Gluten-Free Diet in Celiac Disease: Nutrient Imbalances and Alternative Grain Sources

Öz

Celiac disease is a chronic, autoimmune disorder of the small intestine that develops in genetically predisposed individuals through the immune system due to gluten intake. The disease is triggered by the consumption of gluten found in grains such as wheat, barley and rye, and as gluten intake continues, it causes damage to the villi in the intestinal mucosa, impaired nutrient absorption and various symptoms. Currently, the only known effective treatment for celiac disease is a strict gluten-free diet that must be maintained for life. However, complete elimination of gluten from the diet may lead to energy, fiber, vitamin and mineral deficiencies due to the lack of adequate food alternatives to replace wheat and similar grains. The aim of this review is to reveal possible nutrient deficiencies that may be observed in individuals following a gluten-free diet, to evaluate strategies to prevent these deficiencies and to discuss alternative gluten-free food sources. In particular, some gluten-free cereals and pseudocereals with functional properties have significant potential to improve the nutritional quality of gluten-free diets. This study aims to support healthcare professionals, dietitians and celiac patients in planning an adequate and balanced diet during the gluten-free diet.

Anahtar Kelimeler

• Celiac disease
• gluten-free diet
• nutrient imbalances
• functional grains
• pseudocereals

Çölyak Hastalığında Glutensiz Diyet: Besin Dengesizlikleri ve Alternatif Tahıl Kaynakları

Öz

Çölyak hastalığı, genetik yatkınlığı olan bireylerde gluten alımına bağlı olarak bağışıklık sistemi aracılığıyla gelişen kronik ve otoimmün bir ince bağırsak bozukluğudur. Bu hastalık, buğday, arpa ve çavdar gibi tahıllarda bulunan glutenin tüketilmesiyle tetiklenir ve gluten alımı sürdükçe bağırsak mukozasında villusların zarar görmesine, besin emiliminde bozulmalara ve çeşitli semptomlara neden olur. Günümüzde çölyak hastalığının bilinen tek etkili tedavisi, ömür boyu sürdürülmesi gereken katı bir glutensiz diyettir. Ancak glutenin diyetten tamamen çıkarılması, buğday ve benzeri tahılların yerini alabilecek yeterli sayıda besin alternatifi olmaması nedeniyle enerji, posa, vitamin ve mineral eksikliklerine yol açabilir. Bu derlemenin amacı, glutensiz diyet uygulayan bireylerde görülebilecek olası besin ögesi yetersizliklerini ortaya koymak, bu eksikliklerin önlenmesine yönelik stratejileri değerlendirmek ve alternatif glutensiz gıda kaynaklarını ele almaktır. Özellikle fonksiyonel özelliklere sahip glutensiz tahıllar ve psödotahıllar, glutensiz beslenmenin besin kalitesini artırmada önemli potansiyel taşımaktadır. Bu çalışmanın amacı, çölyak hastalarında besin ögesi dengesizliklerini değerlendirmek ve glutensiz tahılların besin içerikleri ile sağlık faydalarını inceleyerek, glutensiz diyet uygulamalarında dengeli ve yeterli beslenme sağlanmasına rehberlik etmektir.

