Health Risks Associated with a Long-Term Gluten-Free Diet and the Potential Protective Role of Anthocyanins

Gluten-free diets (GFDs) are gaining popularity worldwide. Originally, GFDs were designed for individuals with gluten intolerance, including conditions such as celiac disease, non-celiac gluten sensitivity, gluten ataxia, or dermatitis herpetiformis. However, many individuals without gluten sensitivity have subsequently adopted this diet, leading to a growing demand for gluten-free food products. Meanwhile, the health risks associated with a long-term gluten-free diet (LTGFD) and the inherent related issues, such as nutrient imbalances, remain uncertain. Scientific studies have indicated that obesity, non-alcoholic fatty liver disease (NAFLD), dysbiosis, and poor mental health represent the most probable health risks associated with a LTGFD. Moreover, high fat and simple carbohydrate content, increased calorie content, and vitamin deficiencies, including vitamin B derivatives (B1, B2, B3, B5, B6, B7, B9, and B12), vitamin D, and minerals (Fe, Mg, Se, and Zn), are key components in a GFD that are at the helm of health issues due to a LTGFD. Anthocyanins, a class of flavonoids found predominantly in red, purple, and blue fruits and vegetables, may provide a promising solution to alleviate health risks associated with a LTGFD due to their inherent antioxidant, anti-inflammatory, neuroprotective, anti-diabetic, and anti-obesity properties. Therefore, this review critically examines <i>in vivo</i>, <i>in vitro</i>, clinical, and mechanistic studies to explore the potential of anthocyanin-enriched GFDs in alleviating the health risks associated with a LTGFD, highlighting their significant advantages over regular GFDs.