Gluten-free is not enough – perception and suggestions of celiac consumers

The Economic Iceberg of Celiac Disease: More Than the Cost of Gluten-Free Food

Celiac disease (CeD) is a chronic autoimmune disorder of global relevance, with the potential for acute and long-term complications. However, the economic burden of CeD is rarely considered and largely thought of as limited to the cost of gluten-free food. Fortunately, recent research has shed light on the various societal costs of CeD across the health care continuum. This article summarizes the current evidence on the economic impacts of CeD, which suggest that the societal economic burden of CeD stretches beyond the cost of gluten-free food. This review provides ample evidence of larger but hidden costs related to excess health care use for complications and comorbidities, as well as reduced productivity. Although significant advances are expected in the management of CeD, their effect on the economic burden of CeD remain uncertain. The aim of this review was to inform stakeholders across society and contribute to improved policies to support patients with CeD.

Development of Gluten-Free Bread Production Technology with Enhanced Nutritional Value in the Context of Kazakhstan

This research aims to enhance the nutritional value of gluten-free bread by incorporating a diverse range of components, including additives with beneficial effects on human health, e.g., dietary fibers. The research was focused on improving the texture, taste, and nutritional content of gluten-free products by creating new recipes and including novel biological additives. The goal was to develop gluten-free bread with less than 3 ppm gluten content that can be eaten by people suffering from gluten sensitivity. The physical and chemical properties of gluten-free rice, corn, green buckwheat, chickpea, amaranth, and plantain flours were examined to understand their unique characteristics and the possibility of their mixing combination to achieve the desired results. Initially, nine recipes were prepared, and in survey research, four baking recipes were selected and tested. The composition of amino acids in the prepared gluten-free bread was determined. The variant made of corn, green buckwheat flour with plantain was found to be top-rated. Changes in the nutritional content of the new product were analyzed, and general regulations and nutritional values were identified. Experimental baking processes were carried out, leading to the successful formulation of gluten-free bread containing corn, green buckwheat, and plantain flour in a ratio of 40:40:20, meeting gluten-free requirements and demonstrating improved nutritional properties, as well as consumption properties, confirmed by surveys conducted on a group of consumers.

Defining Amaranth, Buckwheat and Quinoa Flour Levels in Gluten-Free Bread: A Simultaneous Improvement on Physical Properties, Acceptability and Nutrient Composition through Mixture Design

The study aimed to define the ideal proportions of pseudocereal flours (PF) in sensory-accepted gluten-free bread (GFB) formulations. The characteristics of GFB developed with PF (amaranth, buckwheat, and quinoa) were verified through a mixture design and response surface methodology. Three simplex-centroid designs were studied to analyze the effects of each PF and their interactions with potato starch (PS), and rice flour (RF) on GFB’s physical and sensory characteristics, each design producing three single, three binary and six ternary GFB formulations. Results showed that using PF alone resulted in unacceptable GFB. However, the interactions between PF and RF improved the loaf specific volume and the crumb softness and also enhanced appearance, color, odor, texture, flavor, and overall liking. Moreover, the composite formulations prepared with 50% PF and 50% RF (flour basis) presented physical properties and acceptability scores like those of white GFB, prepared with 100% RF or a 50% RF + 50% PS blend (flour basis). Maximum proportions of PF to obtain well-accepted GFB (scores ≥7 for all evaluated attributes on a 10-cm hybrid hedonic scale) were defined at 60% for amaranth flour (AF), 85% for buckwheat flour (BF), and 82% for quinoa flour (QF) in blends with RF.

Avaliação de atributos tecnológicos de pão francês com adição de farinhas de vegetais

Resumo O pão francês é considerado um dos produtos de panificação com maior consumo no Brasil, correspondendo a 53% do consumo de pães no Brasil, e está presente na alimentação de indivíduos de todas as classes sociais. O uso de farinhas de vegetais em pães vem sendo estudado a fim de obter produtos enriquecidos com fibras e com melhorias sensoriais de sabor, cor e textura. Assim, o objetivo deste estudo foi avaliar o efeito da adição de farinhas de cenoura e de casca de jabuticaba-açu na formulação de pão francês após assamento, por meio do planejamento fatorial completo 22, sendo investigadas as seguintes respostas variáveis: pH, atividade de água, firmeza, volume específico, perda de massa, umidade e cor da casca e do miolo. Adicionalmente, para fins de comparação, foi elaborado um pão controle sem adição de farinhas de vegetais e, nos demais ensaios, foram adicionadas as duas farinhas em cada formulação em concentrações diferentes. Por meio da análise de variância dos coeficientes de regressão, observaram-se efeitos significativos das farinhas sobre os parâmetros de luminosidade (L*) da crosta, cor do miolo a* e cor do miolo b*. Nos demais atributos de pH, atividade de água, firmeza, volume específico, perda de massa, umidade, luminosidade do miolo, cor da crosta a* e cor da crosta b*, não foram observados efeitos significativos por análise de variância dos coeficientes de regressão. Conclui-se que a adição de farinhas de cenoura e de casca de jabuticaba-açu nos níveis de 2% a 6% na formulação do pão francês, sugerindo uma melhoria nutricional sem perdas tecnológicas.

