A Mixed-Methods Study of Knowledge, Attitudes, and Practices Related to Gluten- Free Diets in India

Recent evidence suggests a growing popularity of gluten-free diets (GFDs) beyond clinically indicated contexts in low middle income countries. However, a comprehensive investigation of public perceptions, motivations, and professional challenges related to both medically and non-medically indicated GFD adoption remains limited. Therefore, we conducted a mixed method study to explore the perspectives of dietetic professionals and assess the knowledge, attitudes, and practices (KAP) related to gluten and GFDs among adults aged 18–45 years in India. The clinical and nutritional considerations for GFD were examined through in-depth interviews (n = 9) and an online survey was conducted among adults (n = 285) to assess their KAP. Thematic analyses revealed fragmented public understanding, symptom-led self-diagnosis, influence of “anti-inflammatory” narratives, concerns regarding nutritional adequacy of GFDs, and the need to leverage traditional food systems. Data highlighted limited knowledge regarding gluten (50.9%), and GFDs (38.6%). Reasons for GFD adoption included perceived health benefits (19.8%), weight loss (26.4%) and no reasons (32.1%). Consumption of naturally gluten-free staples such as rice (58.9%), lentils (55.8%) and millets (30.9%) was higher than that of oats (7.7%), barley/ quinoa (2.8%), and speciality flours (2.1%). The study provides timely insights into the drivers of the GFD trend within India’s rapidly evolving urban nutrition landscape.