Naturally gluten-free food
Fruit, vegetables, pulses, eggs, meat, fish, rice and maize can support a varied diet when preparation and cross-contact are considered.
Evidence guide reviewed 2 August 2026
Celiac disease: from diagnosis and the gluten-free diet to current research.
This guide starts with diagnosis.
It covers cross-contact, follow-up and emerging therapies.
Every section links to 24 selected sources.
NUTRIMI adds warnings, a multilingual card and shared diary.
- 24 sourcesGuidelines, systematic reviews, trials and regulation.
- Primary linksPubMed, health authorities, scientific societies and EUR-Lex.
- Named authorDiego Russo, with a public profile and responsibilities.
- Practical featuresCeliac profile, warnings, restaurant card, diary and professional support.
NUTRIMI in real use
Three screens, three separate jobs.
The condition is declared in the profile, the restriction can be communicated when eating out and meals can be logged through the most practical method. None of these screens certifies that food is gluten-free.
Direct answer
What is celiac disease?
Celiac disease is a permanent autoimmune disease rather than an allergy or simple intolerance. In genetically susceptible people, gluten from wheat, barley and rye triggers an immune response that primarily damages the small-intestinal mucosa and can cause intestinal or extra-intestinal manifestations. A global meta-analysis estimated biopsy-confirmed prevalence at about 0.7%.
Do not remove gluten as a diagnostic experiment
Reducing or eliminating gluten before clinical assessment can change serology and mucosal findings. Speak to a doctor before changing the diet when celiac disease is suspected.
Diagnosis
Symptoms and risk raise suspicion; clinical tests establish the diagnosis.
Presentation can include diarrhoea, abdominal pain or bloating, iron-deficiency anaemia, fatigue, weight loss, reduced bone density, liver-test abnormalities, dermatitis herpetiformis and other manifestations. A lack of gastrointestinal symptoms does not exclude celiac disease.
Clinical assessment
A clinician reviews symptoms, family history and associated conditions.
Serology
Testing generally includes tissue-transglutaminase IgA and total IgA, with changes for IgA deficiency.
Confirmation
Adults commonly require duodenal biopsy; selected children may follow validated no-biopsy criteria.
Follow-up
Diet, symptoms, serology, nutritional status and recovery are reviewed over time.
Current treatment
The gluten-free diet is strict, lifelong and must remain nutritionally complete.
The current standard is permanent gluten exclusion. In the European Union, a “gluten-free” statement requires no more than 20 mg/kg in food as sold. That legal threshold does not turn a photo, spoken recipe or menu into a measurement: hidden ingredients and cross-contact require labels, procedures and informed staff.
Packaged products
Regulated statements and ingredient lists matter. “Wheat-free” does not automatically mean gluten-free.
Nutritional quality
An unbalanced gluten-free diet can be low in fibre or micronutrients and high in sugars, fat or salt.
Cross-contact
Crumbs, airborne flour, shared toasters, utensils and porous surfaces can compromise otherwise suitable ingredients.
Follow-up and adherence
Symptoms, antibodies and dietary recall measure different things.
Feeling well does not prove that gluten exposure or mucosal injury is absent. Self-report, questionnaires, serology, gluten immunogenic peptides and histology have different strengths and limitations. Stool or urine GIP tests are emerging clinical tools; they are not a NUTRIMI feature and need clinical interpretation.
Food diary
Reconstructs products, preparation, place and circumstances around a possible exposure.
Symptoms
They matter but cannot independently measure intestinal damage or identify gluten with certainty.
Serology and review
They form part of medical follow-up; persistent symptoms or abnormal results require systematic assessment.
GIP research
Stool or urine peptides can document recent exposure within specific detection windows.
State of the art in 2026
Research is testing mucosal protection, gluten degradation and immune tolerance.
Investigational approaches include transglutaminase 2 inhibitors, gluten-degrading enzymes, sequestrants, tight-junction modulators and immune therapies. A proof-of-concept ZED1227 trial attenuated gluten-induced mucosal injury during a controlled challenge, but this does not permit routine gluten consumption and does not replace the diet. Some programmes remain early; others have failed to meet their targets.
Promising is not the same as available
Phase 1 and 2 candidates still need evidence of clinical benefit, safety and durable outcomes. The present standard remains a strict gluten-free diet with follow-up.
Where NUTRIMI helps
NUTRIMI simplifies everyday management.
Add celiac disease to your profile. Receive ingredient warnings. Show the multilingual restaurant card. Log meals and symptoms. Share the diary with your nutrition professional.
