Gluten-free Research Articles

Gluten-free foods are expensive and nutritionally imbalanced than their gluten-containing counterparts.

Nutritional quality of gluten-free (GF) food products is very important, as patients with celiac disease consume these products for lifelong. There is paucity of data on the nutritional content and cost of GF food products compared with their gluten-containing (GC) counterparts from India (Asia). After a detailed market survey, packaged and labeled GF food products (n=485) and their packaged GC counterparts (n=790) from the supermarkets of Delhi (India) and e-commerce websites were included. Nutritional content and cost/100 g food (in US dollars) were calculated using the information on food label. Gluten-free food products were 232% (range: 118% to 376%) more expensive than their GC counterparts. Energy content of all GF food products was similar to their GC counterparts, except cereal-based snacks (GF: 445 kcal vs. GC: 510 kcal, p<0.001). The protein content was significantly lower in GF pasta and macaroni products (single-grain: GF: 6.5 g vs. GC:11. 5 g, p-0.002; multigrain: GF:7.6 g vs. GC:11.5 g, p-0.027), cereal flours (single-grain: GF: 7.6 g vs. GC: 12.3 g, p<0.001; multigrain: GF:10.9 g vs. GC: 14.1 g, p-0.009) and nutritional bars (GF: 21.81 g vs. GC:26 g, p-0.028) than their GC counterparts. Similarly, the dietary-fiber content of GF pasta and macaroni products, cereal flours, cereal premix and nutritional bars of GF foods was significantly lower than their GC counterparts. Gluten-free bread and confectionary items, biscuits and cookies and snacks had higher total fats and trans-fat content than their GC counterparts. Gluten-free cereal-based snacks had higher sodium content than their GC counterparts (GF: 820 mg vs. GC:670 mg; p<0.001). GF foods are significantly more expensive, contain less protein and dietary fiber and higher fat, trans-fat and sodium than their GC counterparts. Strategies must be developed to reduce the cost and improve the nutritional profile of GF foods.

Gluten migration from biodegradable food contact materials poses a risk to celiac disease patients

Due to the ban of certain single-use plastics in the European Union, food contact materials (FCM) from biobased and/or biodegradable polymers are increasingly being used. Some FCM are made from wheat or rye and therefore contain gluten, which is a food allergen and known to cause celiac disease. Legislation currently does not require allergen labelling on FCM and there is only some first information that gluten from FCM can migrate into gluten-free foods. Our aim was to analyze the extent of gluten migration from six different FCM into a variety of liquid and solid foods to assess the risk of exposure for wheat allergy and celiac disease patients. We show that the extent of gluten migration depended on the properties of the material, the liquid or solid food it comes into contact with and contact time. There was no clear effect of temperature or pH value. Of the six FCM studied, wheat bran-based plates had the highest potential to release gluten with concentrations of up to 203.0 mg/L of gluten in deionized water after 30 min. To protect patients, it is important to raise awareness of the risk of gluten migration from such FCM and help patients identify and avoid gluten-containing FCM. Further, legislation needs to be adapted urgently to include mandatory labelling of allergens on these biodegradable FCM.

Salivary interleukin-17A and interleukin-18 levels in patients with celiac disease and periodontitis.

An increased level of interleukin-17A and interleukin-18 in the serum and intestinal mucosa of celiac disease patients reflecting the severity of villous atrophy and inflammation was documented. Thus, the objective of this study was to evaluate the concentrations of salivary-17A, interleukin-1 beta, and interleukin-18 in patients with celiac disease who are on a gluten-free diet, both with and without periodontitis, and to compare these levels with those in healthy individuals. The study involved 23 participants with serologically confirmed celiac disease (CD) and 23 control subjects. The CD patients had been following a gluten-free diet (GFD) for a minimum of 1 year and had no other autoimmune disorders. The research involved collecting demographic data, conducting periodontal examinations, gathering unstimulated whole saliva, and performing enzyme-linked immunosorbent assays to measure salivary interleukin-17A, interleukin-1 beta, and interleukin-18 levels. Spearman's correlation analysis was utilized to explore the relationships between CD markers in patients on a GFD and their periodontal clinical findings. The periodontal findings indicated significantly lower values in celiac disease patients adhering to a gluten-free diet compared to control subjects (p = 0.001). No significant differences were found in salivary IL-17A, IL-18, and IL-1B levels between celiac disease patients and control subjects. Nevertheless, the levels of all interleukins were elevated in periodontitis patients in both the celiac and control groups. The IL-1 Beta level was significantly higher in periodontitis patients compared to non-periodontitis patients in the control group (p = 0.035). Significant negative correlations were observed between serum IgA levels and plaque index (r = -0.460, p = 0.010), as well as gingival index (r = -0.396, p = 0.030) in CD patients on a gluten-free diet. Celiac disease patients on gluten-free diet exhibited better periodontal health compared to control subjects. However, increased levels of salivary IL-17A, IL-18 and IL-1B levels were associated with periodontitis. Additionally, serum IgA level was significantly inversely associated with periodontitis clinical manifestations and with salivary inflammatory mediators in CD patients on GFD.

