Gluten-free products in celiac disease: Nutritional and technological challenges and solutions

Gluten Unraveled: Latest Insights on Terminology, Diagnosis, Pathophysiology, Dietary Strategies, and Intestinal Microbiota Modulations-A Decade in Review

A decade of research on gluten-related disorders (GRDs) is reviewed in this study, with a particular emphasis on celiac disease (CD) and non-celiac gluten sensitivity (NCGS). GRDs are triggered by the ingestion of gluten and gluten-like proteins found in wheat, barley, and rye. These proteins lead to intestinal damage in celiac disease, an autoimmune condition characterized by villous atrophy and a variety of gastrointestinal and extraintestinal symptoms. More enigmatic and less understood, NCGS involves symptoms similar to CD but without the immunological reaction or intestinal damage. Recent years have seen advances in the understanding of GRDs, particularly in connection to how intestinal microbiota influences disease progression and patient outcomes. The gluten-free diet (GFD) is still the standard therapy recommended for GRDs despite significant challenges, as discussed in this article. Precise diagnostic methods, patient education and dietary counseling are critical for improving patients' quality of life. The purpose of this review is to provide a more clear and up-to-date understanding of GRDs, and to help further research on this important topic.

Adherence to the Gluten-Free Diet Role as a Mediating and Moderating of the Relationship between Food Insecurity and Health-Related Quality of Life in Adults with Celiac Disease: Cross-Sectional Study

This cross-sectional study aimed to estimate the relationship between food insecurity (FI) and health-related quality of life (HRQoL) in patients with celiac disease (CD) and assess whether this relationship is mediated or moderated by adherence to the gluten-free diet (GFD). The results of 1162 samples of patients diagnosed with CD showed that 8.3% of individuals who have a combined score of less than 13 exhibited excellent or very good adherence to the GFD. Furthermore, moderate and fair to poor adherence to the GFD was demonstrated, respectively and 71.9% of the patients had poor HRQoL levels. A significant and moderate positive correlation between FI and GFD adherence (r = 0.489) was found, indicating that 24% of the variance in FI is shared with GFD adherence. The patients' gender, marital status, and monthly income made statistically significant contributions to the prediction (p < 0.05). Females had significantly lower HRQoL scores than males (B = -4.619, 95% CL: -6.08, -3.16) after holding all other variables constant. In conclusion, FI is mediated by GFD adherence to HRQoL. Moreover, a significant total effect relation was found between HRQoL and both FI and GFD adherence, suggesting that lowering symptoms and complications associated with CD may reduce the impact of FI on HRQoL.

Risk of Gluten Cross-Contamination Due to Food Handling Practices: A Mini-Review

Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals, affecting 1.4% of the world population. CD induces an inflammatory reaction that compromises small intestine villi, leading to nutrient malabsorption, and gastro and extraintestinal manifestations. Although other treatment approaches are being studied, adherence to a gluten-free diet (GFD) is the only effective intervention to date. Despite this, about 50% of patients experience persistent inflammation, often associated with unintentional gluten ingestion through contaminated food. There are regulations for labeling gluten-free foods which specify a limit of 20 mg/kg (20 ppm). The risks of gluten cross-contamination above that level are present throughout the whole food production chain, emphasizing the need for caution. This review explores studies that tested different procedures regarding the shared production of gluten-containing and gluten-free food, including the use of shared equipment and utensils. A literature review covering PubMed, Scielo, Web of Science, VHL and Scopus identified five relevant studies. The results indicate that shared environments and equipment may not significantly increase gluten cross-contamination if appropriate protocols are followed. Simultaneous cooking of gluten-containing and gluten-free pizzas in shared ovens has demonstrated a low risk of contamination. In general, shared kitchen utensils and equipment (spoon, ladle, colander, knife, fryer, toaster) in controlled experiments did not lead to significant contamination of samples. On the other hand, cooking gluten-free and gluten-containing pasta in shared water resulted in gluten levels above the established limit of 20 ppm. However, rinsing the pasta under running water for a few seconds was enough to reduce the gluten content of the samples to less than 20 ppm.

