GLUTEN-FREE DIET

---------- THE ULTIMATE DIET GUIDE ----------

GLUTEN-FREE DIET

------ THE ULTIMATE DIET GUIDE ------

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The Gluten-Free Diet Promise

By following the gluten-free diet, you can be free of diseases such as celiac disease and other health problems and lead a healthy life.

 

About the Gluten-Free Diet

The latest “fad” diet that seems to have taken the dieting world by storm is the gluten-free diet. So popular is this diet that many stars such as Gwyneth Paltrow, Jenny McCarthy, Miley Cyrus and Ryan Gosling have been singing its praises and going gluten-free not because they are gluten intolerant, but because the gluten-free diet is considered a healthier way of eating. In fact, gluten-free eating has gained so much popularity that around 1.6 million people in the US alone follow the gluten-free diet, even without suffering from celiac disease (severe intolerance to gluten) or gluten sensitivity. Not even Elon Musk has that many followers on Twitter!  

In fact, gluten is considered as a “food enemy” and one US talk show host compared consuming gluten to “Satanism”. Many diseases such as Alzheimer’s, diabetes1, autism2, depression and multiple sclerosis3 have been attributed to consumption of gluten.

It’s important to understand that the gluten-free diet is not a weight loss diet. It is the only treatment available for people suffering from celiac disease where there is no medication available; the only way to manage the disease is by following a 100 percent gluten-free diet. This diet is also beneficial to people who face cramping, gastrointestinal bloating4, headaches and other distress after eating foods containing gluten and may have non-celiac gluten sensitivity5.

 

Brown Rice

Foods such as rice have gluten in them which cannot be consumed by people with the Celiac disease due their allergy to gluten

 

The idea of the gluten-free diet, as you’ve surely gathered by now, is to eliminate all foods that contain gluten. You can consume healthy foods such as vegetables, fruits, poultry, meat, fish, legumes, beans and dairy products while following a gluten-free diet, as these foods are naturally gluten-free.

However, moving to a gluten-free diet isn’t all roses and hearts; it can be quite challenging! Despite this, we assure you that you will be quite surprised by the wide range of foods available today that are gluten-free and don’t make you feel deprived! Hunting for gluten-free foods isn’t a treasure hunt anymore. All it takes is a walk down the supermarket aisles and you’re sure to notice that an increasing number of shelves are stocked with foods that are gluten-free.

 

What Is Gluten?   

To know why exactly gluten is so shunned, it’s important to understand what gluten really is! After all, would Hitler have become “Fuhrer” if he wasn’t rejected by an art school? No cause, no effect, right? Well, gluten is a protein composite that is found in grains like wheat, rye, barley and by-products of these grains such as brewer’s yeast and malt. The two main gluten proteins are glutenin and gliadin, and of the two, it’s gliadin who’s the villain of our story.

When water is added to wheat flour, the gluten proteins develop a cross-linked network which has the sticky consistency of glue. In fact, the name “glu-ten” has originated from this glue-like property. It is this ingredient that makes baked products such as breads chewy and elastic in texture, and what makes them rise during the process of bread-making.

So far, so good, right? Gluten isn’t really sounding as bad as people are making it sound! Well, the problem with gluten present in foods is that it is not digestible. The molecules of the protein are resilient and can pass through the lining of the intestine, causing inflammation in the intestines of people suffering from celiac disease6, as well as gastrointestinal symptoms in people with celiac disease7

Let’s understand a little bit more about how this works. The inside of the small intestine has finger-like protrusions called “villi”. These “villi” help the body absorb nutrients from the food we consume8. In the case of people suffering from celiac disease, the gluten irritates the lining of the small intestine and the immune system attacks the “villi”. Over time, these villi can be impaired or destroyed. This results in the inability of the body to absorb nutrients from the food which may cause malnutrition as the nutrients pass through the digestive tract and are excreted along with the body waste9. Therefore, not including gluten in your diet can “Free Villi” and keep them working well. (Yes, we just said that. There’s something irresistible about bad puns.) 

Additionally, gluten is as a protein is a new arrival to the human diet. Many humans have not adjusted to digesting this protein, which can cause significant physical and emotional misery.

Gluten can cause health problems for people suffering from gluten-linked disorders such as celiac disease10, gluten ataxia11, wheat allergy, dermatitis herpetiformis12, and non-coeliac gluten sensitivity13.