Anahtar Kelimeler

• Çölyak hastalığı
• Glutensiz diyet
• Besin ögesi dengesizlikleri
• Fonksiyonel tahıllar
• Psödotahıllar

Kaynakça

1. Abdel-Aal, E.-S. M., & Gamel, T. H. (2025). Potential of hairless canary seed as a food-based remedy for celiac disease and diabetes. Foods, 14(17), 3011. https://doi.org/10.3390/foods14173011
2. Abdel-Aal, E.-S. M., & Hucl, P. (2002). Amino acid composition and in vitro protein digestibility of selected ancient wheats and their end products. Journal of Food Composition and Analysis, 15(6), 737–747.https://doi.org/10.1006/jfca.2002.1094
3. Abdi, F., Zuberi, S., Blom, J.-J., Armstrong, D., & Pinto-Sanchez, M. I. (2023). Nutritional considerations in celiac disease and non-celiac gluten/wheat sensitivity. Nutrients, 15(6), 1475. https://doi.org/10.3390/nu15061475
4. Abebe, B. S., Aprodu, I., Istrati, D. I., & Vizireanu, C. (2025). Nutritional characteristics, health-related properties, and food application of teff (Eragrostis tef): An overview. International Journal of Molecular Sciences, 26(19), 9293. https://doi.org/10.3390/ijms26199293
5. Abouel-Yazeed, A. M., Nassar, M. A. A., Ebaid, R. A., & Hassan, M. A. M. (2019). Chemical and sensory properties of black rice compared with Giza 177 rice cultivar. Alexandria Science Exchange Journal, 40(October-December), 574–584. https://doi.org/10.21608/asejaiqjsae.2019.59814
6. Aboulaghras, S., Piancatelli, D., Oumhani, K., Balahbib, A., Bouyahya, A., & Taghzouti, K. (2022). Pathophysiology and immunogenetics of celiac disease. Clinica Chimica Acta, 528, 74–83. https://doi.org/10.1016/j.cca.2022.01.022
7. Aggarwal, N., Agarwal, A., Alarouri, H., Dwarakanathan, V., Dang, S., Ahuja, V., & Makharia, G. K. (2024). Patients with celiac disease have high prevalence of fatty liver and metabolic syndrome. Digestive Diseases and Sciences, 69(8), 3029–3042. https://doi.org/10.1007/s10620-024-08426-5
8. Agregán, R., Guzel, N., Guzel, M., Bangar, S. P., Zengin, G., Kumar, M., & Lorenzo, J. M. (2023). The effects of processing technologies on nutritional and anti-nutritional properties of pseudocereals and minor cereal. Food and Bioprocess Technology, 16(5), 961–986. https://doi.org/10.1007/s11947-022-02936-8

9. Al-Bawardy, B., Codipilly, D. C., Rubio-Tapia, A., Bruining, D. H., Hansel, S. L., & Murray, J. A. (2017). Celiac disease: A clinical review. Abdominal Radiology, 42(2), 351–360. https://doi.org/10.1007/s00261-016-1034-y
10. Aljada, B., Zohni, A., & El-Matary, W. (2021). The gluten-free diet for celiac disease and beyond. Nutrients, 13(11), 3993. https://doi.org/10.3390/nu13113993
11. Al-Toma, A., Volta, U., Auricchio, R., Castillejo, G., Sanders, D. S., Cellier, C., Mulder, C. J., & Lundin, K. E. A. (2019). European Society for the Study of Coeliac Disease (ESsCD) guideline for coeliac disease and other gluten‐related disorders. United European Gastroenterology Journal, 7(5), 583–613. https://doi.org/10.1177/2050640619844125
12. Alvarez-Jubete, L., Arendt, E. K., & Gallagher, E. (2009). Nutritive value and chemical composition of pseudocereals as gluten-free ingredients. International Journal of Food Sciences and Nutrition, 60(sup4), 240–257. https://doi.org/10.1080/09637480902950597
13. Alvarez-Jubete, L., Arendt, E. K., & Gallagher, E. (2010). Nutritive value of pseudocereals and their increasing use as functional gluten-free ingredients. Trends in Food Science & Technology, 21(2), 106–113. https://doi.org/10.1016/j.tifs.2009.10.014
14. Bai, J. C., Fried, M., Corazza, G. R., Schuppan, D., Farthing, M., Catassi, C., Greco, L., Cohen, H., Ciacci, C., Eliakim, R., Fasano, A., González, A., Krabshuis, J. H., & LeMair, A. (2013). World Gastroenterology Organisation global guidelines on celiac disease. Journal of Clinical Gastroenterology, 47(2), 121–126. https://doi.org/10.1097/MCG.0b013e31827a6f83
15. Beker Sanli, D., Aliyazicioglu, Y., & Gazi Kalayci, A. (2015). Homosistein, Vitamin B12 and folic acid levels in patients with pediatric celiac disease. Güncel Pediatri, 13(1), 1–6. https://doi.org/10.4274/jcp.92400
