Figure 2.

Gluten-free (GF) diet and the development of type 2 diabetes (T2D)—a hypothesis. A GF diet decreases intestinal permeability thereby preventing food particles such a gliadin from crossing the intestinal barrier and reaching the adipose tissue and pancreas. A GF diet increases the proportion of Lactobacillus and decreases the proportion of Akkermansia, Dorea, Clostridium, and Coriobacteriacae. In the blood, a GF diet decreases the level of proinflammatory cytokines and adipokines and increases the anti-inflammatory adiponectin. A GF diet reduces obesity and improves the regulation of lipid metabolism by upregulating peroxisome proliferator activator receptor alpha (PPARA) and peroxisome proliferator activator receptor gamma (PPARG) in adipose tissue. This, in turn, leads to increased insulin sensitivity and improved glucose tolerance, which is further improved by reduced beta-cell stress and increased beta-cell volume.