 

Breads High in Carbs

Most of the breads are made from grains that contain gluten and are a no-no in the Gluten-free diet

How Does the Gluten-Free Diet Work?

Now that we’ve understood how gluten works, we can now understand the need for a gluten-free diet. Like we mentioned earlier, the main idea behind the gluten-free diet is that if you suffer from celiac disease, it is a good idea to eliminate gluten from your diet, as the gluten in the food produces an autoimmune response14, where the lining of the small intestine is damaged and the absorption of nutrients is blocked.

The gluten-free diet recommends that you eliminate grains including oats, barley, wheat, rye, seitan (an Asian food that contains gluten) and triticale (a mixture of rye and wheat) from your diet plan. Gluten is also contained in other foods such as semolina, spelt, farro and bulgur. Gluten can also be found in a variety of products such as food additives, medications, makeup, salad dressings and sauces, all which should be avoided when on a gluten-free diet.

Before you start having a panic attack about the wide range of restricted foods, going gluten-free does not mean that all foods should be eliminated. There are plenty of foods that are gluten-free and can be consumed when on this diet. However, most of the market-bought foods are eliminated as they contain gluten. A gluten-free diet should mainly comprise natural gluten-free foods with a good balance of macro and micro nutrients.This means you can include nutrient-rich grain alternatives such as millet, quinoa, rice (preferably brown or black) and amaranth in your diet. You can also consume unprocessed and whole foods such as poultry, veggies, fruits, meat, nuts, potatoes, maize, legumes, beans, dairy and eggs. In case you are depending on packaged foods that are gluten-free, then choose foods that have been fortified or enriched with minerals and vitamins.

However, since the gluten-free diet is not a structured diet plan and is essentially a “way of eating”, figuring out the calories to consume to lose weight or maintain it, your exercise or activity routine, and your gluten-free menu, is all left up to you to decide. Empowerment for the win!

 

Couscous

Foods such as couscous, which contains gluten, must be eliminated from the Gluten-free diet

 

What Is Cross-Contamination?

When foods containing gluten comes in contact with gluten-free foods, cross-contamination occurs. To avoid this, ensure you check both the ingredients as well as any cross-contamination with ingredients containing gluten when the food is manufactured, packaged or prepared.

 

Cross-Contamination Can Occur When

  • During the manufacturing process, if the same equipment is used to manufacture a variety of food products
  • At home, if foods are prepared on surfaces that are common for all foods or common utensils that are not thoroughly cleaned after preparing foods containing gluten. For example, using the same toaster for regular bread and gluten-free bread is a cause for cross-contamination.
  • Cross-contamination can occur even with crumbs- in the microwave, left on the cutting board, in the corners of baking dishes or even on countertops.

 

Avoiding Cross-Contamination at Home

  • You should have a separate cutting board and butter dish that is used only for gluten-free foods.
  • Have your own toaster or a toaster oven where the toasting rack can be removed and washed. If you do not have a separate toaster, then you can use a toaster or a silicon bag to hold your bread while it is being toasted.
  • Keep aside one section of your kitchen counter to prepare gluten-free foods. If this is not possible, make sure that that the counter space is washed thoroughly and there are no crumbs or flour dust.
  • Utensils used to prepare other foods must be thoroughly scrubbed and washed before using them to prepare gluten-free foods.
  • In the case of utensils with porous surfaces such as wooden spoons and ladles, it is best to keep a separate set, as these utensils may contain some gluten even after cleaning.
  • Make gluten-free sandwiches first or wash your hands thoroughly after touching regular bread.
  • While baking, do the gluten-free baking first and store it after wrapping it well before baking with regular flour. The flour dust from the regular flour could settle on the gluten-free products and contaminate them.
  • Make use of clean utensils and avoid dipping knives and spoons twice into the foods. If they have touched food with gluten, then they can contaminate the food if used again. It is a good idea to have your own separate jars of peanut butter, mustard, jam and so on.
  • While preparing lentils, make sure that you check them carefully before cooking, as many times you can find wheat or oat kernels with the lentils, even if you buy them in packaged form.

