The gluten-free label alone is not enough!

Stating that celiac disease and gluten sensitivity are not the same thing, Nutrition Specialist Dr. Hatice Çolak Çetinkaya said that celiac screening should definitely be done before starting a gluten-free diet. Çetinkaya pointed out that label information alone might not provide sufficient assurance for gluten-free products, and recommended certified products to be preferred, especially against the risk of cross-contamination, and that ingredient lists should be regularly checked. Çetinkaya said, "More than 50 percent of newly diagnosed children experience intestinal healing within the first year. In some children, healing can start from the third month. Therefore, early implementation of a gluten-free diet is extremely important." 

Res. Asst. Dr. Hatice Çolak Çetinkaya from Üsküdar University Faculty of Health Sciences, Department of Nutrition and Dietetics, made important evaluations regarding celiac disease, gluten sensitivity, and the intricacies of a gluten-free diet.

Celiac disease and gluten sensitivity are not the same thing

Stating that celiac disease is a chronic autoimmune small intestinal disease that develops against gluten protein, Dr. Hatice Çolak Çetinkaya said, "In celiac patients, after gluten consumption, the immune system damages the absorptive surfaces of the small intestine, and nutrient malabsorption disorders can develop. The disease can manifest with very different symptoms such as diarrhea, abdominal pain, bloating, weight loss, iron deficiency anemia, osteoporosis, and fatigue. Serological tests and, if necessary, small intestinal biopsy are used for diagnosis. The only treatment for celiac disease today is the complete removal of gluten from the diet." 

Çetinkaya stated that non-celiac gluten sensitivity is a different picture, saying, "Non-celiac gluten sensitivity is a condition where symptoms such as bloating, abdominal pain, gas, fatigue, or headache appear after gluten consumption, but without the autoimmune response and small intestinal damage seen in celiac disease.

In gluten sensitivity, celiac antibodies are usually detected as negative, and villous atrophy is not observed in intestinal biopsy. Therefore, the main difference between celiac disease and gluten sensitivity is that in celiac disease, the immune system creates an autoimmune process that damages the intestinal tissue, while in gluten sensitivity, despite similar symptoms, there is no permanent intestinal damage."

Get tested before starting a gluten-free diet!

Çetinkaya pointed out that the symptoms are very similar to each other, saying, "Clinicians cannot distinguish between the two conditions merely by looking at the symptoms. Therefore, celiac screening must be done before starting a gluten-free diet, because celiac tests do not give reliable results after the diet has begun."
Beware of hidden sources of gluten!

Çetinkaya stated that gluten is not found only in products like bread and pasta, and continued:
"Gluten is a group of proteins primarily found in wheat, barley, and rye, and is present in many foods produced from these grains. Bread, pasta, bulgur, noodles, cakes, pastries, cookies, bagels, pizza dough, and processed foods containing flour are the most common sources of gluten. Additionally, products containing malt and malt extract, beer, and some breakfast cereals can also contain gluten. Naturally gluten-free foods include rice, corn, potatoes, buckwheat, quinoa, legumes, vegetables, fruits, eggs, meat, and dairy products. Although oats are naturally gluten-free, certified gluten-free products should be preferred due to the risk of cross-contamination during production. Among the most frequently overlooked sources of gluten are soy sauce, malt vinegar, sujuk, salami, instant soups, and bouillon cubes. Furthermore, some medicines, supplements, cosmetic products, and shared fryer oils used in restaurants can also pose a risk of cross-contamination." 

The "gluten-free" label may not always provide sufficient assurance

Noting that according to international standards, gluten-free products are allowed to contain gluten within certain limits, Dr. Hatice Çolak Çetinkaya said that consumers should be aware.

Çetinkaya said, "According to European Union, FDA, and Codex Alimentarius standards, 'gluten-free' products must contain 20 ppm or less gluten. This limit is considered safe for the vast majority of celiac patients. However, studies show that higher than expected gluten levels can be found in both naturally gluten-free products and some products labeled 'gluten-free' due to cross-contamination."

Therefore, emphasizing that label information alone is not enough, Çetinkaya stated, "It is recommended to prefer third-party certified products, regularly check ingredient lists, and pay particular attention to the risk of cross-contamination, especially when eating out."