Utilization of Sustainable Ingredients (Cañihua Flour, Whey, and Potato Starch) in Gluten-Free Cookie Development: Analysis of Technological and Sensorial Attributes.

In recent years, the consumption of gluten-free products has increased due to the increasing prevalence of celiac disease and the increased preference for gluten-free diets. This study aimed to make cookies using a mixture of cañihua flour, whey, and potato starch. The use of a Box-Behnken design allowed for flexible ingredient proportions and physicochemical properties, centesimal composition, color, texture, and sensory attributes to be evaluated through consumer tests (Sorting and acceptability). The results highlighted significant variations in physicochemical data, composition, color, and texture across formulations. The blend with 38.51% cañihua flour, 10.91% sweet whey, 25.69% potato starch, 8.34% margarine, 11.10% sugar, 0.19% sodium chloride, 0.51% baking powder, 0.51% vanilla essence, and 4.24% egg exhibited superior sensory appeal. This formulation boasted excellent texture, aroma, flavor, color, and appearance, indicating high sensory and physicochemical quality. The use of cañihua flour, sweet whey, and potato starch not only provides a gluten-free option but also delivers a nutritious and sensorily pleasing choice for those with dietary restrictions. Future research could explore the commercial viability of producing these cookies on a larger scale, as well as investigating the potential health benefits of these ingredients.

Global Approach to Follow-Up of Celiac Disease.

Celiac disease, an autoimmune disorder induced by the ingestion of gluten, affects approximately 1.4% of the population. Gluten damages the villi of the small intestine, producing symptoms such as abdominal pain, bloating and a subsequent loss of nutrient absorption, causing destabilization of the nutritional status. Moreover, gluten can trigger extra intestinal symptoms, such as asthma or dermatitis, but also mental disorders such as depression or anxiety. Moreover, people suffering from celiac disease sometimes feel misunderstood by society, mainly due to the lack of knowledge about the disease and the gluten-free diet. Thus, the treatment and follow-up of patients with celiac disease should be approached from different perspectives, such as the following: (1) a clinical perspective: symptomatology and dietary adherence monitorization; (2) nutritional assessment: dietary balance achievement; (3) psychological assistance: mental disorders avoidance; and (4) social inclusion: educating society about celiac disease in order to avoid isolation of those with celiac disease. The aim of this narrative review is to gain deep insight into the different strategies that currently exist in order to work on each of these perspectives and to clarify how the complete approach of celiac disease follow-up should be undertaken so that the optimum quality of life of this collective is reached.

The immune and microbial homeostasis determines the Candida-mast cells cross-talk in celiac disease.

Celiac disease (CD) is an autoimmune enteropathy resulting from an interaction between diet, genome, and immunity. Although many patients respond to a gluten-free diet, in a substantive number of individuals, the intestinal injury persists. Thus, other factors might amplify the ongoing inflammation. Candida albicans is a commensal fungus that is well adapted to the intestinal life. However, specific conditions increase Candida pathogenicity. The hypothesis that Candida may be a trigger in CD has been proposed after the observation of similarity between a fungal wall component and two CD-related gliadin T-cell epitopes. However, despite being implicated in intestinal disorders, Candida may also protect against immune pathologies highlighting a more intriguing role in the gut. Herein, we postulated that a state of chronic inflammation associated with microbial dysbiosis and leaky gut are favorable conditions that promote C. albicans pathogenicity eventually contributing to CD pathology via a mast cells (MC)-IL-9 axis. However, the restoration of immune and microbial homeostasis promotes a beneficial C. albicans-MC cross-talk favoring the attenuation of CD pathology to alleviate CD pathology and symptoms.

