The Healthy Gluten-Free Diet: Practical Tips to Prevent Metabolic Disorders and Nutritional Deficiencies in Celiac Patients

The gluten-free diet (GFD) is the cornerstone treatment for coeliac disease (CD). However, a healthy GFD is more complex than the only exclusion of gluten-containing foods. Most celiac patients do not receive nutritional advice and tend to consume industrial gluten-free products (GFPs), which often lack fiber, vitamins, and other micronutrients while being rich in saturated fats and refined sugars. This review focuses on the main potential metabolic disorders and nutritional deficiencies in CD patients at diagnosis and dissects the main nutritional and metabolic issues due to a non-balanced GFD. Nutritional tips to achieve an adequate dietary approach in CD are provided. We also compared the main nutritional components of naturally gluten-free cereals (including pseudocereals) to give an exhaustive overview of the possible healthy alternatives to processed GFPs. Clinicians and dietitians should be systematically involved in the diagnosis of CD to monitor the appropriateness of GFD and the patient’s nutritional status over time.

[1]  Elena Diller Which Concerns Deserve Consideration in Dietary Counseling of Patients Earning Low Incomes? , 2023, AMA journal of ethics.

[2]  T. Nestares,et al.  Influence of Ultra-Processed Foods Consumption on Redox Status and Inflammatory Signaling in Young Celiac Patients , 2021, Nutrients.

[3]  Namrata Singh,et al.  Patients with celiac disease are at high risk of developing metabolic syndrome and fatty liver , 2020, Intestinal research.

[4]  S. Asadi,et al.  Dietary fat quantity and quality in relation to general and abdominal obesity in women: a cross-sectional study from Ghana , 2020, Lipids in Health and Disease.

[5]  G. Frieri,et al.  Celiac Disease, Gluten-Free Diet, and Metabolic and Liver Disorders , 2020, Nutrients.

[6]  T. Nestares,et al.  Is a Gluten-Free Diet Enough to Maintain Correct Micronutrients Status in Young Patients with Celiac Disease? , 2020, Nutrients.

[7]  B. Hernández-Ledesma,et al.  Pseudocereal grains: Nutritional value, health benefits and current applications for the development of gluten-free foods. , 2020, Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association.

[8]  A. Verma,et al.  Nutritional Status, Dietary Intake, and Adherence to the Mediterranean Diet of Children with Celiac Disease on a Gluten-Free Diet: A Case-Control Prospective Study , 2020, Nutrients.

[9]  A. Pession,et al.  Gluten Deprivation: What Nutritional Changes Are Found During the First Year in Newly Diagnosed Coeliac Children? , 2019, Nutrients.

[10]  G. Varela-Moreiras,et al.  Nutritional Status in Spanish Children and Adolescents with Celiac Disease on a Gluten Free Diet Compared to Non-Celiac Disease Controls , 2019, Nutrients.

[11]  Yu’e Jiang,et al.  Regulatory Function of Buckwheat-Resistant Starch Supplementation on Lipid Profile and Gut Microbiota in Mice Fed with a High-Fat Diet. , 2019, Journal of food science.

[12]  T. Alalwan,et al.  Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review , 2019, Medicina.

[13]  M. Marcone,et al.  Characterisation of several types of millets as functional food ingredients , 2019, International journal of food sciences and nutrition.

[14]  I. Delgado,et al.  Impact of cooking methods and malting on amino acids content in amaranth, buckwheat and quinoa , 2019, Journal of Food Composition and Analysis.

[15]  Valentina Melini,et al.  Gluten-Free Diet: Gaps and Needs for a Healthier Diet , 2019, Nutrients.

[16]  S. Necozione,et al.  Metabolic Alterations in Celiac Disease Occurring after Following a Gluten-Free Diet , 2018, Digestion.

[17]  A. Mazur,et al.  The Relationship between Body Composition and a Gluten Free Diet in Children with Celiac Disease , 2018, Nutrients.