Gluten-Free Diet and Other Celiac Disease Therapies: Current Understanding and Emerging Strategies

A lifelong gluten-free diet (GFD) is the only treatment for celiac disease and other gluten-related disorders. Nevertheless, strict adherence to the GFD is often challenging due to concerns about social isolation, risk of gluten contaminations, high cost, poor quality and the taste of gluten-free products. Moreover, although the GFD is effective in achieving mucosal healing, it may lead to dietary imbalances due to nutrient deficiencies over a long period of time. To overcome these issues, several gluten-free wheat flours have been developed to create products that closely resemble their gluten-containing counterparts. Furthermore, given the critical importance of adhering to the GFD, it becomes essential to promote adherence and monitor possible voluntary or involuntary transgressions. Various methods, including clinical assessment, questionnaires, serology for celiac disease, duodenal biopsies and the detection of Gluten Immunogenic Peptides (GIPs) are employed for this purpose, but none are considered entirely satisfactory. Since adherence to the GFD poses challenges, alternative therapies should be implemented in the coming years to improve treatment efficacy and the quality of life of patients with celiac disease. The aim of this narrative review is to explore current knowledge of the GFD and investigate its future perspectives, focusing on technology advancements, follow-up strategies and insights into a rapidly changing future.

Exploring Scientific Validation of Millets in Contemporary Healthcare: A Traditional Food Supplement

Millets, small-seeded grasses, are gaining interest for their nutrition and health benefits. This abstract provides a comprehensive overview of millets' pharmacological activities, highlighting their rich bioactive compounds. These compounds, including phenolic compounds, flavonoids, and dietary fibers, contribute to antioxidant effects, safeguarding against chronic diseases. Millets also possess anti-inflammatory properties, potentially alleviating conditions, like arthritis and asthma. They show anti-carcinogenic potential, possibly preventing various cancers' development through mechanisms, like apoptosis induction and inhibiting tumor growth. Moreover, millets offer hypolipidemic and hypoglycemic effects, beneficial for managing conditions, such as dyslipidemia and diabetes. Their high dietary fiber and resistant starch content regulate blood lipids and glucose, reducing the cardiovascular risk. Additionally, millets act as antimicrobials, inhibiting pathogens and serving as natural alternatives to synthetic antimicrobials. They exhibit immunomodulatory effects, enhancing immune function and response. Overall, millets' pharmacological properties, including antioxidant, antiinflammatory, anti-carcinogenic, hypolipidemic, hypoglycemic, antimicrobial, and immunomodulatory traits, position them as functional foods with varied health benefits. Further research can integrate millets into preventive and therapeutic approaches for diverse diseases.

Impact of Nutritional Profile on Gut Microbiota Diversity in Patients with Celiac Disease

The pathogenesis of celiac disease (CD) is significantly influenced by gut microbiota. Daily nutritional profile influences the diversity of gut microbiota. This study was aimed to compare the abundance of gut microbiota in CD patients compared to normal control (NC), and to investigate the impact of nutritional factors on their fecal microbiota diversity. In this study, a selected panel of intestinal bacteria was assessed in 31 confirmed CD patients adhering to gluten-free diet (GFD) for more than 6 months and in 20 NC subjects. Stool samples were collected from each participant, DNA was extracted, and absolute quantitative real-time PCR (qPCR) was carried out. The gut microbiota including Bacteroidetes, Bifidobacterium, Clostridium, Staphylococcus, Enterobacteiaceae, Firmicutes, and Lactobacillus were assessed. The quantities of fruits, vegetables, meat, liquids, sugar and gluten-free candy/bread consumption were evaluated using a questionnaire. The proportion of Bifidobacterium, Firmicutes, and Lactobacillus in CD cases was significantly lower than NC (P < 0.005). Significant correlation coefficients between Bifidobacterium and Lactobacillus (P < 0.001), and also Firmicutes and Lactobacillus (P < 0.001) were recorded. Moreover, a significant association between medium amount of meat and bean consumptions and low abundance of Lactobacillus and Firmicutes (P = 0.024 and P = 0.027, respectively), and also high amount of bean consumptions and low abundance of Lactobacillus (P = 0.027) in CD were observed. The results showed that meat and bean consumptions could reduce the beneficial bacteria including Firmicutes and Lactobacillus in CD patients. Therefore, changes in the gut microbiota abundance may contribute to dietary changes and unimproved CD symptoms.