Who gets an annual review for coeliac disease? Patients with lower health literacy and lower dietary adherence consider them important.

A lifelong gluten-free (GF) diet to manage coeliac disease is recognised to be challenging. This paper comprises two studies: study one aimed to report the opinions of adults with coeliac disease on review provision and explore factors influencing dietary adherence. Study two aimed to report dietetic provision for adults with coeliac disease. A cross-sectional online survey was completed by 722 adults with coeliac disease, including validated dietary adherence, health literacy and quality-of-life questionnaires. An online and paper survey designed to capture the provision of dietetic services to adults with coeliac disease was completed by 88 dietetic departments within the United Kingdom. Only 26% of adults with coeliac disease were offered annual reviews. In contrast, 85% considered reviews important, with 62% preferring dietetic provision. Those who considered reviews important had lower health literacy, greater dietary burden, poorer GF dietary adherence and lower GF food knowledge (all p < 0.05) compared with those who did not consider reviews important. GF dietary adherence was associated with health literacy, self-regulatory behaviours, dietary burden and GF food knowledge; 53% agreed with the 'cost of GF food restricts what I eat'; they had poorer GF dietary adherence compared with those who disagreed (p < 0.001). More than 72% of dietetic coeliac review provision provided content on improving access to GF foods and eating out of the home. A subpopulation of adults with coeliac disease have a greater need for support and guidance, which supports the viewpoint that limited resources should be targeted towards patients with the most need for support to enable successful disease management.

Carob powder-enhanced bread: a promoting alternative for the gluten-free diet

Carob powder-enhanced bread: a promoting alternative for the gluten-free diet

The relevance of a gluten-free diet in the treatment of patients with hashimoto's thyroiditis without celiac disease

The relevance of a gluten-free diet in the treatment of patients with hashimoto's thyroiditis without celiac disease

Exploring Millet Grains: Nutritional Benefits, Processing Advancements, and Future Directions for Food Security and Health Improvement

Millet grains have gained recognition as nutritious, climate-resilient crops with the potential to contribute to food security and public health. This review explores the nutritional benefits, processing advancements, and future prospects of millet grains. Millets are rich sources of dietary fiber, protein, vitamins, minerals, and antioxidants, making them suitable for gluten-free diets and beneficial for managing chronic diseases. Recent advancements in processing technologies have led to the development of a variety of millet-based products that retain nutritional integrity while enhancing sensory attributes. These innovations offer convenient and nutritious alternatives to traditional grain-based foods. Looking ahead, millets hold promise for sustainable agriculture and improved human health, especially in regions facing food insecurity and malnutrition. Government support and consumer awareness are crucial for realizing the full potential of millet grains in addressing global challenges.

Evaluation of Hearing Functions in Children with Celiac Disease and the Effect of Gluten-free Diet on these Functions.

The present study aims to investigate the potential impact of celiac disease (CD) on hearing functions and assess the effect of a gluten-free diet (GFD) on this condition. The study included 55 children with CD (110 ears) and 25 healthy controls (50 ears) matched for age and gender. The CD group was divided into adherent (n = 31) and nonadherent (n = 24) to GFD. Participants underwent tympanometry and pure tone audiometry assessments covering frequencies from 500 to 4000 Hz. Patients with CD showed significantly higher air and bone conduction hearing averages compared to the control group at frequencies of 500, 1000, 2000, and 4000 Hz for air conduction, and at 500 Hz for bone conduction (P < 0.05). Celiac patients, those who fully adhered to GFD, had notably higher air conduction hearing averages at 500, 2000, and 4000 Hz compared to healthy controls (P < 0.05). However, there was no difference in bone conduction hearing averages between the two groups. In contrast, celiac patients who did not comply with GFD had statistically significantly higher air and bone conduction hearing averages than the control group (P < 0.05), at frequencies of 500, 1000, and 4000 Hz for air conduction, and at 500 and 1000 Hz for bone conduction (P < 0.05). The study suggests that nonadherence to GFD may elevate the risk of hearing loss in children with CD. As a result, it is recommended to conduct hearing screenings for children with CD and underscore the importance of complying with GFD to mitigate further detrimental effects on hearing functions.