[18]  A. Alisi,et al.  PNPLA3 rs738409 Polymorphism Predicts Development and Severity of Hepatic Steatosis but Not Metabolic Syndrome in Celiac Disease , 2018, Nutrients.

[19]  A. Maggio,et al.  Fatty Acid Composition of Gluten-Free Food (Bakery Products) for Celiac People , 2018, Foods.

[20]  G. Lizard,et al.  Correlation of trans fatty acids with the severity of coronary artery disease lesions , 2018, Lipids in Health and Disease.

[21]  R. Fallaize,et al.  An investigation into the nutritional composition and cost of gluten‐free versus regular food products in the UK , 2018, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[22]  C. Y. Ooi,et al.  Paediatric Patients with Coeliac Disease on a Gluten-Free Diet: Nutritional Adequacy and Macro- and Micronutrient Imbalances , 2018, Current Gastroenterology Reports.

[23]  L. Qin,et al.  Dietary Fiber and Metabolic Syndrome: A Meta-Analysis and Review of Related Mechanisms , 2017, Nutrients.

[24]  V. Mohan,et al.  Even minimal polishing of an Indian parboiled brown rice variety leads to increased glycemic responses. , 2017, Asia Pacific journal of clinical nutrition.

[25]  F. Olivero,et al.  Cardiometabolic risk factors in children with celiac disease on a gluten-free diet , 2017, World journal of clinical pediatrics.

[26]  C. Krittanawong,et al.  Is white rice consumption a risk for metabolic and cardiovascular outcomes? A systematic review and meta-analysis , 2017, Heart Asia.

[27]  Zach Conrad,et al.  Relationship of the Reported Intakes of Fat and Fatty Acids to Body Weight in US Adults , 2017, Nutrients.

[28]  R. Alfenas,et al.  Comparing sorghum and wheat whole grain breakfast cereals: Sensorial acceptance and bioactive compound content. , 2017, Food chemistry.

[29]  E. Newnham Coeliac disease in the 21st century: paradigm shifts in the modern age , 2017, Journal of gastroenterology and hepatology.

[30]  J. Jane,et al.  Macronutrients in Corn and Human Nutrition. , 2016, Comprehensive reviews in food science and food safety.

[31]  K. Stanhope Sugar consumption, metabolic disease and obesity: The state of the controversy , 2016, Critical reviews in clinical laboratory sciences.

[32]  M. Diaf,et al.  Correlation Between Dietary Fat Intake and Atherogenic Indices in Normal, Overweight and Obese Adults with or Without Type 2 Diabetes , 2015 .

[33]  Flávia Xavier Valente,et al.  B vitamins related to homocysteine metabolism in adults celiac disease patients: a cross-sectional study , 2015, Nutrition Journal.

[34]  J. Friedman,et al.  Higher Intake of PUFAs Is Associated with Lower Total and Visceral Adiposity and Higher Lean Mass in a Racially Diverse Sample of Children. , 2015, The Journal of nutrition.

[35]  E. Topal,et al.  Vitamin and Mineral Deficiency in Children Newly Diagnosed With Celiac Disease , 2015 .

[36]  J. Bao,et al.  Polyphenols in whole rice grain: genetic diversity and health benefits. , 2015, Food chemistry.

[37]  Lori A Welstead,et al.  The Gluten-Free Diet in the 3rd Millennium: Rules, Risks and Opportunities , 2015, Diseases.

[38]  F. A. Martín,et al.  [Nutritional assessment of gluten-free diet. Is gluten-free diet deficient in some nutrient?]. , 2015, Anales de pediatria.

[39]  B. Neal,et al.  Are gluten-free foods healthier than non-gluten-free foods? An evaluation of supermarket products in Australia , 2015, British Journal of Nutrition.

[40]  W. Willett,et al.  Reducing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative , 2015, Globalization and Health.

