骨头：钙吸收不良，长期跟不上，骨质疏松风险升高血：铁和叶酸吸收不良，贫血反复出现，口服补铁也常常补不上去神经：B12 长期不足，出现手脚发麻、平衡变差这类神经病变生育：长期营养不良与不孕相关肠道本身：长年拖着不治，还有一种少见但严重的风险——肠病相关 T 细胞淋巴瘤 诊断要靠抽血加活检来确诊。顺序很关键：抽血查的是免疫系统对麸质起反应时留下的抗体，活检看的是绒毛有没有被磨平。你一旦提前自行停掉麸质，免疫反应会平息、绒毛会开始修复，两项检查都可能转成阴性，于是你既拿不到诊断，又要一直怀疑自己到底该不该吃。这就是先确诊、再改饮食这个顺序背后的机制原因。
Lebwohl, B., Sanders, D. S., & Green, P. H. R. (2018). Coeliac disease. The Lancet, 391(10115), 70-81. A strict gluten-free diet is the established treatment for celiac disease; diagnosis requires serology and biopsy. 10.1016/S0140-6736(17)31796-8
Skodje, G. I., Sarna, V. K., Minelle, I. H., et al. (2018). Fructan, rather than gluten, induces symptoms in patients with self-reported non-celiac gluten sensitivity. Gastroenterology, 154(3), 529-539. A double-blind crossover trial implicating FODMAP fructans over gluten in many self-reported cases. 10.1053/j.gastro.2017.10.040
Lebwohl, B., Cao, Y., Zong, G., et al. (2017). Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ, 357, j1892. Restricting gluten in people without celiac disease was not associated with lower cardiovascular risk and may reduce whole-grain intake. 10.1136/bmj.j1892
Halmos, E. P., Power, V. A., Shepherd, S. J., Gibson, P. R., & Muir, J. G. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(1), 67-75. Randomized controlled cross-over trial; a low-FODMAP diet significantly reduced overall IBS symptoms versus a typical Australian diet. Onion and garlic are among the highest-fructan (FODMAP) foods. 10.1053/j.gastro.2013.09.046
Hall, K. D., Ayuketah, A., Brychta, R., Cai, H., Cassimatis, T., Chen, K. Y., et al. (2019). Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metabolism, 30(1), 67-77.e3. 20 inpatients, 2 weeks per diet, crossover. Meal eating rate was greater on the ultra-processed diet by 17 +/- 1 kcal/min (7.4 +/- 0.9 g/min), p < 0.0001 - that is the between-diet difference; ratings of pleasantness and familiarity did not differ (full text, PMC7946062). Diets were matched for presented calories, energy density including beverages (1.024 vs 1.028 kcal/g), macronutrients, sugar, sodium and fiber (21.3 vs 20.7 g/1000 kcal, partly via fiber supplements added to ultra-processed meals); non-beverage energy density was 1.957 vs 1.057 kcal/g (~85% higher), which the authors say likely contributed. Intake was 508 +/- 106 kcal/day greater on the ultra-processed diet (full text, Table 1 and Results). 10.1016/j.cmet.2019.05.008