Influence of pseudocereals on gluten-free bread quality: A study integrating dough rheology, bread physical properties and acceptability

This study describes the use of the Mixture Design for simultaneals to improve the physical properties and acceptability of gluten-free bread (GFB) based on whole pseudocereals flour, as well as to define dough and bread instrumental predictors of the sensory quality of GFB. Three simplex-centroid designs were used to study the effects of each pseudocereal flour (amaranth - AF, buckwheat - BF, and quinoa - QF) blended with rice flour (RF) and potato starch (PS) on dough and bread properties. A total of 30 GFB formulations were produced and evaluated. Results reveal relationships between dough Mixolab parameters, such as C3 and C4, related to gelatinization and starch stability, with crumb moisture and firmness of GFB formulation, in which higher values of these parameters related to higher acceptability scores (>7 on a 10 cm hydroid hedonic scale). However, higher values of the secondary parameter C3-C4 was related to lower loaf-specific volume, impairing appearance and texture acceptability, as well as overall liking. The interaction effects between pseudocereal flour and RF increases dough consistency, bread volume, softness, and acceptability. Blends of 50% AF, BF, or QF with 50% RF results in GFB with high acceptability (overall liking of 8). The maximum pseudocereal proportions to obtain acceptable GFB (scores ≥ 7 for appearance, color, odor, texture, flavor acceptability and overall liking) were 60% AF, 85% BF, and 82% QF blended with RF. The combination of instrumental and sensory methods was useful to identify parameters capable of predicting the GFB quality, which may be useful for food scientists and producers to face the challenges regarding the development of healthier and better quality GFB to meet consumer needs.

Effect of formulations and fermentation processes on volatile organic compounds and prebiotic potential of gluten-free bread fortified by spirulina (Arthrospira platensis)

Gluten free (GF) foods, designed and marketed for the needs of people who are unable to metabolize gluten, in recent years have aroused growing interest that has led to the conquest of important market segments, with a strongly growing trend. Given the low protein content of standard GF flours, it is particularly important to fortify GF foods, and to study the effect that this process exerts on functional and sensorial characteristics. In this work, fortification of GF bakery goods was done with the addition of Arthrospira platensis (spirulina) flour. Two different dough formulations (with and without fortification) were fermented by four different processes, including spontaneous, single strains and sourdough starters. The baked products were then subjected to "consumer's tests". During the process, fermentation performances, prebiotic activity, and the VOC (Volatile Organic Compound) profiles were analyzed and compared through robust multivariate statistics. The results obtained evidenced that fortification led to a product with more abundant (medium organic acids) and exclusive bioactives (thymol, borneol, and nicotinic acid), which were correlated to the prebiotic activity of spirulina breads. This work, for the first time indicates that spirulina can be used to fortify GF bakery, improving also its functional potential.

Barriers of Adherence to a Gluten-Free Diet in Iranian Adults With Celiac Disease

This cross-sectional study aimed to evaluate and classify barriers to adherence to the gluten-free diet in 137 Iranian adults with celiac disease. We used a 23-point Likert questionnaire and exploratory factor analysis to identify and classify the barriers. Adherence to gluten-free diet was assessed by measuring the serum level of anti-tTG-IgA. The correlation between the barriers and adherence to gluten-free diet was assessed using logistic regression. A total of 117 subjects completed the study. Seven factors were extracted: "gluten-free diet restrictions," "self-awareness and social awareness," "psychological barriers," "education," "situational barriers and gatherings," "lack of access/labeling," and "cost." There was a significant correlation between the situational barriers and gatherings and nonadherence to the diet in the adjusted model (odds ratio = 1.63; 95% confidence interval [1.03, 2.54], p = .03). Nutritionists and physicians should consider these barriers when consulting patients with celiac disease.