Physicochemical, Organoleptic Evaluation and Shelf Life Extension of Quinoa Flour-Coated Chicken Nuggets

The objective of the current study was to develop innovative quinoa-coated chicken nuggets by using quinoa flour instead of wheat flour and evaluate the impact of this substitution on the shelf life of the product and its nutritional and sensorial stability. The evaluation of the product has been done through physiochemical and microbiological analysis every three days of the storage period compared with negative control (NC) and positive control (BHT) through 24 days of cold storage (4 ± 1°C). During storage, the quinoa flour-coated chicken nuggets showed the best ability for delay of lipid oxidation with a lowest TBARS value of 1.07 mg MDA/kg compared to negative control (NC) (2.39 mg MDA/kg) and positive control (BHT) (2.00 mg MDA/kg). The same trend was observed in protein oxidation, where the quinoa flour was able to retard the protein oxidation better than negative and positive control (BHT) where it showed a carbonyl content of 6.44, 5.39, and 4.20 nmol carbonyl content/mg protein, respectively. The quinoa-coated chicken nuggets showed the lowest microbial load (5.8 × 103 cfu/g) compared to negative and positive controls (1.8 × 105 and 3.8 × 104 cfu/g) at 24 days of cold storage. These findings could be emphasized such that the utilization of quinoa flour in the coating of chicken nuggets is more effective in retarding lipid and protein oxidation, furthermore preventing microbial contamination during cold storage. All these findings might be playing a crucial role in the extending of the shelf life of the product in addition to giving the product a pleasant taste and flavor to consumers.

Acute Effect of Riceberry Waffle Intake on Postprandial Glycemic Response in Healthy Subjects

Gluten-free products have been developed due to increasing consumer demand. The improvement of the sensory quality and nutritional value of these products may support functional food development and provide health benefits. The purpose of this study was to develop a gluten-free waffle formulation with Riceberry rice flour by replacing the sucrose with maltitol and palm sugar powder. Evaluations of the sensory acceptability of these products and the blood glucose levels of healthy volunteers after consuming Riceberry and wheat flour waffles were carried out. The glycemic responses of the volunteers to the Riceberry and wheat flour waffles at 0, 15, 30, 45, 60, 90, 120, 150, and 180 min were monitored. In addition, the glycemic index of the products was calculated. The finding revealed that replacing sugar with 50% (w/w of total sugar) palm sugar powder and 50% maltitol was the most acceptable formulation that received the highest acceptability scores in terms of overall acceptability and texture. The blood glucose levels of both Riceberry waffle and wheat flour were not significantly different. The glycemic index of Riceberry waffle and wheat flour waffle were 94.73 ± 7.60 and 91.96 ± 6.93, respectively. Therefore, Riceberry waffle could be used as an alternative gluten-free product for celiac patients, but not for diabetic patients.

Optimization and Development of Ready to Eat Chocolate Coated Roasted Flaked Rice as Instant Breakfast Food

The present study aimed to optimize and develop ready-to-eat rice-based functional breakfast food using response surface methodology. The levels of ingredients viz. skim milk powder, guar gum, and ferrous sulfate were pre-optimized and remained constant, whereas jaggery and dark chocolate were taken as independent variables. The optimum levels of jaggery and dark chocolate for chocolate-coated roasted flaked rice (CCRFR) were 8.49 g and 25.43 g, respectively. The physical, pasting, textural, functional, morphological, optical, and sensory characteristics of CCRFR and uncoated roasted flaked rice (RFR) were also studied. CCRFR had significantly higher mineral (iron and calcium) and total polyphenolic contents. Furthermore, the dimensional, sensory, and functional properties were also improved. The changes in morphological structure were also observed between the CCRFR and uncoated product using scanning electron microscopy. The coating adds nutritional value to the roasted rice and renders it an essential functional RTE convenience gluten-free cereal breakfast item.

