A Holistic Approach to the Gluten-Free Diet Trend

gluten-free diet trend

1.Celiac Disease

Celiac disease, which can appear at any stage in the life of genetically predisposed individuals, is a chronic enteropathy that occurs with oral intake of gluten or other prolamins (Gluten-free nutrition guide). The possible presence of gluten in people with this sensitivity causes destruction on the intestinal surface by deforming the villi, which are hairy formations in the small intestine and which enable them to participate in the circulatory system by assuming the absorption of nutrients. In addition to this damage, factors such as the loss of the barrier (permeable) function of the intestine, the development of an inappropriate immune response and the formation of an unbalanced gut microbiome; It triggers malabsorption symptoms by reducing intestinal absorption surface and insufficiency of digestive enzymes [1]. (You can find the diagnosis, treatment and monitoring guide prepared by the Ministry of Health for Family Physicians here)

Figure 1. Healthy appearance of villi (left) and impaired structure in celiac patients (right) [2]

The most obvious treatment for celiac disease is a gluten-free diet, and it is essential that patients adhere to this diet for life. However, there are difficulties in the implementation of a gluten-free diet due to difficulties in obtaining gluten-free products, risks of cross-contamination and being relatively expensive.

1.2. Non Celiac Gluten Free Diet (Gluten Free Diet-GFD)

A gluten-free diet is a diet plan followed by an increasing number of consumers worldwide, without a known disease or presence of allergies, for reasons such as weight loss or motivation to eat right. The main trigger of this situation is the discourse of many conscious or unconscious speakers that this diet is healthy and the media attention on the subject. Compared to gluten-free equivalent products, the energy, saturated fat and trans fatty acid content of processed foods that have been removed from gluten, sugar, fat, etc. It is known to be higher due to the use of substitutes[3].

In a study conducted by Ülger, Altunoğlu and Çakır (2020), in which the majority of the participants were women, the attitudes of adult individuals who were not diagnosed with celiac, gluten sensitivity and wheat allergy towards the gluten-free diet were examined. Participants on a gluten-free diet; They stated that they applied it for reasons such as creating a good feeling, the thought of being healthy, and weight loss. In addition, the participants emphasized that they strongly agreed that the gluten-free diet would be effective in strengthening the immune system, increasing exercise performance, and improving the quality of life, and that they experienced a decrease in gastrointestinal system problems with the gluten-free diet application. In addition, some of the participants also stated that they may experience deficiencies in micronutrients such as vitamins A, E, D, iron and zinc, especially in group B vitamins, with gluten-free diet practices.

1.2.1. Nutritional Deficiencies

Summarizing research on gluten-free nutritional profiles compared to gluten-free food products, GFDs are deficient in fiber, protein, folate, iron, potassium, and zinc; It has been determined that it has higher quantities in terms of fat, carbohydrate, sugar and sodium. The fact that most GFD products are not fortified with vitamins and minerals exacerbates the deficiencies. For example, substitution of gluten-containing prolamins with rice and corn may put the individual at higher glycemic index risk group with protein, fiber and folate deficiencies.

1.2.2. Toxicity

There are two main sources for toxic or potentially harmful compounds when following a gluten-free diet plan. The first is the presence of enzymes such as microbial transglutaminase or proteases, which are used as food additives in gluten-free foods and impair food quality. Another is due to the combined consumption of fish and rice with high levels of heavy metals such as lead, cadmium, mercury and arsenic.

In a recent study, people who followed a gluten-free diet, including celiac patients, had increased levels of arsenic, mercury, lead and cadmium according to their urine and blood results compared to people who consumed gluten. These results link the accumulation of toxic heavy metals with a gluten-restrictive diet rather than with celiac disease, since most consumers who currently adopt a gluten-free diet are non-celiacs [4].

1.2.3. Gluten-Free Diet and Mental Health

Various studies point to the nervous system as the main site of gluten damage. It has been reported in the literature that gluten can cause neurological damage through a combination of cross-reacting antibodies, immune complex disease, and direct toxicity. Anxiety, depression, attention deficit hyperactivity, mood and sleep disorders, poor social adjustment etc. Health schooners are disorders that occur in both sexes of different age groups and are considered by some to be extra-intestinal manifestations of celiac disease. Adapting to a gluten-free diet is often stressful and difficult to accept.
It is a challenging path associated with major changes in daily lifestyle routine, activities and eating habits, and it is thought that dietary change, including gluten-free diet, may be associated with pathological eating practices [5].


Prolamin: Storage proteins found in seeds, containing a high amount of the amino acid called proline and having an important role in the germination of seeds.
Malabsorption: Absorption disorder.
Microbiome: The entire genetic material of the microbiota.
Protease: A group of enzymes responsible for the breakdown of proteins.

Transglutaminase: It is an enzyme that can change the protein structure in foods. It provides the formation of high molecular weight polymers by forming intramolecular and intermolecular covalent cross-links between glutamine and lysine in the structure of proteins.
[1] Yıldırım, E. (2020). Celiac disease and gluten-free diet. Journal of General Health Sciences, 2(3), 175-187.
[2] Koh, J.E.W., Hagiwara, Y., Oh, S.H., Tan, J.H., Ciaccio, E., Green, P., Lewis, S., Acharya, U.R. (2018). Automated Diagnosis of Celiac Disease Using DWT and Nonlinear Features with Video Capsule Endoscopy Images. Future Generation Computer Systems, 90(1).
[3] Ulger, T.G., Altun, C., Çakıroğlu, F.P. (2020). Gluten-Free Diet Applications for Different Diseases Apart from Known Therapeutic Efficacy. Ankara Journal of Health Sciences (ASBD), 9(2), 112-123.
[4] Patel, N.K., Lacy, B.E. (2018). Another reason to avoid the gluten-free fad? Clin Gastroenterol Hepatol, 16: 184-5.
[5] Lerner, A., O’Bryan, T., Matthias, T. (2019) Navigating the Gluten-Free Boom: The Dark Side of Gluten Free Diet. front. Pediatr, 7: 414.

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