[41]  J. Ludvigsson,et al.  Increased risk of non-alcoholic fatty liver disease after diagnosis of celiac disease. , 2015, Journal of hepatology.

[42]  P. Grace-Farfaglia Bones of Contention: Bone Mineral Density Recovery in Celiac Disease—A Systematic Review , 2015, Nutrients.

[43]  N. Caporaso,et al.  Metabolic syndrome in patients with coeliac disease on a gluten‐free diet , 2015, Alimentary pharmacology & therapeutics.

[44]  R. Coimbra,et al.  Molecular mechanism driving retroperitoneal adipocyte hypertrophy and hyperplasia in response to a high-sugar diet. , 2014, Molecular nutrition & food research.

[45]  R. Kelishadi,et al.  Association of fructose consumption and components of metabolic syndrome in human studies: a systematic review and meta-analysis. , 2014, Nutrition.

[46]  R. Rizzoli Dairy products, yogurts, and bone health. , 2014, The American journal of clinical nutrition.

[47]  M. Moghadasian,et al.  Nutritional constituents and health benefits of wild rice (Zizania spp.). , 2014, Nutrition reviews.

[48]  M. Bustamante,et al.  Nutritional Differences Between a Gluten-free Diet and a Diet Containing Equivalent Products with Gluten , 2014, Plant Foods for Human Nutrition.

[49]  D. Leffler,et al.  Nutritional consequences of celiac disease and the gluten-free diet , 2014, Expert review of gastroenterology & hepatology.

[50]  F. Pallone,et al.  Appropriate nutrient supplementation in celiac disease , 2013, Annals of medicine.

[51]  V. Fabiano,et al.  Gluten-Free Diet in Children: An Approach to a Nutritionally Adequate and Balanced Diet , 2013, Nutrients.

[52]  P. Brambilla,et al.  Intakes of nutrients in Italian children with celiac disease and the role of commercially available gluten-free products. , 2013, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[53]  C. Mulder,et al.  Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients , 2013, Nutrients.

[54]  P. Gibson,et al.  Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. , 2013, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[55]  D. Hougaard,et al.  N-3 Polyunsaturated Fatty Acids, Body Fat and Inflammation , 2013, Obesity Facts.

[56]  J. Stein,et al.  Inadequate Nutrient Intake in Patients with Celiac Disease: Results from a German Dietary Survey , 2013, Digestion.

[57]  R. Betensky,et al.  Patients with celiac disease have a lower prevalence of non-insulin-dependent diabetes mellitus and metabolic syndrome. , 2013, Gastroenterology.

[58]  A. Rubio‐Tapia,et al.  ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease , 2013, The American Journal of Gastroenterology.

[59]  M. Zali,et al.  The concentration of serum zinc in celiac patients compared to healthy subjects in Tehran , 2013, Gastroenterology and hepatology from bed to bench.

[60]  L. Qin,et al.  Effects of Dietary Carbohydrate Replaced with Wild Rice (Zizania latifolia (Griseb) Turcz) on Insulin Resistance in Rats Fed with a High-Fat/Cholesterol Diet , 2013, Nutrients.

[61]  Zhengyu Jin,et al.  Germinated Brown Rice and Its Role in Human Health , 2013, Critical reviews in food science and nutrition.

[62]  E. Chambers,et al.  Consumer input for developing human food products made with sorghum grain. , 2012, Journal of food science.

[63]  M. Uusitupa,et al.  Effects of n-6 PUFAs compared with SFAs on liver fat, lipoproteins, and inflammation in abdominal obesity: a randomized controlled trial. , 2012, The American journal of clinical nutrition.

[64]  S. Hercberg,et al.  High dietary saturated fat intake accentuates obesity risk associated with the fat mass and obesity-associated gene in adults. , 2012, The Journal of nutrition.

[65]  A. Afify,et al.  Biochemical changes in phenols, flavonoids, tannins, vitamin E, β-carotene and antioxidant activity during soaking of three white sorghum varieties. , 2012, Asian Pacific journal of tropical biomedicine.