Nutritional facts regarding commercially available gluten-free bread worldwide: Recent advances and future challenges

Recently, there has been an increase in demand for gluten-free (GF) products due to the growing number of gluten-intolerant and healthy individuals choosing to follow a gluten-free diet. Gluten-free bread (GFB) is a staple food product; therefore, many recent studies have reported the nutritional properties of GFB. However, an overview of the current ingredients and nutritional labeling of GFB worldwide has not yet been provided. This review aimed to gather the latest information regarding the most used ingredients in GFB formulations and the nutritional quality of these products from different countries, based on studies published in the last decade (2010-2020). Our analysis showed that GFB had a lower protein and a higher fat content than gluten-containing bread, and the dietary fiber content was highly variable between countries. Some studies have revealed a high glycaemic index in most products, which is associated with the extensive use of rice flour and starch as the main ingredients in GFB formulation. Label information presented significant differences from the data obtained through the chemical analysis of fiber and other nutritional components. Micronutrient fortification is not common in the GFB. The nutritional quality of commercial GFB is a crucial issue that needs to be addressed.

Comparison of the In Vitro Bioavailability of Selected Minerals from Gluten-Free Breads Enriched with Grains and Synthetic Organic and Non-Organic Compounds

Introduction: Despite the constant efforts of scientists to improve the texture, sensory properties, and nutritional value of gluten-free bread, obtaining high bioavailability of minerals is still a huge challenge. Gluten-free bakery products are characterized by a low bioavailability of minerals. The aim of this study was to design gluten-free bread with high bioavailability of minerals commonly found in deficiencies in people struggling with gluten intolerance. Material and methods: The material consisted of gluten-free breads designed to obtain the highest possible content of minerals in the bread while maintaining a good structure and taste. Results: Higher contents of all the analyzed minerals were obtained in breads with natural and synthetic additives, both in rice and buckwheat bread, compared to basic bread. There was also a higher content of the analyzed minerals in buckwheat bread in comparison to rice bread for each type of additive. Higher bioavailability of iron, copper, calcium, and magnesium was noted in rice bread, while the bioavailability of zinc was higher in buckwheat bread. Conclusion: The additives used increased the bioavailability of the analyzed minerals from the gluten-free breads. The use of various variants of flour (rice, buckwheat) influenced the bioavailability of iron, zinc, copper, calcium, and magnesium. The release of minerals from gluten-free bread depends on the element and added components (seeds or synthetic additives).

Teff Type-I Sourdough to Produce Gluten-Free Muffin

The increasing number of persons following a gluten-free (GF) diet and the need for healthy and natural products are forcing researchers and industries to provide gluten-free products with high nutritional value. Here, a biotechnological approach combining the use of teff flour and type-I sourdough has been proposed to produce GF muffins with nutritional benefits. Teff-sourdough was prepared and propagated following the traditional daily refreshment procedure until the biochemical stability was achieved. The sourdough, dominated by Lactiplantibacillus plantarum, Limosilactobacillus fermentum and Saccharomyces cerevisiae strains, was used to produce muffins at three different levels (up to 15%, wt/wt) of fortification, achieving several positive effects on the nutritional properties of the products. The use of teff flour led to high content of fiber (>3 g/100 g) and proteins (>6 g/100 g) in muffins achieving the nutritional requirements for the healthy claims "source of fiber" and "rich in protein". Thanks to their metabolic traits, sourdough lactic acid bacteria caused the increase of the total free amino acids (TFAA, up to 1000 mg/kg, final concentration) and phytic acid decrease (50% lower than control), which positively affect the nutritional properties of the products. Besides, high in vitro protein digestibility (IVPD, 79%) and low starch hydrolysis rate (HI, 52%) characterized the fortified muffins. Muffins also presented high in vitro antioxidant (56%) and mold-inhibitory activities, potentially contributing to an extended shelf-life of the products.