 

Lentils

You should ensure that there aren’t any grains that contain gluten mixed with lentils

 

Cross-Contamination Away from Home

  • Food items stored in bulk bins can get contaminated if common scoops are used in more than one bin. Also, the flour dust in the air can cause contamination.
  • At buffets where the temperature of the foods in all dishes is checked using the same thermometer, or common spoons are used for the dishes
  • Gluten-free meat is cooked on a grill which has not been cleaned after cooking gluten-containing food
  • Pasta that is gluten-free may be cooked in water which has also been used to cook regular pasta and rice cooked in broth containing gluten
  • French fries made in oil where battered, gluten-containing foods have been fried
  • Where gluten-free meats are cut along with other meats without cleaning the cutting utensils
  • Milling of gluten-free grains on machines used to mill regular grains too
  • Gluten-free candy bars or cereal bars may be produced after a regular product without cleaning the equipment thoroughly

 

Difference Between Cross-Contamination and Hidden Gluten

Cross-contamination cannot be found on the food label, whereas hidden gluten is normally found on the food label. We are all aware that foods like cereal, bread and pasta contain gluten. However, hidden gluten is found in products we do not think to be grain products or do not expect to contain gluten. So make sure you read the fine print!

 

Cross-Contamination vs. Hidden Gluten

Cross-Contamination occurs:

  • When food is prepared
  • Utensils such as spoons, knives, can openers, to name a few, are shared
  • Cookware is shared
  • Countertop surfaces are shared in the kitchen
  • Flour is used in breading
  • Breadcrumbs are used in salads
  • At restaurants

 

Hidden Gluten Occurs:

  • In foods not expected to contain gluten: lunch meat, soups, and dressings, for example
  • In unclear label ingredients: maltodextrin, modified food starch, and MSG
  • In other non-food items not considered to contain gluten: toothpastes, stamps, lotions, envelopes, and makeup, for example

 

Examples of Gluten Cross-Contamination:

  • Wooden utensils
  • Cutting boards
  • Bulk bins at the supermarket
  • Toaster oven
  • Can opener
  • Hand towel
  • Cutlery and cutlery drawer
  • Shared kitchen surfaces or tables

Examples of Hidden Gluten:

  • Toiletries: Toothpaste, soaps, lotions, shampoos, and hairspray
  • Cosmetics: Lipstick, makeup, and face powder
  • Stamps and envelopes
  • Pet food
  • Medication and vitamins
  • Playdoh
  • Detergents
  • Food Products: Boullion cubes, cold cuts, sausages, candy, chocolate, ice cream, frozen yogurt, instant teas, instant coffees, canned soups, mayonnaise, cheese spreads and other processed cheese items, dip mixes, dry sauce mixes, honey hams, and mustard

 

Dark Chocolate

Chocolate can often have hidden gluten

 

Gluten-Free Diet and Weight Loss

When on a gluten-free diet, if your diet comprises gluten-free packaged foods, cookies and crackers, you may gain weight. However, if you substitute the glutinous grains in your diet with whole grains such as amaranth and millets, consume complex carbs such as veggies and fruits and other whole foods such as legumes, meat and dairy, you could lose weight when on a gluten-free diet.

What’s on the Menu?

 

Assortment of Dairy Products

Dairy products are free from gluten and are a part of the foods allowed on the Gluten-free diet

 

What’s off the Menu?

  • Baked Goods: Biscuits, crackers, bread, donuts, cakes, cookies, muffins, and pies
  • Other Foods: Couscous, chocolate bars, pizzas, burgers, gravies, pretzels, corned beef, pasta, sausages, salami, and soups with wheat as a thickening agent
  • Cereals and Flours: Wheat flour, durum flour, barley and products made of barley, farina, rye, graham flour, Kamut, triticale (cross between rye and wheat), spelt, and semolina
  • Beverages: Beer, malt-based beverages, and whiskey
  • Condiments: Monosodium glutamate, malt vinegar, sauces, and sauces with wheat as thickening agent

 

Burgers

The buns in burgers contain gluten (besides being unhealthy) which checks it off the foods list

 