Celiac Disease and Autoimmune Diseases in a Pediatric Population in Morocco: A Cross-Sectional Study.

Celiac disease (CD) is defined as an autoimmune disease (AD) caused by gluten ingestion in genetically sensitive individuals. Several publications have demonstrated the increased risk of AD in patients with CD, both adults and children, which requires systematic research. Our study aimed to determine the prevalence of AD in 60 patients diagnosed with CD and to highlight risk factors that may contribute to the emergence of AD. We collected medical data from all CD patients under 16 years of age who also had AD. Our study was conducted in the Gastroenterology-Hepatology and Pediatric Nutrition Unit of the Pediatrics Department of the Mohamed VI Hospital and University Center in Oujda, Morocco, during a seven-year period between January 2017 and January 2024. We studied 60 patients with CD in our study. Eight patients (13%) had an associated AD. Their average age was eight years, with extremes varying between two and 15 years. AD was diagnosed before CD in six cases (75%), in parallel with CD in one patient (12.5%), while in only one case, it was diagnosed after CD (12.5%).All our patients had a single AD associated with CD. These ADs were mainly type 1 diabetes in seven cases and autoimmune thyroiditis in only one case. All our patients followed a gluten-free diet in addition to specific treatment for associated AD. Nevertheless, despite regular medical follow-up and targeted dietary advice for the management of CD and associated AD, three patients encountered difficulties in following the recommended diet. Younger patients with CD have an increased risk of hypothyroidism and insulin-dependent diabetes. These data necessitate improved surveillance to discover these illnesses as early as possible in order to optimize management and reduce related consequences.

Gluten-free diet not only for celiac patients? Type 1 diabetes and gluten

Gluten-free diet not only for celiac patients? Type 1 diabetes and gluten

Influence of enzyme treatment approach on the phenolics content and antioxidant potential of sorghum grain samples

Enzyme-assisted extraction of phenolics was performed from commercial broom, and GK Emese and Farmsugro 180 hybrid sorghum grain residues with cellulolytic and esterolytic cocktails of Rhizomucor miehei NRRL 5282, Gilbertella persicaria SZMC 11086 and Mucor corticolus SZMC 12031 fungi. Results showed an increasing tendency for total phenolic content (TPC) during incubation that was in a positive relation with total flavonoid content (TFC) for most treatments. Best TPC and TFC yields were obtained on broom sorghum with maximal values of 256.9 ± 11.7 mg gallic acid equivalent (GAE)/100 g dry matter (DM) and 159.4 ± 6.8 mg catechin equivalent (CE)/100 g DM, respectively, achieved during R. miehei enzyme treatment. Reducing power and radical scavenging activity assays demonstrated improved antioxidant activity for most treated samples that was in positive correlation (0.942 ≥ r ≥ 0.522) with the TPC and TFC variables. Chromatography analysis revealed hydroxybenzoates, i.e., protocatechuic, 4-hydroxybenzoic and vanillic acids, as major phenolics with yields ranging from 5.40 ± 0.57 to 132.85 ± 14.21 μg/g DM, but the content of hydroxycinnamates increased to a greater extent during the treatments. The enzyme treatments can be reliable methods for enriching phenolic antioxidants in sorghum substances utilizable in gluten-free food products.

Enzymatic hydrolysis of wheat gluten employing cysteine proteases from noni fruits (Morinda citrifolia L.)

