFD. Furthermore, increasing awareness on the availability of the local naturally GF foods may help promote their consumption, resulting in a more balanced and economically advantageous diet. Indeed, these aspects should always be addressed during dietary counseling. With regards to the commercially purified GFPs, it is recommended to pay special attention to the labeling and chemical composition. (...) Increasing awareness on the possible nutritional deficiencies associated with GFD may help healthcare professionals and families tackle the issue by starting from early education on GFD and clear dietary advice on how to choose the most appropriate gluten-free foods. 
  3. ^ Comino I, Moreno Mde L, Sousa C. Role of oats in celiac disease. World J Gastroenterol. Nov 7, 2015, 21 (41): 11825–31. PMC 4631980. PMID 26557006. doi:10.3748/wjg.v21.i41.11825. 
  4. ^ Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, Hadjivassiliou M, Kaukinen K, Kelly CP, Leonard JN, Lundin KE, Murray JA, Sanders DS, Walker MM, Zingone F, Ciacci C. The Oslo definitions for coeliac disease and related terms. Gut. January 2013, 62 (1): 43–52. PMC 3440559. PMID 22345659. doi:10.1136/gutjnl-2011-301346. 
  5. ^ Mulder CJ, van Wanrooij RL, Bakker SF, Wierdsma N, Bouma G. Gluten-free diet in gluten-related disorders. Dig Dis. (Review). 2013, 31 (1): 57–62. PMID 23797124. doi:10.1159/000347180. The only treatment for CD, dermatitis herpetiformis (DH) and gluten ataxia is lifelong adherence to a GFD. 
  6. ^ Hischenhuber C, Crevel R, Jarry B, Mäki M, Moneret-Vautrin DA, Romano A, Troncone R, Ward R. Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease. Aliment Pharmacol Ther. Mar 1, 2006, 23 (5): 559–75. PMID 16480395. doi:10.1111/j.1365-2036.2006.02768.x. For both wheat allergy and coeliac disease the dietary avoidance of wheat and other gluten-containing cereals is the only effective treatment. 
  7. ^ Volta U, Caio G, De Giorgio R, Henriksen C, Skodje G, Lundin KE. Non-celiac gluten sensitivity: a work-in-progress entity in the spectrum of wheat-related disorders. Best Pract Res Clin Gastroenterol. Jun 2015, 29 (3): 477–91. PMID 26060112. doi:10.1016/j.bpg.2015.04.006. A recently proposed approach to NCGS diagnosis is an objective improvement of gastrointestinal symptoms and extra-intestinal manifestations assessed through a rating scale before and after GFD. Although a standardized symptom rating scale is not yet applied worldwide, a recent study indicated that a decrease of the global symptom score higher than 50% after GFD can be regarded as confirmatory of NCGS (Table 1) [53]. (…) After the confirmation of NCGS diagnosis, according to the previously mentioned work-up, patients are advized to start with a GFD [49]. 
  8. ^ 無麩質飲食 真相探索
  9. ^ El-Chammas K, Danner E. Gluten-free diet in nonceliac disease. Nutr Clin Pract (Review). Jun 2011, 26 (3): 294–9. PMID 21586414. doi:10.1177/0884533611405538. The prescription of a GFD has been recommended for patients with IBS-like symptoms without histologic evidence of CD and who have positive IgA tTG antibodies or have the at-risk haplotypes DQ2 or DQ8.46 (…) Historically, a GFD was occasionally used in the management of multiple sclerosis (MS), because anecdotal reports indicated a positive effect (reversal of symptoms) of a GFD in MS patients. (…) what has been demonstrated so far is that a glutenfree vegan diet for 1 year significantly reduced disease activity and levels of antibodies to β-lactoglobulin and gliadin in patients with RA. (...) The beneficial effect of a GFD on diarrhea and weight gain in patients with HIV enteropathy has been demonstrated in a few case series. Treatment with a GFD has been observed to decrease the frequency of diarrhea and thus allow weight gain.84 (IBS=irritable bowel syndrome; RA=rheumatoid arthritis; GFD=gluten-free diet) 
  10. ^ 10.0 10.1 Lamacchia C, Camarca A, Picascia S, Di Luccia A, Gianfrani C. Cereal-based gluten-free food: how to reconcile nutritional and technological properties of wheat proteins with safety for celiac disease patients. Nutrients (Review). 2014, 6 (2): 575–90. PMC 3942718. PMID 24481131. doi:10.3390/nu6020575.