Advantages of the Gluten-Free Diet

  • Gluten-Free Diet for Other Health Problems: Other than being beneficial for celiac disease, a gluten-free diet is beneficial for other medical conditions such as non-celiac gluten intolerance and IBS or “irritable bowel syndrome”15. It is believed that the gluten-free diet can help to reduce the signs of autism in children16 and help in improving social skills, behavior and learning in children suffering from autism.A gluten-free diet can also help to reduce the risk of type-117 or type-2 diabetes and anemia18.  It can also help you lose weight thereby reducing the risk of obesity and heart disease19.
  • No Inflammation: Going gluten-free in many cases can be advantageous. Sensitivity or intolerance to gluten can be caused by some diseases that may cause inflammation, or due to damaged intestines. Following a gluten-free diet can help to reverse these problems and you may be able to get rid of them permanently20.
  • Healthier Diet: Following a gluten-free diet can lead to healthier eating as it eliminates the consumption of processed foods. Also, the diet encourages you to be more aware of the foods that you eat and make healthier eating choices. The diet also encourages you to eat healthy, high-quality grains.
  • Healthier Life: Eliminating gluten from your diet can result in you being healthier. If you are suffering from celiac disease, consuming a gluten-free diet will lead to optimal health21. You will feel much better if you cut out foods containing gluten. Also, the body will begin to absorb nutrients better. Even if you are not suffering from celiac disease and suffer from stomach-related problems, cutting out on gluten can help you feel better.
  • More Grains in Your Diet: By going gluten-free, you can ensure that you are eating natural and healthy carbs rather than refined carbs. Eating healthier grains such as quinoa can be very beneficial.

 

Quinoa

Including healthier grains such as quinoa ensures that you’re not only avoiding gluten but also consuming a better source of carbs

 

  • Feel Energetic: Eliminating gluten from your diet makes you feel more energetic22. This means removing high-calorie carbs from your diet, which may make you feel bloated and sluggish23. However, if you are an athlete or a sportsperson, you may require carbs. You could use a natural substitute such as sweet potato, which is gluten-free.
  • Weight Loss: A gluten-free diet can help in weight loss as you replace pasta and breads with nutrient-rich foods such as veggies and fruits. This will definitely help you shed the unwanted pounds.

Disadvantages of the Gluten-Free Diet

  • Unstructured Diet: The gluten-free diet plan is not a structured one. It does not tell you how many calories you must eat to lose or maintain weight, what kind of an exercise routine you must follow, and what kinds of foods you must consume. You must decide all this on your own and for those us who are master procrastinators and bad decision-makers, this spells gluten-filled gloom and doom. 
  • Nutritional Deficiencies: Although gluten has a low nutritional value and the grains that have gluten content are not necessary for the diet, incorrect choices of gluten-free products and an unbalanced choice of foods may lead to nutritional deficiencies. By replacing wheat flour or other flours containing gluten with gluten-free flours, your intake of important nutrients such as B vitamins and iron may be reduced. Many times, gluten-free products are not fortified with vitamins and minerals and may have a greater carbohydrate or fat content, which can be unhealthy.
  • Weight Gain: You could experience weight gain when on the gluten-free diet as gluten-free products often contain higher levels of sugar and fat. Also, when following the gluten-free diet, your intestinal tract recovers and begins to absorb nutrients from the food properly, causing weight gain24.
  • Less Folate: One major disadvantage of the gluten-free diet is that it lacks some vital nutrients. Most gluten-free foods do not have the amount of folate required by the body, which may cause deficiency and anemia25 in the long run.

 

Broccoli

You should include more green, leafy veggies like broccoli to give you the folate you require

 

  • Time Consuming: Choosing gluten-free foods and preparing them can be quite time-consuming. Gluten-free foods must be prepared separately from other foods to ensure that you don’t add any gluten to the dishes and to avoid cross-contamination.
  • Digestion May Suffer: A gluten-free diet may result in you suffering from digestion problems.  Lack of carbs can cause problems and you may be losing weight because of lack of the vital nutrition that the body requires to sustain.

 

Side Effects

  • When following a gluten-free diet, a wide range of nutrients such as fiber, iron, calcium, thiamine, riboflavin, niacin, zinc, vitamin D, and folic acid are reduced. This can cause nutritional deficiency which may result in problems such as weakness, hair loss26, fatigue, mood swings, and missed periods27.
  • A gluten-free diet can cause constipation as gluten-free foods contain very little fiber28.
  • You may be more sensitive and prone to gluten cross-contamination in your foods when following a gluten-free diet.
  • If you suffer from celiac disease and you eat foods with gluten, you could experience diarrhea and pain in the abdomen29. Over time, if you do not follow a gluten-free diet despite having celiac disease, you can suffer from serious health problems such as intestinal cancer30.

