Considering a more sustainable gluten-free diet? Gluten-free cereals in European dietary practice

Background The inclusion of minor and pseudo-cereals enhances the nutritional quality of a gluten-free diet. Yet, affordability determines practical implementation. Environmental concerns should also be considered as moving towards a more sustainable diet. How do these aspects of sustainability manifest themselves in a special diet, such as gluten-free? Methods An international pilot survey among practicing dietitians was conducted during the Congress of The European Federation of the Associations of Dietitians (EFAD, Budapest, 2023). Respondents marked their recommendation for eight gluten-free cereals based on five criteria, including nutritional quality, accessibility/price, and climate change. Differences were analysed using Cohran's Q and pairwise post-hoc tests (N = 38). Results There were significant differences in the recommendation for cereals (p < 0.05 for each grain), with quinoa (89.5%), gluten-free oats (89.5%), rice (86.8%), and corn (65.8%) being the most recommended. Buckwheat (55.3%), millet (50.0%), amaranth (44.7%) and sorghum (26.3%) were less recommended. Although gluten-free oats were recommended overall, quinoa was recommended for its nutritional content, and rice and corn were recommended for accessibility/price. No cereal received a high recommendation for climate change. Conclusions According to this pilot survey, nutritional content and accessibility/price were the most important criteria for evaluating gluten-free grains. Dietitians were willing to integrate climate change considerations into practice, but more information is needed. The recommendation for minor and pseudo-cereals contradicted the importance emphasised by the literature. Further research is needed to integrate these aspects, helping dietitians formulate recommendations.