16. Caeiro, C., Pragosa, C., Cruz, M. C., Pereira, C. D., & Pereira, S. G. (2022). The role of pseudocereals in celiac disease: Reducing nutritional deficiencies to improve well-being and health. Journal of Nutrition and Metabolism, 2022, 1–8. https://doi.org/10.1155/2022/8502169
17. Caio, G., Volta, U., Sapone, A., Leffler, D. A., De Giorgio, R., Catassi, C., & Fasano, A. (2019). Celiac disease: A comprehensive current review. BMC Medicine, 17(1), 142. https://doi.org/10.1186/s12916-019-1380-z
18. Calder, P. C., Albers, R., Antoine, J.-M., Blum, S., Bourdet-Sicard, R., Ferns, G. A., Folkerts, G., Friedmann, P. S., Frost, G. S., Guarner, F., Løvik, M., Macfarlane, S., Meyer, P. D., M’Rabet, L., Serafini, M., van Eden, W., van Loo, J., Vas Dias, W., Vidry, S., … Zhao, J. (2009). Inflammatory disease processes and interactions with nutrition. British Journal of Nutrition, 101(S1), 1–45. https://doi.org/10.1017/S0007114509377867
19. Cardo, A., Churruca, I., Lasa, A., Navarro, V., Vázquez-Polo, M., Perez-Junkera, G., & Larretxi, I. (2021). Nutritional imbalances in adult celiac patients following a gluten-free diet. Nutrients, 13(8), 2877. https://doi.org/10.3390/nu13082877
20. Chao, H.-C. (2023). Zinc deficiency and therapeutic value of zinc supplementation in pediatric gastrointestinal diseases.Nutrients, 15(19), 4093. https://doi.org/10.3390/nu15194093
21. Colasanto, A., Savastio, S., Pozzi, E., Gorla, C., Coïsson, J. D., Arlorio, M., & Rabbone, I. (2023). The impact of different types of rice and cooking on postprandial glycemic trends in children with type 1 diabetes with or without celiac disease. Nutrients, 15(7), 1654. https://doi.org/10.3390/nu15071654
22. Colombo, F., Di Lorenzo, C., Petroni, K., Silano, M., Pilu, R., Falletta, E., Biella, S., & Restani, P. (2021). Pigmented corn varieties as functional ingredients for gluten-free products. Foods, 10(8), 1770. https://doi.org/10.3390/foods10081770
23. Comba, A., Demirbaş, F., Eren, E., Çaltepe, G., Kayadibi, H., & Kalaycı, A. G. (2018). Çölyak hastalarında serum homosistein düzeylerinin değerlendirilmesi. Pamukkale Medical Journal. https://doi.org/10.31362/patd.402656
24. Comino, I., De Lourdes Moreno, M., Real, A., Rodríguez-Herrera, A., Barro, F., & Sousa, C. (2013). The gluten-free diet: Testing alternative cereals tolerated by celiac patients. Nutrients, 5(10), 4250–4268. https://doi.org/10.3390/nu5104250
25. Cornicelli, M., Saba, M., Machello, N., Silano, M., & Neuhold, S. (2018). Nutritional composition of gluten-free food versus regular food sold in the Italian market. Digestive and Liver Disease, 50(12), 1305–1308. https://doi.org/10.1016/j.dld.2018.04.028
26. Dahele, A., & Ghosh, S. (2001). Vitamin B12 deficiency in untreated celiac disease. The American Journal of Gastroenterology, 96(3), 745–750. https://doi.org/10.1111/j.1572-0241.2001.03616.x
27. Di Nardo, G., Villa, M. P., Conti, L., Ranucci, G., Pacchiarotti, C., Principessa, L., Raucci, U., & Parisi, P. (2019). Nutritional deficiencies in children with celiac disease resulting from a gluten-free diet: A systematic review. Nutrients, 11(7), 1588. https://doi.org/10.3390/nu11071588
28. Di Stefano, M., Miceli, E., Mengoli, C., Corazza, G. R., & Di Sabatino, A. (2023). The effect of a gluten-free diet on vitamin D metabolism in celiac disease: The state of the art. Metabolites, 13(1), 74. https://doi.org/10.3390/metabo13010074
29. FDA. (2013). Food labeling; Gluten-free labeling of foods. U.S. Food and Drug Administration Federal Register. Final Rule; Document 78 FR 47154. Retrieved [November 10, 2025], from https://www.federalregister.gov/articles/2013/08/05/2013-18813/food-labeling-gluten-free-labeling-of-foods
30. Ferrara, P., Cicala, M., Tiberi, E., Spadaccio, C., Marcella, L., Gatto, A., Calzolari, P., & Castellucci, G. (2009). High fat consumption in children with celiac disease. Acta Gastro-Enterologica Belgica, 72(3), 296–300.
