Wheat/Gluten-Related Disorders and Gluten-Free Diet Misconceptions: A Review

Abstract

In the last 10,000 years, wheat has become one of the most important cereals in the human diet and today, it is widely consumed in many processed food products. Mostly considered a source of energy, wheat also contains other essential nutrients, including fiber, proteins, and minor components, such as phytochemicals, vitamins, lipids, and minerals, that together promote a healthy diet. Apart from its nutritional properties, wheat has a set of proteins, the gluten, which confer key technical properties, but also trigger severe immune-mediated diseases, such as celiac disease. We are currently witnessing a rise in the number of people adhering to gluten-free diets unwarranted by any medical need. In this dynamic context, this review aims to critically discuss the nutritional components of wheat, highlighting both the health benefits and wheat/gluten-related disorders, in order to address common misconceptions associated with wheat consumption.

The 10,000-Year Success Story of Wheat!

“…With the increasing interest in organic farming, these characteristics have led to a higher global interest in the production of this species that may have several impacts on human nutrition, health, and sustainability [ 67 ]. On the other hand, general consumption habits are shifting to a gluten-free diet, as people are removing wheat from their diet without any medical advice and, consequently, are not consuming the necessary nutrients of wheat [ 70 ]. This demand for gluten-free products can arise from the belief that gluten-free and sugar-free foods help people overcome problems, such as bloating, indigestion, and others.…”

Gluten-related disorders

“…It occurs as a result of damage to the cerebellum as one, and sometimes the only manifestation of the CD [8,36]. Gluten-induced ataxia also occurs in the absence of CD [37,38].…”

“…Antibody cross-reactivity may be one of the mechanisms involved in GA pathogenesis because of the similarity between gluten proteins and antigenic epitopes on Purkinje cells [36]. Diagnostic delay leads to irreversible loss of Purkinje cells followed by permanent neurological damage [8,39]. GA is most often manifested with dysarthria, pyramidal dysfunction, gait problems, limb ataxia, pyramidal dysfunction, altered eye motions, progressive loss of stability, and inability to stand straight [8,9].…”

“…[4][5][6][7]. Classification of GRDs based on variations in pathogenesis and clinical expression identified celiac disease, non-celiac gluten sensitivity, and wheat allergy [1][2][3][4]8]. As a specific manifestation of the celiac disease or specific clinical entities within the GRDs, there are separated the gluten ataxia and dermatitis herpetiformis [1,[8][9][10][11][12][13].…”

“…Classification of GRDs based on variations in pathogenesis and clinical expression identified celiac disease, non-celiac gluten sensitivity, and wheat allergy [1][2][3][4]8]. As a specific manifestation of the celiac disease or specific clinical entities within the GRDs, there are separated the gluten ataxia and dermatitis herpetiformis [1,[8][9][10][11][12][13]. Underlying the pathogenesis of the celiac disease, dermatitis herpetiformis, and gluten ataxia is the immune system's response to gluten intake, IgE-mediated and/or non-IgEmediated immune response in wheat allergy, and stimulation of the innate immunity with direct cytotoxic effects of gluten and some non-immunological mechanisms in non-celiac gluten sensitivity [1-4, 8, 14].…”