Prevalence of Adverse Reactions to Gluten and People Going on a Gluten-Free Diet: A Survey Study Conducted in Brazil

Background: The prevalence of gluten-related disorders (GRD) and adherence to a gluten-free diet (GFD) remains unknown in Brazilian population and there is no published information on the scientific literature about the proportion of Brazilians that were diagnosed with a gluten-related disorder. Thus, the aim of this work was to estimate the prevalence of GRDs and adherence to a GFD by self-report in adult Brazilian population. Materials and Methods: A questionnaire-based cross-sectional study was conducted in two Brazilian cities. Results: The response rate was 93.2% (1630/1749). The self-reported prevalence rates were (95% CI): adverse reactions to gluten 10.06% (8.64–11.62); gluten sensitivity 2.33% (1.65–3.18); physician-diagnosed celiac disease 0.3% (0.09–0.71); non-celiac gluten sensitivity 1.71% (1.14–2.47); wheat allergy 0.79% (0.42–1.36); adherence to gluten-free diet 7.48% (6.25–8.87); gluten avoiders 15.21% (13.5–17.05). Among those who were following a GFD (n = 122), 65.6% (n = 80) of them reported that they did not develop symptoms after wheat/gluten ingestion and 50% (n = 61) were following the diet without medical/dietitian advice. The main motivation for following a GFD in the self-reported and non-self-reported gluten sensitivity groups were the symptoms triggered after wheat/gluten ingestion (86.8%) and weight control (57.1%), respectively. Conclusions: Implementation of programs to increase awareness about GRDs among healthcare professionals and giving scientifically sound information to the general population about the risks and benefits for following a GFD are desirable actions in Brazil. The results also add to the growing body of evidence for highlighting the under-diagnosis of GRD and the trend for following a GFD in Latin America.

Yogurt as an Alternative Ingredient to Improve the Functional and Nutritional Properties of Gluten-Free Breads

Absence of gluten in bakery goods is a technological challenge, generating gluten-free breads with low functional and nutritional properties. However, these issues can be minimized using new protein sources, by the addition of nutritional added-value products. Fresh yogurt represents an interesting approach since it is a source of protein, polysaccharides, and minerals, with potential to mimic the gluten network, while improving the nutritional value of gluten-free products. In the present work, different levels of yogurt addition (5% up to 20% weight/weight) were incorporated into gluten-free bread formulations, and the impact on dough rheology properties and bread quality parameters were assessed. Linear correlations (R² > 0.9041) between steady shear (viscosity) and oscillatory (elastic modulus, at 1 Hz) values of the dough rheology with bread quality parameters (volume and firmness) were obtained. Results confirmed that the yogurt addition led to a significant improvement on bread quality properties, increasing the volume and crumb softness and lowering the staling rate, with a good nutritional contribution in terms of proteins and minerals, to improve the daily diet of celiac people.

Edible Brown Seaweed in Gluten-Free Pasta: Technological and Nutritional Evaluation

Seaweed is a novel source of important nutritional compounds with interesting biological activities that could be processed into added-value products, namely gluten-free foods. In this study, two previously developed products obtained from Laminaria ochroleuca processing (liquid extract and a purée-like mixture) were incorporated in gluten-free (GF) pasta in order to develop functional products especially designed for the celiac population. The raw and cooked pastas were characterized in terms of their cooking quality parameters, nutritional composition, texture and rheological properties, and antioxidant activity. It was found that the developed GF pastas had similar mechanical and texture characteristics to the control. Both supplemented GF pastas presented a significantly (p < 0.05) higher fibre and mineral content than the control pasta.

Rice malting optimization for the production of top-fermented gluten-free beer

BACKGROUND

A safe method to obtain gluten-free beer led to the use of naturally gluten-free grains, such as rice, but the specific malting program for rice is long and requires a large amount of water, and the resulting beer showed a flat flavour profile. In this study, an optimization of the malting and brewing procedure is proposed to overcome the aforementioned issues. Different steeping conditions and kilning temperatures are considered, and a top-fermented beverage from rice malt is obtained for the first time.

RESULTS

The malting procedure has been optimized by assessing the use of short-time steeping as an alternate to long air rest to obtain sufficient moisture content in the green malt, saving water consumption. The malt obtained allowed a regular fermentation, as confirmed by the sensorial analysis, which did not reveal any off-flavours. The use of a top-fermenting yeast formed high content of higher alcohol and relatively low amount of esters.

CONCLUSION

This study confirms the potential of rice for the production of malt and beer. The optimized malting programme allowed water saving. The production of a top-fermented rice malt beer was a successful attempt to introduce a new flavoured product for consumption by individuals affected by coeliac disease. © 2018 Society of Chemical Industry.