31. Fleet, J. C. (2017). The role of vitamin D in the endocrinology controlling calcium homeostasis. Molecular and Cellular Endocrinology, 453, 36–45. https://doi.org/10.1016/j.mce.2017.04.008
32. García‐Manzanares, Á., & Lucendo, A. J. (2011). Nutritional and dietary aspects of celiac disease. Nutrition in Clinical Practice, 26(2), 163–173. https://doi.org/10.1177/0884533611399773
33. Gessaroli, M., Frazzoni, L., Sikandar, U., Bronzetti, G., Pession, A., Zagari, R. M., Fuccio, L., & Forchielli, M. L. (2023).Nutrient intakes in adult and pediatric coeliac disease patients on gluten-free diet: A systematic review and meta-analysis. European Journal of Clinical Nutrition, 77(8), 784–793. https://doi.org/10.1038/s41430-023-01280-0
34. González, M. P., López-Laiz, P., Achón, M., de la Iglesia, R., Fajardo, V., García-González, Á., Úbeda, N., & Alonso-Aperte, E. (2025). Determination and comparison of fat and fibre contents in gluten-free and gluten-containing flours and breads: Nutritional implications. Foods, 14(5), 894. https://doi.org/10.3390/foods14050894
35. Halfdanarson, T. R., Litzow, M. R., & Murray, J. A. (2007). Hematologic manifestations of celiac disease. Blood, 109(2), 412–421. https://doi.org/10.1182/blood-2006-07-031104
36. Herrera-Quintana, L., Navajas-Porras, B., Vázquez-Lorente, H., Hinojosa-Nogueira, D., Corrales-Borrego, F. J., Lopez-Garzon, M., & Plaza-Diaz, J. (2025). Celiac disease: Beyond diet and food awareness. Foods, 14(3), 377. https://doi.org/10.3390/foods14030377
37. James Freeman, H. (2022). Molecular mechanisms of zinc absorption in health, acrodermatitis enteropathica and celiac disease. International Journal of Celiac Disease, 10(1), 8–10. https://doi.org/10.12691/ijcd-10-1-6 Jamieson, J. A., & Neufeld, A. (2020). Food sources of energy and nutrients among Canadian adults following a gluten-free diet. PeerJ, 8, e9590. https://doi.org/10.7717/peerj.9590
38. Kelly, C. P., Bai, J. C., Liu, E., & Leffler, D. A. (2015). Advances in diagnosis and management of celiac disease. Gastroenterology, 148(6), 1175–1186. https://doi.org/10.1053/j.gastro.2015.01.044
39. Khairuddin, M. A. N., & Lasekan, O. (2021). Gluten-free cereal products and beverages: A review of their health benefits in the last five years. Foods, 10(11), 2523. https://doi.org/10.3390/foods10112523
40. Koreissi-Dembélé, Y., Fanou-Fogny, N., Hulshof, P. J. M., & Brouwer, I. D. (2013). Fonio (Digitaria exilis) landraces in Mali: Nutrient and phytate content, genetic diversity and effect of processing. Journal of Food Composition and Analysis, 29(2), 134–143. https://doi.org/10.1016/j.jfca.2012.07.010
41. Kori, M., Gabbai, A., Shamir, R., & Guz-Mark, A. (2024). Children with celiac disease, diagnosed with or without biopsy, present similar adherence to gluten-free diet and serology decline. European Journal of Pediatrics, 184(1), 21. https://doi.org/10.1007/s00431-024-05849-0
42. Kreutz, J. M., Adriaanse, M. P. M., van der Ploeg, E. M. C., & Vreugdenhil, A. C. E. (2020). Narrative review: Nutrient deficiencies in adults and children with treated and untreated celiac disease. Nutrients, 12(2), 500. https://doi.org/10.3390/nu12020500
43. Kreutz, J. M., Heynen, L., & Vreugdenhil, A. C. E. (2023). Nutrient deficiencies in children with celiac disease during long term follow-up. Clinical Nutrition, 42(7), 1175–1180. https://doi.org/10.1016/j.clnu.2023.05.003
44. Lamjadli, S., Oujamaa, I., Souli, I., Eddehbi, F. E., Lakhouaja, N., M’raouni, B., Salami, A., Guennouni, M., Belghali, M. Y., Hazime, R., & Admou, B. (2025). Micronutrient deficiencies in patients with celiac disease: A systematic review and meta-analysis. International Journal of Immunopathology and Pharmacology, 39. https://doi.org/10.1177/03946320241313426