 

Common Myths and Misconceptions of the Gluten-Free Diet

 

Following a Gluten-Free Diet Guarantees Weight Loss

We’re sorry to burst any bubbles, but like we mentioned, a gluten-free diet isn’t aimed at weight loss. Following a gluten-free diet does not guarantee weight loss or a slimmer waistline. In fact, many gluten-free products contain more fat and sugar than foods that contain gluten. If you consume large portions of gluten-free breads, potato chips and gluten-free processed foods, you will definitely gain weight.

 

Anyone Can Benefit from a Gluten-Free Diet  

People suffering from celiac disease face problems such as malnutrition, and digestive problems. This is because the gluten contained in certain foods triggers an autoimmune response that destroys the small intestine lining. This can cause many other problems in turn such as diarrhea and anemia, as mentioned earlier. 

However, generally, gluten is not harmful if you are healthy. Eliminating gluten from your diet, if you don’t have gluten intolerance, will not really make your healthier or help you lose weight. While many foods that are gluten-free such as veggies, fruits and lean proteins are healthy, by default gluten-free diets are not healthy.

 

Any Food Is Gluten-Free If It Is Not Bread

You will be rather surprised at the things that contain gluten. Foods like pasta, bread, cake, pizza and other wheat-based foods contain gluten. Foods such as soup, blue cheese, energy bars, salad dressings, soy sauce, brining liquid of pickles, and hot dogs also contain gluten. In fact, many cosmetics and medications also use gluten as a binding agent.

 

Soups

Flour made from grains that contain gluten are often used to thicken soups

 

Gluten Intolerance Is an Allergic Reaction

Gluten triggers an immune reaction in people who suffer from celiac disease. Some people who do not have celiac disease can also have adverse reactions if they consume gluten. In such a case, the person suffers from non-celiac gluten sensitivity or may be suffering from wheat allergy.

 

You Will Have to Say Goodbye to Carbs When on a Gluten-Free Diet

A gluten-free diet does not mean “no carbs”. Foods like potatoes, yams, squash, sweet potatoes, beans, lentils and peas are all “healthy” gluten-free foods. Using healthy gluten-free alternatives instead of gluten laden foods can increase your intake of protein, fiber, vitamins, minerals and antioxidants.

 

On a Gluten-Free Diet, You Cannot Consume Any Grains

You can eat grains such as wild rice, buckwheat, quinoa, teff, amaranth, sorghum, corn and millet when on a gluten-free diet. Your fiber and nutrient intake will be elevated by replacing processed grains containing gluten with gluten-free whole-grain varieties. This will make you healthy as well as consuming whole grains can aid to reduce the risk of heart disease31.

 

Buckwheat

Buckwheat is a great alternative grain for the Gluten-free diet

 

Other Uses

Many supporters claim that going gluten-free can help many ailments such as:

  • Digestive problems such as constipation, bloating, gas, abdominal pain and diarrhea
  • Irritable Bowel Syndrome
  • Osteopenia and osteoporosis
  • Multiple sclerosis
  • Mood disorders such as anxiety, depression, and brain fog
  • Chronic inflammation
  • Rheumatoid Arthritis
  • Diabetes
  • HIV enteropathy
  • Eczema
  • Anemia
  • Joint and muscle aches and pains
  • Infertility
  • ADHD
  • Autism
  • Chronic fatigue
  • Headaches including migraines
  • Thyroid disease
  • Weight gain
  • Dermatitis herpetiformis
  • Weight gain or weight loss

 

Phases of the Gluten-Free Diet

Going completely gluten-free can be quite overwhelming. The diet is quite as high-maintenance as Audrey Hepburn’s Holly Golightly. You could get frustrated and eventually give up the diet completely, but here are a few easy steps to start your gluten-free diet and follow it successfully in the long run.

 

Phase 1: Clear out All the Gluten-Laden Foods from Your Pantry

When your kitchen is laden with gluten-filled temptations, you will not be able to stick to the diet. Out of sight, out of mind, so the first step is to clean out your pantry and refrigerator of all foods containing gluten.

 

Phase 2: Learn to Read and Understand Food Labels

Be cautious of ingredients such as hydrolyzed vegetable protein or hydrolyzed vegetable protein as this could contain wheat. All products that contain malt, especially barley malt,  contain gluten. Another food that contains gluten is modified food starch which could be derived from wheat.