[66]  D. Leffler,et al.  Body mass index and the risk of obesity in coeliac disease treated with the gluten‐free diet , 2012, Alimentary pharmacology & therapeutics.

[67]  D. Sanders,et al.  The Oslo definitions for coeliac disease and related terms , 2012, Gut.

[68]  F. Hu,et al.  Sweeteners and Risk of Obesity and Type 2 Diabetes: The Role of Sugar-Sweetened Beverages , 2012, Current Diabetes Reports.

[69]  A. Martí,et al.  Dietary fatty acid distribution modifies obesity risk linked to the rs9939609 polymorphism of the fat mass and obesity-associated gene in a Spanish case–control study of children , 2011, British Journal of Nutrition.

[70]  C. Rosell,et al.  Chemical Composition and Starch Digestibility of Different Gluten-free Breads , 2011, Plant foods for human nutrition.

[71]  C. Geissler,et al.  Iron, Meat and Health , 2011, Nutrients.

[72]  S. Tanumihardjo,et al.  Maize: A Paramount Staple Crop in the Context of Global Nutrition. , 2010, Comprehensive reviews in food science and food safety.

[73]  T. Beta,et al.  Antioxidant properties of commercial wild rice and analysis of soluble and insoluble phenolic acids , 2010 .

[74]  O. Hernell,et al.  Dietary shortcomings in children on a gluten-free diet. , 2010, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[75]  P. Mattila,et al.  Flavonoids and other phenolic compounds in Andean indigenous grains: Quinoa (Chenopodium quinoa), kañiwa (Chenopodium pallidicaule) and kiwicha (Amaranthus caudatus) , 2010 .

[76]  P. Green,et al.  Body Mass Index in Celiac Disease: Beneficial Effect of a Gluten-free Diet , 2010, Journal of clinical gastroenterology.

[77]  G. Ferretti,et al.  The Gluten-Free Diet: Safety and Nutritional Quality , 2010, Nutrients.

[78]  M. Garg,et al.  Plasma n-3 Polyunsaturated Fatty Acids are negatively associated with obesity. , 2009, The British journal of nutrition.

[79]  L. Agellon,et al.  Wild rice (Zizania latifolia (Griseb) Turcz) improves the serum lipid profile and antioxidant status of rats fed with a high fat/cholesterol diet , 2009, British Journal of Nutrition.

[80]  L. Tucker,et al.  Increasing total fiber intake reduces risk of weight and fat gains in women. , 2009, The Journal of nutrition.

[81]  M. L. Clodoveo,et al.  Evaluation of the nutritional quality of the lipid fraction of gluten-free biscuits , 2008 .

[82]  H. McNulty,et al.  Homocysteine and related B-vitamin status in coeliac disease: Effects of gluten exclusion and histological recovery , 2008, Scandinavian journal of gastroenterology.

[83]  F. Robin,et al.  Slowly digestible starch – its structure and health implications: a review , 2007 .

[84]  W. Dickey,et al.  Overweight in Celiac Disease: Prevalence, Clinical Characteristics, and Effect of a Gluten-Free Diet , 2006, The American Journal of Gastroenterology.

[85]  N. Scrimshaw Quality Protein Maize , 2006, Food and nutrition bulletin.

[86]  F. Hu,et al.  Intake of sugar-sweetened beverages and weight gain: a systematic review. , 2006, The American journal of clinical nutrition.

[87]  A. Fasano,et al.  Celiac disease in the pediatric population. , 2006, Pediatric annals.

[88]  L. Aston Glycaemic index and metabolic disease risk , 2006, Proceedings of the Nutrition Society.

[89]  I. Graham,et al.  Celiac Disease: Evaluation of the Diagnosis and Dietary Compliance in Canadian Children , 2005, Pediatrics.