The most common mistake in a gluten-free diet is turning to ready-made products

Çetinkaya stated that vitamin and mineral deficiencies are frequently observed in individuals on a gluten-free diet, and warned against excessive consumption of processed gluten-free products.

Çetinkaya, stating that "The gluten-free diet is known to be nutritionally inadequate and frequently associated with vitamin and mineral deficiencies," made the following assessment:

"Especially when gluten-free ready-made products are consumed, excessive sugar and fat intake can also be prepared. In a healthy diet, fresh, natural, and as unprocessed foods as possible are recommended to be prioritized. Sources such as buckwheat, quinoa, brown rice, and legumes should be consumed regularly; iron, calcium, magnesium, vitamin D, vitamin E, folate, and some B group vitamins should be regularly monitored. Additionally, after switching to a gluten-free diet, some individuals may tend to consume excessive amounts of meat and animal protein. To ensure a balanced diet, it is recommended to add pulses, oilseeds, and other plant-based protein sources to diversify the diet."

Natural foods should be prioritized for breakfast

Çetinkaya said that breakfast can be prepared much more diversely for individuals on a gluten-free diet than generally thought, "A classic Turkish breakfast consisting of eggs, cheese, olives, tomatoes, cucumbers, and greens is a naturally gluten-free option; however, if bread is preferred, certified gluten-free bread should be used. Certified gluten-free oats can be prepared with milk or yogurt and turned into a nutritious breakfast by adding fruit, cinnamon, walnuts, or chia seeds. Omelet and menemen varieties are also safe and satisfying options. Vegetable omelets can be enriched with mushrooms, peppers, spinach, or cheese. In addition, buckwheat crisps or gluten-free crackers can be preferred alongside boiled eggs. Fruit bowls prepared with yogurt are also among easily implementable breakfasts. Fresh fruit, hazelnuts, almonds, walnuts, and gluten-free granola can be added to yogurt. For those who want to prepare smoothies, mixtures made with banana, milk or kefir, peanut butter, and cocoa offer a quick option. Coconut milk can be an alternative for diversification. Also, pancakes made using buckwheat flour, rice flour, or almond flour can be consumed with honey, fruit, or cheese. Instead of relying solely on packaged gluten-free products for breakfast, creating variety based on eggs, dairy products, vegetables, fruits, and natural grains provides a more balanced approach."

Instead of using a single flour in gluten-free recipes, mixtures should be preferred

Stating that gluten-free flours have different nutritional values and baking properties, Çetinkaya said, "Studies have indicated that chickpea and pea flours have high fiber content; while buckwheat, quinoa, and oat flours are quality protein sources providing essential amino acids. Buckwheat flour is rich in B vitamins, minerals, and antioxidants. It is especially used in crepe, flatbread, and quick bread recipes. Chickpea flour is preferred in tortilla, meatball, and savory recipes due to its high protein and fiber content; almond flour stands out in cookie and cake recipes with its low glycemic index. Rice flour is frequently used as a base flour in gluten-free recipes due to its light and neutral taste, while quinoa flour draws attention as a complete protein source. Coconut flour, on the other hand, has a very high fiber content and requires more liquid in recipes due to its strong water-absorbing property. Since gluten provides elasticity and structure to dough, binding agents are needed in gluten-free recipes. Xanthan gum, psyllium husk, and eggs are most frequently used for this purpose. Additionally, using 2-3 different gluten-free flours together instead of a single flour provides more successful results in terms of texture and taste."

Presentation is important for adherence to a gluten-free diet in children

Stating that a gluten-free diet plays a critical role in improving intestinal health in children with celiac disease, Çetinkaya said that taste and presentation are of great importance for children's adherence to the diet and added, "More than 50 percent of newly diagnosed children experience intestinal healing within the first year. In some children, healing can start from the third month. Therefore, early implementation of a gluten-free diet is extremely important."

Recommending fun and healthy alternatives for children, Çetinkaya concluded by saying, "Mini pizzas prepared with buckwheat and rice flour, cocoa energy balls made with gluten-free oats, banana buckwheat waffles, cornflour baked nuggets, fruity quinoa pudding, and flatbreads prepared with chickpea flour are among the options that are both nutritious and can attract children's interest."