Celiac Disease

CD: Wheat Starch (2006)

• Intervention
  How does the inclusion of wheat starch-based gluten-free foods (as defined by the Codex Alimentarius), in a dietary pattern for people with celiac disease, impact the effectiveness and acceptability of their dietary pattern (as compared to a gluten-free diet comprised solely of naturally gluten-free foods, as defined by Codex)?

  • Conclusion

    Studies have shown that both natural and wheat starch-based gluten-free diets produce similar histological and clinical recovery in people with celiac disease. Overall compliance with a gluten-free diet may be more important than the specific type of diet followed (i.e., natural or wheat starch-based), as evidenced by the incomplete bowel mucosal recovery and positive serology generally seen in those study subjects with dietary lapses. Further research regarding the acceptability of wheat starch-based gluten-free foods and the threshold level of tolerance for gluten is needed.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: How does the inclusion of wheat starch-based gluten-free foods (as defined by the Codex Alimentarius), in a dietary pattern for people with celiac disease, impact the effectiveness and acceptability of their dietary pattern (as compared to a gluten-free diet comprised solely of naturally gluten-free foods, as defined by Codex)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Chartrand LJ, Russo PA, Duhaime AG, Seidman EG.  Wheat starch intolerance in patients with celiac disease.  J Am Diet Assoc 1997; 97: 612-618.
      • Faulkner-Hogg KB, Selby WS, Loblay RH. Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet:  the role of trace amounts of gluten and non-gluten food intolerances. Scand J Gastroenterol 1999; 34: 784-789.
      • Kaukinen K, Collin P, Holm K, Rantala I, Vuolteenaho N, Reunala T, Maki M. Wheat starch-containing gluten-free flour products in the treatment of coeliac disease and dermatitis herpetiformis. A long-term follow-up study.  Scand J Gastroenterol 1999; 34: 163-169. 
      • Lohiniemi S, Maki M, Kaukinen K, Laippala P, Collin P. Gastrointestinal symptoms rating scale in coeliac disease patients on wheat starch-based gluten-free diets. Scand J Gastroenterol 2000; 35:947-949.
      • Peraaho M, Kaukinen K, Paasikivi K, Sievanen H, Lohiniemi S, Maki M, Collin P. Wheat-starch-based gluten-free products in the treatment of newly detected coeliac disease: Prospective and randomized study. Aliment Pharmacol Ther 2003; 17:587-594. 
      • Selby WS, Painter D, Collins A, Faulkner-Hogg KB, Loblay RH. Persistent mucosal abnormalities in coeliac disease are not related to the ingestion of trace amounts of gluten. Scand J Gastroenterol 1999; 34: 909-914.
      • Thompson T. Questionable foods and the gluten-free diet: Survey of current recommendations. J Am Diet Assoc 2000; 100(4):463-465.
  • Search Plan and Results: CD: Inclusion of Wheat Starch 2007