Celiac profile
The selected condition activates contextual food checks and warnings.
Ingredient checks
NUTRIMI flags gluten, wheat, barley, rye, spelt and declared gluten allergens in available data.
Restaurant communication
A multilingual card communicates celiac disease and cross-contact precautions.
Diary and symptoms
Meals, products, notes and symptoms preserve context for follow-up.
Professional plan
A published professional plan reaches the app after connection and consent.
Verifiable sources
The public catalogue links every reference used by the software.
What to check before eating.
Read the label, ingredients and gluten-free declaration. Ask staff how they manage cross-contact. Use NUTRIMI warnings to support that check.
Curated bibliography
24 guidelines, reviews and studies.
Each item opens the original document or PubMed record. The selection prioritises public authorities, scientific societies, systematic reviews and relevant clinical trials.
1 · Italian epidemiology
2024 annual report to Parliament
Official Italian data published in 2026.
Italian Ministry of Health 2 · Public healthCeliac disease in Italy
Prevalence, manifestations and national documents.
Italian Ministry of Health 3 · Clinical overviewCeliac disease
Definition, diagnosis, treatment and complications.
Italian National Institute of Health 4 · Italian guidelineDiagnosis, treatment and follow-up
SIGE recommendations in the national guideline system.
ISS · SNLG 5 · GuidelineACG Guidelines Update 2023
Diagnosis and management across age groups.
PMID 36602836 6 · Updated guidelineESsCD 2025, part 1
European adult diagnostic approach.
PMID 40999951 7 · PaediatricsESPGHAN 2020 guideline
Paediatric diagnosis and selected no-biopsy criteria.
PMID 31568151 8 · RegulationEU Implementing Regulation 828/2014
Conditions for gluten-free and very-low-gluten statements.
EUR-Lex 9 · EpidemiologyGlobal prevalence meta-analysis
96 studies; seroprevalence and biopsy-confirmed prevalence.
PMID 29551598 10 · State of the artAdvances in understanding and management
Pathophysiology, diagnosis and emerging treatment.
BMJ 2025 11 · NutritionMicronutrient deficiencies meta-analysis
Deficiencies and certainty of evidence during gluten-free diets.
PMC12296119 12 · AdherenceGluten-free diet adherence tools
Systematic review and meta-analysis against laboratory tests.
PMID 39125309 13 · MonitoringFecal gluten peptides
Multicentre comparison with serology and questionnaires.
PMID 27644734 14 · MonitoringUrinary gluten immunogenic peptides
Diet transgressions and incomplete mucosal healing.
PMID 26608460 15 · Follow-upClinical utility of urinary GIP
Repeated exposure and persistent villous atrophy.
PMID 36890679 16 · 2025 researchOptimising stool GIP testing
Prospective work on sampling frequency.
PMID 40516107 17 · Digital healthMyHealthyGut pilot RCT
Diet adherence and quality of life with app support.
PMID 32071731 18 · Digital healthSmartphone application RCT
Evaluation of gastrointestinal symptoms.
PMID 35846977 19 · Digital platformGluten-free diet evaluation
Digital dietary assessment in adults and children.
PMID 35161479 20 · Remote supportTelephone clinic and adherence
Sustained improvements in knowledge and adherence.
PMID 34917316 21 · Digital interventionTEACH randomised trial
Education, patient activation and quality of life.
PMID 28343658 22 · Experimental therapyZED1227 randomised trial
Transglutaminase 2 inhibition during gluten challenge.
PMID 34192430 23 · Therapeutic researchBeyond the gluten-free diet
2024 review of pharmacological and immune strategies.
PMID 39493330 24 · Clinical pipelineNew therapies in celiac disease
Updated review of advanced clinical approaches.
PMC11970589Direct questions
Celiac disease and digital tools.
Is celiac disease a gluten allergy?
No. It is a permanent autoimmune disease. Wheat allergy and non-celiac gluten sensitivity are distinct conditions.
Can I start a gluten-free diet before tests?
Not independently: doing so can make diagnostic tests negative or difficult to interpret. Speak to a clinician first.
Does “gluten-free” mean absolute zero?
EU-regulated use allows no more than 20 mg/kg in food as sold. Practical safety also depends on preparation and cross-contact.
Can an app detect gluten cross-contact?
No. A standard nutrition app cannot measure gluten concentration or inspect a kitchen. It can support ingredient review, warnings, diaries and communication while declaring these limits.
Do investigational drugs already allow people to eat gluten?
No. Current research has not replaced the gluten-free diet in routine clinical care.