Role of Front-of-Package Gluten-Free Product Labeling in a Pair-Matched Study in Women with and without Celiac Disease on a Gluten-Free Diet

Gluten-free (GF) product labeling is one of the most important determinants of food product choices by patients with celiac disease, due to the need for following a GF diet. The aim of this study was to assess the role of front-of-package GF product labeling in pair-matched celiac and non-celiac women on a GF diet in a choice experiment (CE). In subgroups of celiac (n = 77) and non-celiac pair-matched respondents on a GF diet, but with no gluten-related diseases diagnosed (n = 77), the influence of front-of package labeling of GF bread on the choice of products was assessed. The labeling assessed in a CE included for all the products crossed grain logotype and additional logotypes of European Union (EU) organic production, “dairy-free” product, wheat starch-free product, quality and vegan product, as well as additional “gluten-free” written information. It was stated that the frequency of selection of products with “gluten-free” written information did not differ between subgroups of celiac and non-celiac respondents, as well as in subgroups stratified by age, body mass index (BMI), place of residence, and economic status. The frequency of selection of products with “vegan” logotype was higher for non-celiac respondents than for celiac ones (p = 0.0011). The frequency of selection of a product with additional logotypes was influenced by BMI and place of residence, but not by age and economic status of assessed women.

A Review on the Gluten-Free Diet: Technological and Nutritional Challenges

Consumers, food manufacturers and health professionals are uniquely influenced by the growing popularity of the gluten-free diet. Consumer expectations have urged the food industry to continuously adjust and improve the formulations and processing techniques used in gluten-free product manufacturing. Health experts have been interested in the nutritional adequacy of the diet, as well as its effectiveness in managing gluten-related disorders and other conditions. In this review, we aim to provide a clear picture of the current motivations behind the use of gluten-free diets, as well as the technological and nutritional challenges of the diet as a whole. Alternative starches and flours, hydrocolloids, and fiber sources were found to play a complex role in mimicking the functional and sensory effects of gluten in gluten-free products. However, the quality of gluten-free alternatives is often still inferior to the gluten-containing products. Furthermore, the gluten-free diet has demonstrated benefits in managing some gluten-related disorders, though nutritional imbalances have been reported. As there is limited evidence supporting the use of the gluten-free diet beyond its role in managing gluten-related disorders, consumers are urged to be mindful of the sensorial limitations and nutritional inadequacies of the diet despite ongoing strategies to improve them.

Tracking celiac disease-triggering peptides and whole wheat flour quality as function of germination kinetics

Germination is already a well-accepted process by consumers with many products made from sprouted seeds or containing limited amounts of flour form sprouted grains. The present work aimed assessing the usefulness of germination in reducing gluten peptides associated with celiac disease, at the same time evaluating some technological features of the obtained germinated wheat. In the first part of the work, celiac disease (CD)-triggering peptides were tracked as a function of germination kinetics (from day 1 to day 6). Using simulated gastrointestinal digestion and liquid chromatography coupled to mass spectrometry, ten celiac disease triggering peptides were identified: seven peptides presumably involved in the adaptive immune response (TI) and three peptides mainly involved in the innate immune response (TT). All the identified peptides belonged to gliadins. TI track pattern showed three phases: the first two days displayed a significant degradation, a stability phase was observed from day 3 to day 5, and finally a drastic reduction occurred on the 6th day. For TT peptides, important degradation was exclusively observed at the 6th day. In the second part, some techno-functional features of germinated whole wheat flour were assessed to estimate its potential as an alternative to conventional flour. Functionality comparison of the non-germinated versus germinated flours revealed that germination significantly influenced solvents retention capacities as well as swelling and solubility. Thus, with a reduced amount of celiac disease triggering peptides, but also with different technological behavior compared to traditional wheat flour.

In Vitro Bioavailability of Calcium, Magnesium, Iron, Zinc, and Copper from Gluten-Free Breads Supplemented with Natural Additives

The aim of this study was to measure the content of calcium, magnesium, iron, zinc, and copper and determine the bioavailability of these ingredients in gluten-free breads fortified with milk and selected seeds. Due to the increasing prevalence of celiac disease and mineral deficiencies, it has become necessary to produce food with higher nutritional values which maintains the appropriate product characteristics. This study was designed for gluten-free breads fortified with milk and seeds such as flax, poppy, sunflower seeds, pumpkin seeds or nuts, and flour with amaranth. Subsequently, digestion was performed in vitro and the potential bioavailability of the minerals was measured. In the case of calcium, magnesium, iron, and copper, higher bioavailability was observed in rice bread, and, in the case of copper and zinc, in buckwheat bread. This demonstrated a clear increase in bioavailability of all the minerals when the bread were enriched. However, satisfactory results are obtained only for the individual micronutrients.