[90]  J. Drai,et al.  Plasma fatty acid composition is associated with the metabolic syndrome and low-grade inflammation in overweight adolescents. , 2005, The American journal of clinical nutrition.

[91]  L. Higgins,et al.  Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods? , 2005, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[92]  M. Mäki,et al.  Nutritional Status in Adolescents and Young Adults with Screen-Detected Celiac Disease , 2005, Journal of pediatric gastroenterology and nutrition.

[93]  C. Kupper Dietary guidelines and implementation for celiac disease. , 2005, Gastroenterology.

[94]  J. Awika,et al.  Sorghum phytochemicals and their potential impact on human health. , 2004, Phytochemistry.

[95]  Marisa Porrini,et al.  In vitro starch digestibility and in vivo glucose response of gluten–free foods and their gluten counterparts , 2004, European journal of nutrition.

[96]  A. Simopoulos,et al.  The importance of the ratio of omega-6/omega-3 essential fatty acids. , 2002, Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.

[97]  D. Kelly,et al.  Metabolic Liver Disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition , 2002, Journal of pediatric gastroenterology and nutrition.

[98]  P. Corey,et al.  Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. , 2002, The American journal of clinical nutrition.

[99]  A. Gaddi,et al.  Rice Bran Oil and γ‐Oryzanol in the Treatment of Hyperlipoproteinaemias and Other Conditions , 2001 .

[100]  J. Mann,et al.  A definition for dietary fibre , 2000, European Journal of Clinical Nutrition.

[101]  M. Bardella,et al.  Body composition and dietary intakes in adult celiac disease patients consuming a strict gluten-free diet. , 2000, The American journal of clinical nutrition.

[102]  A. Alwitry Vitamin A deficiency in coeliac disease , 2000, The British journal of ophthalmology.

[103]  S M Grundy,et al.  Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. , 2000, The New England journal of medicine.

[104]  S. Jameson Coeliac Disease, Insulin-like Growth Factor, Bone Mineral Density, and Zinc , 2000, Scandinavian journal of gastroenterology.

[105]  M. Viti,et al.  The gluten-free diet: a nutritional risk factor for adolescents with celiac disease? , 1998, Journal of pediatric gastroenterology and nutrition.

[106]  M. Black Zinc deficiency and child development. , 1998, The American journal of clinical nutrition.

[107]  V. Kosma,et al.  Nutritional status of newly diagnosed celiac disease patients before and after the institution of a celiac disease diet--association with the grade of mucosal villous atrophy. , 1998, The American journal of clinical nutrition.

[108]  E. Rosenthal,et al.  Serum Lipoprotein Profile in Children With Celiac Disease , 1990, Journal of pediatric gastroenterology and nutrition.

[109]  M. Farhangi,et al.  Does a gluten-free diet increase body mass index and lipid profile in celiac patients? A systematic review and meta-analysis , 2019 .

[110]  G. Castillejo,et al.  Patients With Celiac Disease Reported Higher Consumption of Added Sugar and Total Fat Than Healthy Individuals , 2017, Journal of pediatric gastroenterology and nutrition.

[111]  M. Barone,et al.  A comparison of the nutritional status between adult celiac patients on a long-term, strictly gluten-free diet and healthy subjects , 2016, European Journal of Clinical Nutrition.

[112]  L. Rodrigo Celiac disease. , 2006, World journal of gastroenterology.

[113]  M. JonesJulie,et al.  The definition of dietary fibers , 2001 .

[114]  A. Cicero,et al.  Rice bran oil and gamma-oryzanol in the treatment of hyperlipoproteinaemias and other conditions. , 2001, Phytotherapy research : PTR.

[115]  B. Rosner,et al.  Cholesterol-lowering effects of dietary fiber: a meta-analysis. , 1999, The American journal of clinical nutrition.

[116]  A. Gasbarrini,et al.  Assessment of body composition by bioelectrical impedance in adolescent patients with celiac disease , 1999, American Journal of Gastroenterology.