45. Cruz, J. F. (2004). Fonio: a small grain with potential. LEISA-LEUSDEN-, 20, 16-17.
46. Li, Z., Zhang, L., Li, L., & Du, Z. (2023). Evaluation of serum levels of copper and zinc in patients with celiac disease seropositivity: Findings from the National Health and Nutrition Examination Survey. Biological Trace Element Research, 201(2), 683–688. https://doi.org/10.1007/s12011-022-03212-8
47. Ludvigsson, J. F., Leffler, D. A., Bai, J. C., Biagi, F., Fasano, A., Green, P. H. R., Hadjivassiliou, M., Kaukinen, K., Kelly, C. P., Leonard, J. N., Lundin, K. E. A., Murray, J. A., Sanders, D. S., Walker, M. M., Zingone, F., & Ciacci, C. (2013).The Oslo definitions for coeliac disease and related terms. Gut, 62(1), 43–52. https://doi.org/10.1136/gutjnl-2011-301346
48. Mahadev, S., Laszkowska, M., Sundström, J., Björkholm, M., Lebwohl, B., Green, P. H. R., & Ludvigsson, J. F. (2018). Prevalence of celiac disease in patients with iron deficiency anemia—A systematic review with meta-analysis. Gastroenterology, 155(2), 374-382.e1. https://doi.org/10.1053/j.gastro.2018.04.016
49. Martin, J., Geisel, T., Maresch, C., Krieger, K., & Stein, J. (2013). Inadequate nutrient intake in patients with celiac disease: Results from a German dietary survey. Digestion, 87(4), 240–246. https://doi.org/10.1159/000348850
50. Mazzola, A. M., Zammarchi, I., Valerii, M. C., Spisni, E., Saracino, I. M., Lanzarotto, F., & Ricci, C. (2024). Gluten-free diet and other celiac disease therapies: Current understanding and emerging strategies. Nutrients, 16(7), 1006. https://doi.org/10.3390/nu16071006
51. McDermid, J. M., Almond, M. A., Roberts, K. M., Germer, E. M., Geller, M. G., Taylor, T. A., Sinley, R. C., & Handu, D. (2023). Celiac disease: An Academy of Nutrition and Dietetics evidence-based nutrition practice guideline. Journal of the Academy of Nutrition and Dietetics, 123(12), 1793-1807.e4. https://doi.org/10.1016/j.jand.2023.07.018
52. Miranda, J., Lasa, A., Bustamante, M. A., Churruca, I., & Simon, E. (2014). Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant Foods for Human Nutrition, 69(2), 182–187. https://doi.org/10.1007/s11130-014-0410-4
53. Missbach, B., Schwingshackl, L., Billmann, A., Mystek, A., Hickelsberger, M., Bauer, G., & König, J. (2015). Gluten-free food database: The nutritional quality and cost of packaged gluten-free foods. PeerJ, 3, e1337. https://doi.org/10.7717/peerj.1337
54. Nandan, A., Koirala, P., Dutt Tripathi, A., Vikranta, U., Shah, K., Gupta, A. J., Agarwal, A., & Nirmal, N. (2024). Nutritional and functional perspectives of pseudocereals. Food Chemistry, 448, 139072. https://doi.org/10.1016/j.foodchem.2024.139072
55. Newberry, C., McKnight, L., Sarav, M., & Pickett-Blakely, O. (2017). Going gluten free: The history and nutritional implications of today’s most popular diet. Current Gastroenterology Reports, 19(11), 54. https://doi.org/10.1007/s11894-017-0597-2
56. Özkaya, Ş. Ö., & Özkaya, V. (2018). Çölyak hastalığına diyetetik yaklaşım. Selcuk Tip Dergisi, 4(34), 186–193. https://doi.org/10.30733/std.2018.00906
57. Pinto-Sánchez, M. I., Causada-Calo, N., Bercik, P., Ford, A. C., Murray, J. A., Armstrong, D., Semrad, C., Kupfer, S. S., Alaedini, A., Moayyedi, P., Leffler, D. A., Verdú, E. F., & Green, P. (2017). Safety of adding oats to a gluten-free diet for patients with celiac disease: Systematic review and meta-analysis of clinical and observational studies. Gastroenterology, 153(2), 395-409.e3. https://doi.org/10.1053/j.gastro.2017.04.009