Development of gluten-free bread formulations containing whole chia flour with acceptable sensory properties

Increasing the variety of better‐tasting and healthier gluten‐free products is important for consumers with gluten‐related disorders. This work aimed to develop a gluten‐free bread formulation containing whole chia flour with acceptable sensory properties. A mixture design for three ingredients and response surface methodology were used to identify the proportions of potato starch, rice flour and whole chia flour to achieve the best physical properties and result in sensory‐accepted products. The physical properties and visual appearance showed that whole chia flour alone is not suitable for bread production. Nevertheless, it is possible to add up to 14% whole chia flour to a rice flour‐based gluten‐free bread formulation while negligibly diminishing the loaf volume, crumb firmness and crumb moisture. The best formulations were prepared from rice flour blends with 5, 10, and 14% whole chia flour, which received overall acceptability scores of 8.7, 8.1 and 7.9 on a 10‐cm scale, respectively, similar to those of their white gluten‐free bread and wheat bread counterparts. Incorporating 5%–14% whole chia flour in the formulation increased the levels of ash, lipid, protein and dietary fiber compared to those of the white gluten‐free bread.

Are Treated Celiac Patients at Risk for Mycotoxins? An Italian Case-Study

Urinary biomarkers of mycotoxin exposure were evaluated in a group of celiac patients (n = 55) and in a control group of healthy subjects (n = 50) following their habitual diet. Deoxynivalenol (DON), zearalenone (ZEN), and fumonisin B1 (FB1) were monitored in 105 urinary samples collected from the two groups. Dietary habits were also recorded through compilation of a seven-day weighed dietary diary. Biomarkers of mycotoxin exposure were detected in 21 celiac patients and in 15 control subjects, corresponding to about 34% of total participants. In particular, ZEN was the most detected mycotoxin among all the studied subjects with a total of 19 positive cases. Results did not show a statistically significant difference in mycotoxin exposure between the two groups, and the presence of specific mycotoxins was not related to the intake of any particular food category. Our findings suggest little urgency of specific regulation for gluten free products, although the prevalence of exposure observed in free-living diets of both celiac and healthy subjects underlines the need of a constant surveillance on mycotoxins occurrence at large.

Preference mappings for gluten-free chocolate cookies

Purpose

The purpose of this paper was to replace totally the wheat flour for rice flour, whole soy flour and cassava starch in the formulation of chocolate cookies.

Design/methodology/approach

Chocolate cookies with wheat flour, rice flour, whole soy flour and cassava starch were produced, and compared to a commercial chocolate cookie regarding to physical properties and sensory acceptability.

Findings

The chocolate cookie made with rice flour instead of wheat flour was as liked as the cookie with wheat flour, and the greater acceptability scores received by the rice flour cookies correlated with less colour intensity and a lower specific volume thereof. The cookie with cassava starch stood out because of the intensities of its parameters, its more intense colour, and its acceptability scores among the consumers. The cookie with whole soy flour had lower sensory acceptability scores, and the commercial cookie stood out for its high cutting force (instrumental texture).

Originality/value

Celiac consumers desire products with adequate sensory characteristics. This study presents a new gluten-free product, the chocolate cookie made with rice flour, that has the potential to be produced, as this product is as accepted as a cookie made with wheat flour, and even more accepted than a commercial one also made with wheat flour. Therefore, this study offers subsidies for improving the diet of celiac consumers.

Approaches to reduce the glycemic response of gluten-free products: in vivo and in vitro studies

This article aims to discuss the current approaches used to reduce the postprandial glycemic response (GR) of starchy gluten-free products (GFP) and to provide some further prospects.

The Gluten-Free Diet in the 3rd Millennium: Rules, Risks and Opportunities

The gluten-free diet has long been considered the standard treatment for celiac disease. However, a significant number of patients continue to experience persistent symptoms despite following a gluten-free diet. Inadvertent gluten ingestion, fermentable carbohydrates, cross-contamination, and social or financial burdens present obstacles to maintaining a gluten-free diet. Proper diet education and follow-up by an expert Registered Dietitian (RD) is essential to ensure adequate nutrition on the gluten-free diet. Patients may experience unintended weight gain or elevated cholesterol levels after initiating the gluten-free diet due to adequate absorption and healing of the intestines. This review deals with the evolving gluten-free diet, optimal recommendations while considering the overall health of patients, and multi-factorial aspects of the permanent lifestyle change.