 

Phase 3: Find Replacements for Staples

Gluten-free foods do not necessarily equate to bland food. You can replace gluten containing foods with delicious gluten-free substitutes. For example, wheat flour can be replaced with many flours that are gluten-free such as almond flour, chickpea flour, and brown rice flour. You could also substitute wheat pasta with quinoa based pasta.

 

Phase 4: Go to a Local Bakery

You can get delicious gluten-free foods, but not in the frozen section of the supermarket. Gluten-free varieties of freshly baked bread are available at your local neighborhood bakery.

 

Phase 5: Make “Healthy” Food Choices Such as Fresh Produce, Seeds and Nuts

Most snack foods contain gluten. You can stock up on healthy and gluten-free nuts, seeds, veggies and fruits instead. Snack on an apple or a handful of nuts instead of reaching out for a gluten-packed cake.

 

Apples

Snack on apples rather than a cake!

 

Who Is It For?

The gluten-free diet is suitable and beneficial and is used as a treatment for people with medical ailments which require avoiding gluten.

It is advantageous for people with:

  • Celiac disease
  • Wheat allergies
  • Gluten sensitivity

 

Who Is It Not For?

A gluten-free diet may not be beneficial for people who do not suffer from celiac disease, gluten sensitivity or from wheat allergies. However, it is a good idea to consult your gastroenterologist, general practitioner or dietician before starting a gluten-free diet.

 

Final Word

In recent times, the gluten-free diet has become very popular and the popular belief is that if a food is gluten-free. it must be healthy. The spate of celebrities hopping onto the gluten-free bandwagon is only helping to elevate the diet’s status. However, this may not necessarily be true. According to a study, around 21% of Americans are going gluten-free. In fact, many people following the gluten-free diet do not have any medical condition and follow the diet as a fad diet.

While a gluten-free diet is extremely beneficial for people with celiac disease and gluten-sensitivity, it may not benefit those who do not have gluten intolerance. It is believed that gluten-free means low-calorie, low-fat and healthy; however, as highlighted before, this may not be the case.

The biggest danger of going completely gluten-free is that you miss out on a well-balanced and a healthy diet. So, if you do decide to go gluten-free then include more lean meat, veggies, fruits and gluten-free grains such as quinoa or brown rice in your diet.  

Following a gluten-free diet for a few days may not cause any harm and also give your weight loss efforts a boost if you regulate your calories. However, again, the gluten-free diet is not a weight loss strategy for the long-term. Balanced and healthy eating, whether gluten free or not can help you shed unwanted pounds. If you are trying to lose weight, the fundamental idea is to make “healthy” food choices- eating real, whole and natural foods. Focus on eating a variety of nutritious, organic foods and follow a regular exercise regimen to maintain a healthy and fit lifestyle instead of just following fad diets and you’ll see your body thanking you for it. 

 

Related Posts

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185872/
  2. https://www.ncbi.nlm.nih.gov/pubmed/12168688
  3. https://www.ncbi.nlm.nih.gov/pubmed/19758171
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331053/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406911/
  6. https://www.ncbi.nlm.nih.gov/pubmed/22606367
  7. http://foodtest.com.tr/wp-content/uploads/2014/12/GA14-Biesiekierski-Gluten-causes-GI-symptoms-in-subjects-with-celiac-disease.pdf
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179774/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820055/
  10. https://www.ncbi.nlm.nih.gov/pubmed/22313950
  11. https://www.ncbi.nlm.nih.gov/pubmed/18787912
  12. https://www.ncbi.nlm.nih.gov/pubmed/22313950
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406911/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002505/
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331053/
  16. https://www.ncbi.nlm.nih.gov/pubmed/23688532
  17. http://www.sciencedirect.com/science/article/pii/S0022347616308885
  18. https://www.ncbi.nlm.nih.gov/pubmed/11197242
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120182/
  20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331053/
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257612/
  22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129563/
  23. https://www.ncbi.nlm.nih.gov/books/NBK218769/
  24. https://www.ncbi.nlm.nih.gov/pubmed/12087007
  25. https://www.ncbi.nlm.nih.gov/pubmed/17010258
  26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315033/
  27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326908/
  28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544045/
  29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002505/
  30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856316/
  31. https://www.ncbi.nlm.nih.gov/pubmed/20820954

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