Previous reports have shown that noni (Morinda citrifolia L.) puree extract (NPE) is a promising source of cysteine peptidases with potential applications in the food industry. This study expanded the applications of cysteine peptidases from noni fruit by analyzing their potential for wheat gluten hydrolysis and assessing their in vitro toxicity as a new food ingredient. NPE cysteine proteases hydrolyze both gliadins and glutenins, reaching a degree of hydrolysis of 24.40% and 31.78%, respectively. In addition, they reduced gliadin content by 96.80% after 4 h of incubation, as displayed by the R5 ELISA test kit for detecting gliadin based on the monoclonal antibody R5. The chromatographic fractionation of NPE cysteine proteases on a cation exchange column (Source 30S) resulted in an unretained peak (P1) and a retained peak (P2), which showed proteolytic activity with different electrophoretic and zymographic profiles. P1 and P2 had similar (p < 0.05) degrees of hydrolysis for gliadins (approximately 9%). P1 performed better (10.68%) than P2 (8.55%) for glutenins. NPE cysteine proteases did not exhibit genotoxicity or cytotoxicity against mouse fibroblasts (L929 cell line). These findings suggest that NPE cysteine proteases have potential for use as novel ingredients to produce gluten-free foods.

Impact of Cactus Mucilage Powder as New Natural Hydrocolloid on Physicochemical, Staling Rate and Sensory Characteristics of Gluten-free Egyptian Flat Bread

The growing market for gluten-free (GF) products has encouraged the development of several GF bakery products that aim to mimic the high standards of wheat bakery goods. The objective of this study was to investigate the impact of cactus mucilage powder (CMP) as new natural hydrocolloid on the characteristics of GF flat bread. Wheat flour was replaced by rice flour (RF) as a GF cereal. Different levels of Xanthan gum (XG), CMP or their combination between them were used to investigate their impact on physicochemical properties, alkaline water retention capacity (AWRC), staling rate (SR) and sensory characteristics of the resultant GF flat bread. Results showed that addition of XG or CMP, as natural hydrocolloids, resulted in significant increases in flat bread moisture (P ˂ 0.05). In addition, the crust color of GF flat bread was significantly lighter (L* value) than the control. Increases in AWRC were noticed as a result of XG and CMP addition. On the other hand, low concentrations of XG led to decrease in the staling rate while high concentrations resulted in slight increase in the staling rate. Addition of CMP into flat bread formulas resulted in increases in the staling rate of the investigated samples. Combination of XG with CMP led to reduction in the staling rate of flat bread comparing with CMP only. Furthermore, the ability of different formulae to retain alkaline water decreased as the storage period was increased. All gluten-free formulae containing hydrocolloids received significantly higher (P ˂ 0.05) sensory scores compared to the control.

Eating disorder symptoms and diagnoses in adults with celiac disease

Introduction: Treatment for Celiac Disease (CeD) includes strict adherence to a Gluten-Free Diet (GFD) which may result in preoccupation with food choice, unwanted weight gain, and body dissatisfaction. Objective: To determine frequency of Eating Disorder (ED) diagnoses and symptoms in adults with CeD. Method: The Eating Disorder Diagnostic Scale (EDDS-DSM-5) and the Eating Pathology Symptoms Inventory (EPSI) were administered in a cross-sectional study of 50 adults with biopsy-confirmed CeD on a GFD for &gt;1 year attending their routine clinic visits. Results: Based on the EDDS, one participant met criteria for Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis of binge eating disorder and four met criteria for possible diagnosis of Other Specified Feeding and Eating Disorders; none had previously been diagnosed with an ED. EDDS symptom scores were lower (i.e., better) than established cut-points, yet females scored higher than males when asked if they felt fat (p&lt;0.001), feared weight gain (p&lt;0.001), and felt undue influence of weight/ shape (p=0.034). EPSI scores were lower (i.e., better) than normative values, yet females scored significantly higher than males on body dissatisfaction (p&lt;0.001), cognitive restraint (p=0.011), and purging (p=0.044) subscales. Conclusion: Although disordered eating behaviors and weight/ shape concerns were apparent, only one patient met full criteria for an ED diagnosis. The EDDS and EPSI may be useful in screening for comorbidity among adults with CeD; however, clinical assessment is needed to assign a DSM-5 ED diagnosis.

