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无麸质饮食

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小麦

无麸质饮食（英語：Gluten-free diet，缩写GFD）是指沒有麸质的飲食方式。麸质是一種在小麦、大麦及裸麥中含有的蛋白質成份[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）及小黑麦[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]。也有健康民眾進行無麩質飲食，用以避免攝取基因改造的小麥，但不攝取基因改造的小麥有益處此一論點目前沒有科學證據。

概論

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麸质造成的健康問題為麩質相關疾病（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）、疱疹樣皮炎（英语：dermatitis herpetiformis）及小麥過敏（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]。[8]，不過在部份案例中，无麸质饮食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、多发性硬化症或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。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，而且在微量元素及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]。此外像藜、莧和蕎麥等準穀物及其他雜糧也是很好的代替品[2][10]。

提供

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虽然无麸质饮食法2010年代在欧美掀起新风潮，乃至美国食品药品监督管理局（FDA）自2014年针对无麸质食品颁布新标准，一些连锁餐厅也开始为顾客提供无麸质菜肴，但是有不少餐厅表示，无法保证和承诺这些餐点完全不含麸质；一些顾客抱怨称餐点含有麸质，并表示食用后肠胃不适。根据统计，全美国约有两三百万民眾患有乳糜泻消化性疾病，他们食用麸质后会出现肠胃不适。另根据全美乳糜泻觉醒基金会（National Foundation for Celiac Awareness）估计，还有1800万美国人对麦麸过敏，他们声称食用麸质食品后会发生腹泻、贫血及其他类似乳糜泻疾病的症状。2013年市场调查机构NPD Group的一份报告显示，近3成美国民眾表示会避开含麸质的食品，高于3年前的25.5%[11][12]。

很多航空公司为旅客提供特殊航空餐食选项，其中也包含无麸质餐[13]（英語：Gluten Free Meal，缩写GFML；也称无麦麸餐[14]、无面筋餐[15]）的预定，旅客一般需在航班起飞的24小时之前告知航空公司。

參看

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  • 地中海飲食 - 以不飽和脂肪酸與纖維的高量為重點之飲食法，穀物類略少，肉類脂肪尤其紅肉類大幅壓低。
  • 植物性飲食 - 只吃素食的飲食方式
  • 生酮飲食 - 以脂肪和油類當主食取代醣類，用以治療特定疾病，亦有研究其養生功能但有許多爭議。

相關條目

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参考文献

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  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 可免费查阅. 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 可免费查阅. 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 可免费查阅. 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 可免费查阅. 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. [2016-05-09]. （原始内容存档于2020-02-01）. 
  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 可免费查阅. PMID 24481131. doi:10.3390/nu6020575. 
  11. ^ 萧丽君. 就是要无麸质食品. 工商时报 (中时电子报). [2013-12-29]. （原始内容存档于2020-02-01） （中文（臺灣））. 
  12. ^ At Restaurants, Gluten-Free Is a Tough Recipe - WSJ. [2019-05-17]. （原始内容存档于2020-02-01）. 
  13. ^ 国航机上服务：餐食服务之保健餐膳_新浪旅游_新浪网. [2019-05-17]. （原始内容存档于2019-05-17）. 
  14. ^ 特殊餐食种类 | China Eastern Airlines. [2019-05-17]. （原始内容存档于2019-05-18）. 
  15. ^ 特殊餐食,川航官网. [2019-05-17]. （原始内容存档于2019-05-17）. 
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