Nutritional and Functional Properties of Gluten-Free Flours

This study characterized and compared 13 gluten-free (GF) flours (rice, brown rice, maize, oat, millet, teff, amaranth, buckwheat, quinoa, chickpea, gram, tiger nut, and plantain) for their nutritional and functional properties. For all GF flours investigated, starch was the major component, except for gram, chickpea, and tiger nut flours with lower starch content (<45%), but higher fiber content (8.8–35.4%). The higher amount of calcium, magnesium, zinc, potassium, phosphorus, similar values for iron and lower content of sodium in gram, makes this flour a good alternative to chickpea or other GF flour to develop healthier food products. Amaranth flour had a high protein digestibility, while tiger nut and millet flours were less digestible. Gram, chickpea, quinoa, buckwheat, and oat flours fulfilled amino acids recommendation for daily adult intake showing no limiting amino acid. Total polyphenolic content and antioxidant capacity showed higher values for buckwheat, followed by quinoa and maize flours. Gram, chickpea, maize, and quinoa flours are good candidates to improve health conditions due to lower saturated fatty acid content. The findings of this study provide useful insights into GF flours and may contribute to the development of novel gluten-free products like bread, cookies, or pasta.

Molecular detection of Tropheryma whipplei, Cryptosporidium spp., and Giardia lamblia among celiac disease samples

BACKGROUND

Celiac disease (CD) is one of the most common disorders, resulting from both environmental (gluten) and genetic factors. The clinical features of the Iranian CD are still unknown and there is insufficient information about the atypical presentation of CD from Iran. As, many previous reports revealed an association between controlled protozoal infections and the CD according to cytokines production, the aim of this study was to determine the prevalence of CD and possible co-infection with the most prevalent protozoal infections including Tropheryma whipplei, Cryptosporidium, and Giardia duodenalis among CD samples.

MATERIALS AND METHODS

In this study, from April 2014 to November 2016, 524 samples were obtained from small intestine of patients with gastrointestinal diseases referring to the Pathology Department of Namazi Hospital, Shiraz, Iran. Multiplex polymerase chain reaction assay was then performed on the histological positive CD samples for the prevalence of the microorganisms.

RESULTS

Sixty-four (12.21%) patients were diagnosed as having CD by histopathological examination. The prevalence of T. whipplei and Cryptosporidium spp. was 19 (29.69%) and 8 (12.5%) respectively, among CD positive samples there was no positive sample for Giardia lamblia.

CONCLUSION

The prevalence of CD among the southwestern Iranian population was high and comparable with other areas of Iran as well as many other countries. Furthermore, no significant association between the presence of T. whipplei, Cryptosporidium spp., and level of the histopathological changes of villi in the CD was observed (P > 0.05).

A Comparative Study of the Bioavailability of Fe, Cu and Zn from Gluten-Free Breads Enriched with Natural and Synthetic Additives

The aim of this study was to compare the bioavailability of iron, copper and zinc from newly designed gluten-free breads enriched with natural and synthetic additives. The study was conducted on rats with induced Fe, Cu and Zn deficiency. The nutritional intervention with diets supplemented with a 70% addition of gluten-free breads enriched with natural additives and organic compounds to the control diet AIN-93M lasted 40 days. After the intervention, the rats were euthanized, the organs were collected and their mineral content was measured. Chemical analysis of diets with the addition of fortified gluten-free breads showed significantly higher amounts of iron, zinc and copper in diets with the addition of fortified breads compared to diets with the addition of unenriched breads. The type of additives did not influence the amount of minerals in diets. It is necessary to conduct further research to explain the interactions of ingredients and the factors affecting the bioavailability of Fe, Cu and Zn from gluten-free breads in order to obtain a product with a high bioavailability of these ingredients.

Total and resistant starch from foodstuff for animal and human consumption in Costa Rica

Starchy ingredients are a key source of carbohydrates and have an essential role in a healthy diet. Starch amount in foodstuffs is paramount as it allows diet professionals to base their formulations on scientific data. Herein, the total (TS) and resistant starch (RS) content, in a selection of typical starchy foods available on the Costa Rican market, for both human and animal consumption, is reported. The major types of starch, including physically encapsulated starch, were determined using in vitro methods AOAC OMASM methods 996.11, 2014.10, 996.11, 2002.02 and AACC 76-13.01 and 32-40.01. Samples were collected during 5 years as part of national surveillance plans. For feedstuffs, n = 252 feed ingredients (e.g., cornmeal and wheat products), n = 103 feeds (e.g., dairy and beef cattle), and n = 150 feed ingredient samples (selected based on their usage in feed formulations) were assessed for RS. In food commodities, sample numbers ascended to n = 287 and n = 371 for TS and RS, respectively (e.g. bananas). Feed ingredients with higher TS values were cassava meal, bakery by-products, rice/broken, sweet potato, and cornmeal (93.37, 81.67, 72.33, 66.66, and 61.43 g/100 g, respectively). TS for beef and dairy cattle, pig, and calf feeds, ranged from 30.26 to 34.46 g/100 g. Plantain/green banana flour, as a feed ingredient, exhibited RS absolute and relative contributions of 37.04 g/100 g and 53.89%, respectively. Products with a higher TS content included banana flour, green plantain flour, japonica rice, and cassava flour (62.87, 63.10, 72.90, 83.37 g/100 g). The primary RS sources in the Costa Rican diet are, in absolute terms, green plantain and malanga (50.41 and 56.59 g/100 g). Depending on a person's food habits, these sources may contribute in the range of 20-30 grams of RS per day. TS and RS intake may vary considerably among ingredients, and the contribution of RS may be of nutritional importance for specific individuals.