58. Rai, S., Kaur, A., & Chopra, C. S. (2018). Gluten-free products for celiac susceptible people. Frontiers in Nutrition, 5. https://doi.org/10.3389/fnut.2018.00116
59. Rinninella, E., Cintoni, M., Raoul, P., Triarico, S., Dionisi, T., Gasbarrini, G. B., Gasbarrini, A., & Mele, M. C. (2021). The healthy gluten-free diet: Practical tips to prevent metabolic disorders and nutritional deficiencies in celiac patients. Gastroenterology Insights, 12(2), 166–182. https://doi.org/10.3390/gastroent12020015
60. Roldan, G. A., Goyes, D., Villafuerte-Gálvez, J. A., Urquiaga, M., Dennis, M., Murray, J. A., Leffler, D. A., & Kelly, C. P. (2022). Anemia etiology and the response to a gluten-free diet in untreated patients with celiac disease: A 2-year follow-up. American Journal of Gastroenterology, 117(10), 1684–1692. https://doi.org/10.14309/ajg.0000000000001875
61. Rondanelli, M., Faliva, M. A., Gasparri, C., Peroni, G., Naso, M., Picciotto, G., Riva, A., Nichetti, M., Infantino, V., Alalwan, T. A., & Perna, S. (2019). Micronutrients dietary supplementation advices for celiac patients on long-term gluten-free diet with good compliance: A review. Medicina, 55(7), 337. https://doi.org/10.3390/medicina55070337
62. Rubio-Tapia, A., Hill, I. D., Semrad, C., Kelly, C. P., Greer, K. B., Limketkai, B. N., & Lebwohl, B. (2023). American College of Gastroenterology guidelines update: Diagnosis and management of celiac disease. American Journal of Gastroenterology, 118(1), 59–76. https://doi.org/10.14309/ajg.0000000000002075
63. Saturni, L., Ferretti, G., & Bacchetti, T. (2010). The gluten-free diet: Safety and nutritional quality. Nutrients, 2(1), 16–34. https://doi.org/10.3390/nu2010016
64. Sbravati, F., Cosentino, A., Lenzi, J., Fiorentino, M., Ambrosi, F., Salerno, A., Di Biase, A., Righi, B., Brusa, S., Valin, P. S., Bruni, L., Battistini, B., Pagano, S., Grondona, A. G., Labriola, F., & Alvisi, P. (2022). Antitissue transglutaminase antibodies’ normalization after starting a gluten-free diet in a large population of celiac children-a real-life experience. Digestive and Liver Disease, 54(3), 336–342. https://doi.org/10.1016/j.dld.2021.06.026
65. Scarampi, M., Mengoli, C., Miceli, E., & Di Stefano, M. (2025). Vitamins and celiac disease: Beyond vitamin D. Metabolites, 15(2), 78. https://doi.org/10.3390/metabo15020078
66. Shepherd, S. J., & Gibson, P. R. (2013). Nutritional inadequacies of the gluten‐free diet in both recently‐diagnosed and long‐term patients with coeliac disease. Journal of Human Nutrition and Dietetics, 26(4), 349–358. https://doi.org/10.1111/jhn.12018
67. Simón, E., Molero-Luis, M., Fueyo-Díaz, R., Costas-Batlle, C., Crespo-Escobar, P., & Montoro-Huguet, M. A. (2023). The gluten-free diet for celiac disease: Critical insights to better understand clinical outcomes. Nutrients, 15(18), 4013. https://doi.org/10.3390/nu15184013
68. Simopoulos, A. (2016). An increase in the omega-6/omega-3 fatty acid ratio increases the risk for obesity. Nutrients, 8(3), 128. https://doi.org/10.3390/nu8030128
69. Singh, P., Arora, A., Strand, T. A., Leffler, D. A., Catassi, C., Green, P. H., Kelly, C. P., Ahuja, V., & Makharia, G. K. (2018). Global prevalence of celiac disease: Systematic review and meta-analysis. Clinical Gastroenterology and Hepatology, 16(6), 823-836.e2. https://doi.org/10.1016/j.cgh.2017.06.037
