The impact of a gluten-free (GF) diet on the intake of calcium and iron is broadly unknown, as the micronutrient content of GF cereal-based products has scarcely been measured. The study aimed to measure the calcium and iron content of GF cereal-based products from the UK. Seventy-three GF products were analysed. A laboratory analysis of calcium and iron from GF food samples was performed by spectrophotometric and flame emission photometry, respectively. The values for wheat-based products were from a nutrient database. The calcium in GF white loaf samples varied greatly from 54 to 140 mg/100 g, with a lower average calcium content compared with wheat-based values (99 ± 29 mg/100 g n = 13 versus 177 mg/100 g; p < 0.01). Only 27% of the white loaves and rolls were fortified with calcium; this contrasts with 100% of white wheat-based loaves. The calcium in GF flour mixes ranged from 54 to 414 mg/100 g, with 66% fortified. GF white pasta had more calcium compared with wheat-based pasta (76 ± 27 mg/100 g n = 7 versus 24 mg/100 g; p = 0.002). The iron in GF bread loaves and pasta samples was similar to wheat-based comparators, whereas lower iron levels were observed in GF wraps (0.8 ± 0.2 n = 11 versus 1.6 mg/100 g). GF bread had a significantly higher fibre content, and the majority of GF bread had a lower protein content, compared with wheat-based bread products. These calcium and iron values provide a valuable addition towards enabling more accurate nutrient intake analysis for adults and children with coeliac disease.

People with coeliac disease (CD) have a higher risk of developing cardiovascular disease (CVD), potentially due to inflammation. Probiotics can influence CVD risk through several mechanisms including modifying inflammation. We performed a systematic review of probiotic interventions in people with CD. In total, 4 databases were systematically searched for studies published up to March 2023. All outcomes, inclusive of any cardiovascular risk factors, were collated and reported. We screened 8084 articles and 11 publications reporting on 7 RCTs and 2 non-RCTs met the inclusion criteria for qualitative analysis. In total, 1 RCT and both non-RCTs were considered to have a high risk of bias. There was large heterogeneity between the studies and adherence to a gluten-free diet was only measured in two studies. No specific outcomes related to cardiovascular risk were reported. Two studies reported a significant reduction on serum TNF-α in children over time after probiotic supplementation. One study reported no significant change in intestinal permeability over a 3-week intervention. Currently there is insufficient evidence to advocate a positive impact of probiotics on inflammation in CD, due, in part, to the limited data on adherence to the gluten-free diet and active disease.

Evidence suggests that a gluten-free diet may increase the risk of metabolic abnormalities associated with cardiovascular disease in adults with Coeliac Disease (CeD). This 9-week, double-blind, placebo-controlled, randomised pilot study investigated the effects of a combined supplement containing probiotic Lactiplantibacillus plantarum ECGC 13110402 and plant sterols and stanols, on cardiometabolic biomarkers and gut microbiota diversity and composition in adults with CeD and hypercholesterolaemia. Blood lipid profiles and vitamin D concentrations were analysed, and gut microbiota was profiled via 16S rRNA amplicon sequencing. In the active group, significant reductions in total cholesterol, LDL-cholesterol, non-HDL cholesterol, and apolipoprotein B were observed at multiple time points during the treatment phase, with changes generally greater in magnitude compared with the placebo group. Vitamin D levels also increased in the active group during supplementation. Microbiota analysis revealed potentially beneficial changes in participants receiving the active formulation, including higher alpha diversity and higher proportions of Bifidobacterium spp., Christensenellaceae R-7 group, and Lachnospiraceae ND3007 group. Overall, this feasibility study provides exploratory findings that a combined Lactiplantibacillus plantarum ECGC 13110402-phytosterol formulation may support lipid management and beneficially modulate gut microbiota in adults with CeD, particularly for those seeking non-pharmacological approaches to improving cardiometabolic health biomarkers.