Budesonide Induces Favourable Histologic and Symptomatic Recovery in Patients with Non-responsive and Refractory Coeliac Disease When Given in an Open Capsule Format

IntroductionNon-responsive coeliac disease (NRCD), where symptoms and enteropathy persist despite a prolonged gluten-free diet (GFD), is common. Refractory coeliac disease (RCD), characterised by malabsorption and extensive enteropathy, is rare but serious. In both, treatment options are limited. Topical budesonide may help and an open capsule format promoting proximal small intestinal delivery may be advantageous.AimTo describe the effect of budesonide and its presentation on mucosal healing, symptoms, and tolerability in NRCD and RCD.MethodsA retrospective cohort study of NRCD and RCD patients who received budesonide for enteropathy despite a strict GFD for over 12 months. Primary outcome was improvement in histology. Symptoms and adverse treatment effects were recorded.Results50 patients with NRCD (n = 14; 86% F), RCD type 1 (n = 30; 60% F), and RCD type 2 (n = 6 based on aberrant duodenal T cells; 33% F) were identified. Common RCD symptoms were diarrhoea (68%), fatigue (40%), and weight loss (34%). 16 received closed capsule budesonide (CCB) 9 mg OD and 35 open capsule budesonide (OCB) 3 mg 3 times a day. Complete and partial mucosal healing was significantly higher after OCB compared to CCB (p < 0.001, Mann–Whitney U test). Symptom improvement was also significantly higher after OCB compared to CCB (p = 0.002, Mann–Whitney U test). Side effects were mild and self-limiting and were reported in 25% of both cohorts.ConclusionOCB was well tolerated and associated with improvements in enteropathy (83%) and symptoms (90%) in NRCD and RCD. Our findings support OCB as the preferred 1st-line therapy for NRCD and RCD type 1.

Should We Rule out Celiac Disease in Recurrent Headache Disorders? A Review of the Literature.

Recurrent headaches, encompassing migraine and tension-type headaches, represent prevalent conditions affecting individuals across different age groups, exerting a substantial influence on daily functioning and quality of life. Headaches serve as common manifestations of underlying health issues. Among these, celiac disease, an autoimmune disorder activated by gluten consumption, has emerged as a noteworthy concern. Recent research indicates a correlation between celiac disease and heightened susceptibility to headaches, particularly migraines. Celiac disease (CD) is an immune-mediated systemic, widespread disorder presenting a heterogeneous constellation of symptoms with a relatively easy diagnosis and therapy. Among signs and symptoms exhibited in celiac disease patients, headache is one of the most common neurological issues addressed among both adults and children. Headache disorders and CD are highly prevalent in the general population; for this reason, any causal association between these conditions and the role of a gluten-free diet (GFD) has been debated. The aim of this manuscript is to review the current scientific literature regarding the potential association between CD and headaches and the beneficial effects of a GFD. Among the various authors, in our opinion, the current state of the evidence suggests a significant role for the early screening of CD during the initial diagnosis of recurrent headaches, either in adults or children.

Enhancing life with celiac disease: unveiling effective tools for assessing health-related quality of life.

Celiac disease (CD) is an autoimmune chronic enteropathy provoked by gluten ingestion in genetically predisposed individuals. Considering it´s only safe treatment is a lifelong gluten-free diet, the burden of living with the disease becomes evident, as well as the need to assess CD health-related quality of life (HRQOL). This review aims to identify and analyze the instruments used to evaluate the HRQOL of adults with CD. This integrative review using a systematic approach was designed to achieve high scientific standards. Accordingly, the search strategy was developed and executed as recommended by the guideline of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Detailed individual searches were developed to Pubmed, Science Direct, Scopus, Web of Science, and Google Scholar. After careful analysis of the papers, 43 studies were included, in which seven instruments were identified: Celiac Disease Questionnaire (CDQ) (n=21), Celiac Disease Specific Quality of Life Instrument (CD-QOL) (n=17), Celiac Disease Assessment Questionnaire (CDAQ) (n=4), CeliacQ-7 (n=1), CeliacQ-27 (n=1), Black and Orfila´s self-developed instrument (n=1) and the Coeliac Disease Quality of Life Questionnaire (CDQL) (n=1). The CDQ and CD-QOL were the two most applied instruments. Since the first focuses on the physical and mental symptoms related to the disease and the second focuses on the emotional repercussions of adhering to the GFD treatment for life (dysphoria), the CDQ application is an interesting option for countries that struggle with public policies for CD patients and patients with active CD. The CD-QOL could be used for countries with strict regulations for CD and gluten-free products and populations in remission. When comparing results among different populations, it is preferable to utilize culturally validated instruments, which have been applied across multiple countries, providing greater comparability between study findings.