70. Stefanelli, G., Viscido, A., Longo, S., Magistroni, M., & Latella, G. (2020). Persistent iron deficiency anemia in patients with celiac disease despite a gluten-free diet. Nutrients, 12(8), 2176. https://doi.org/10.3390/nu12082176
71. Suárez-González, M., Bousoño-García, C., Jiménez-Treviño, S., & Díaz-Martín, J. J. (2021). Gluten-free diet: Nutritional strategies to improve eating habits in children with celiac disease: A prospective, single-arm intervention study. Nutrients, 13(4), 1108. https://doi.org/10.3390/nu13041108
72. Talarico, V., Giancotti, L., Mazza, G. A., Miniero, R., & Bertini, M. (2021). Iron deficiency anemia in celiac disease. Nutrients, 13(5), 1695. https://doi.org/10.3390/nu13051695
73. The Canary Seed Development Commission of Saskatchewan. (2016, May). Canaryseed (Phalaris canariensis) nutrient composition of canaryseed groats. https://www.canaryseed.ca/documents/NutritionFacts-CanaryseedGroats-May2016.pdf
74. Theethira, T. G., Dennis, M., & Leffler, D. A. (2014). Nutritional consequences of celiac disease and the gluten-free diet. Expert Review of Gastroenterology & Hepatology, 8(2), 123–129. https://doi.org/10.1586/17474124.2014.876360
75. Tunçer, E., & Yabancı Ayhan, N. (2021). Çölyak hastalığında mikro besin ögesi eksiklikleri ve beslenme önerileri. Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi, 3(1), 29–38. https://doi.org/10.46413/boneyusbad.807225
76. USDA. (2020). National nutrient database for standard reference. Retrieved [December 10, 2025], from https://fdc.nal.usda.gov/
77. Vici, G., Belli, L., Biondi, M., & Polzonetti, V. (2016). Gluten free diet and nutrient deficiencies: A review. Clinical Nutrition, 35(6), 1236–1241. https://doi.org/10.1016/j.clnu.2016.05.002
78. WGO Global Guidelines. (2016). Celiac disease. World Gastroenterology Organisation. Retrieved [December 5, 2025], from https://www.worldgastroenterology.org/UserFiles/file/guidelines/celiac-disease-english-2016.pdf
79. Wierdsma, N., Van Bokhorst-de van der Schueren, M., Berkenpas, M., Mulder, C., & Van Bodegraven, A. (2013). Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients, 5(10), 3975–3992. https://doi.org/10.3390/nu5103975
80. Wild, D., Robins, G. G., Burley, V. J., & Howdle, P. D. (2010). Evidence of high sugar intake, and low fibre and mineral intake, in the gluten‐free diet. Alimentary Pharmacology & Therapeutics, 32(4), 573–581. https://doi.org/10.1111/j.1365-2036.2010.04386.x
81. Winarti, C., Widaningrum, Widayanti, S. M., Setyawan, N., Qanytah, Juniawati, Suryana, E. A., & Widowati, S. (2023).Nutrient composition of Indonesian specialty cereals: Rice, corn, and sorghum as alternatives to combat malnutrition.Preventive Nutrition and Food Science, 28(4), 471–482. https://doi.org/10.3746/pnf.2023.28.4.471
82. Woomer, J. S., & Adedeji, A. A. (2021). Current applications of gluten-free grains – a review. Critical Reviews in Food Science and Nutrition, 61(1), 14–24. https://doi.org/10.1080/10408398.2020.1713724
83. Yiğit, A., & Güneş, F. E. (2018). Epigenetics and one carbon metabolism: The role of folate and vitamin B12. Turkiye Klinikleri Journal of Internal Medicine, 3(3), 95–101. https://doi.org/10.5336/intermed.2018-62699