Gluten-Free Casein-Free Diet for Autism Spectrum Disorders: Can It Be Effective in Solving Behavioural and Gastrointestinal Problems?

Autism spectrum disorder [ASD] is characterized by deficits in communication and social interactions combined with repetitive and restricted patterns of behaviors. Bidirectional changes in brain-gut microbiota are known to be responsible for the pathophysiology of many brain-related disorders, such as autism, as well as well-known gastrointestinal diseases, including gut disorders. Imbalance in the composition of gut microbiota is frequently observed in individuals with ASD. It is therefore believed that this imbalance is significant in the frequent occurrence of gastrointestinal symptoms. The integrity of the intestinal barrier and the blood-brain barrier [BBB] in individuals with ASD is affected. Incompletely digested peptides, toxins, and proinflammatory cytokines cross the BBB by entering the bloodstream and reach the central nervous system. As a result of the accumulation of these elements, brain function is adversely affected. It is hypothesized that incompletely digested peptides acting as opioid agonists reduce pain sensitivity and increase the severity of autism-specific behaviors. However, it is not known exactly how opioid peptides trigger ASD symptoms after they reach the brain. Diet therapies, especially elimination diets, are considered to be an alternative treatment to prevent this condition. Gluten-free casein-free [GFCF] diet is an elimination diet that involves the removal of certain proteins from the normal diet, such as gluten and casein. However, studies that demonstrate the beneficial effects of the GFCF diet on ASD patients and explain its mechanism is limited, which supports the opioid theory. This review aims to investigate the gastrointestinal and behavioral problems that are frequently observed in ASD, the possible action mechanisms of GFCF diets, and the efficacy of these elimination diets.

Gluten Vehicle and Placebo for Non-Celiac Gluten Sensitivity Assessment

Non-celiac gluten sensitivity (NCGS) is a syndrome characterized by gastrointestinal and extraintestinal manifestations triggered after gluten ingestion in the absence of celiac disease and wheat allergy. Because of the lack of biomarkers for NCGS diagnosis, the cornerstone for its assessment is a single- or double-blind placebo-controlled (DBPC) gluten challenge. However, there are some non-standardized points in the diagnostic approach proposed by the experts. This complicate comparisons among the results published by different research groups. The gluten vehicle and placebo must be indistinguishable from each other, which entails sensory and technological evaluations of the designed gluten vehicle and placebo products. At the moment, there is no standardized method for the preparation of the gluten vehicle and placebo for carrying out DBPC gluten challenges for NCGS assessment. This review focuses on the challenges that researchers have to face, either for the development of an accepted gluten vehicle and placebo or for identifying NCGS cases on the basis of DBPC gluten challenges.

Navigating the Gluten-Free Boom: The Dark Side of Gluten Free Diet

In gluten dependent conditions the gluten free diet is the cornerstone of therapy, decreasing disease activity, improving health and quality of life and treating or preventing the associated complications. Gluten withdrawal implies strict and lifelong elimination not only of wheat, barley, rye, and wheat-contaminated oats, but also of numerous non-nutritional products where components of wheat are often added. Due to multiple reasons the diet is difficult to follow and the long-term adherence is decreased with time. The present review summarizes the dark side of gluten restriction where nutritional deficiencies, toxicity, morbidity, mortality, and mental health problems are reported. The aim being to increase awareness, avoid, detect and treat the side effects and to promote a healthier nutrition, for the patient's benefits.