- Gluten is a general name for the proteins found in wheat (einkorn, durum, faro, graham, Kamut®, semolina, and spelt), rye, barley and triticale. A minority of people must avoid foods containing gluten due to troublesome gastrointestinal symptoms and less commonly, malabsorption that may cause anemia, bone loss and growth failure.
- Gluten can also be found in malt in various forms including: malted barley flour, malted milk or milkshakes, malt extract, malt syrup, malt flavoring, malt vinegar.
- Gluten can be found in many types of foods, even ones that would not be expected, remember “wheat-free” may not mean “gluten-free” beers, ales, lagers, and malt beverages that are made from gluten-containing grains are not distilled and therefore are not gluten-free (gluten-free beers are available).
Gluten has become one of the most “scorned” nutrients however, for most of us the need to go gluten-free is not necessary. On the other hand, a life-long commitment to avoid gluten is warranted only for those with two diseases: non-celiac gluten sensitivity or celiac disease.
What is gluten?
Gluten, a general name for the proteins found in wheat (einkorn, durum, faro, graham, Kamut®, semolina, and spelt), rye, barley and triticale and it is not toxic to the majority of the population. The demand for gluten-free products is outstripping the number of people believed to actually have this health condition.
- Currently a produced labeled gluten-free may still contain some ingredients that normally contain gluten, such as wheat, as long as they have been processed to remove gluten to a level below 20 parts per million.
- The labeling of gluten as an ingredient in restaurant food remains voluntary. The gluten-free labeling rule by the U.S. Food and Drug Administration (FDA) for processed foods went into effect in August 2014. The 20 parts per million standard also applies to any cross-contamination of foods that may occur in the manufacturing process.
Beware that gluten-free marketplace is highly commercialized. Gluten-free foods may have a different taste and mouthfeel and texture so some manufacturers add fat and sugar to improve taste. Remember, junk food can still be gluten-free since gluten-free food may be made with refined flours and starch -like white rice, milled corn or tapioca starch. Look for gluten free products made with whole grains (or pseudograins) like millet, amaranth, buckwheat, whole corn, brown or wild rice or gluten-free oats. To make matters worse, many refined gluten-free foods are not enriched or fortified -look for gluten-free, enriched products.
Fresh and frozen fruits and vegetables are naturally gluten-free but beware of hidden gluten. Soups and sauces are one of the biggest sources of hidden gluten since manufacturers have been known to “thicken” their products with wheat thickener. A food can still contain wheat or barley for instance as long as the 20 parts per million standard is followed. According to the FDA, over 3 million Americans live with celiac disease. People with celiac disease and its much milder cousin non-celiac gluten-sensitivity must avoid gluten and look for the label “certified gluten-free.”
Gluten sensitivity, intolerance?
Gluten sensitivity: a relatively common nutrition based concern that has been often confused with true celiac disease -a much more serious and less common condition. Gluten sensitivity is a condition with symptoms similar to those of celiac disease that improves when gluten is eliminated from the diet. In an effort to clarify the terms about gluten and related disorders a select group of experts have published an authorities set of guidelines called the Osler definitions.
The term gluten intolerance is often used to describe gluten sensitivity but the term is non-specific and carries with it weaknesses and contradictions. Although gluten intolerance could be a consequence of poor digestion, it could also be the effect of some lectin-like properties of gluten or foods generated from gluten that cause GI upset. Another problem adding to more confusion is that gluten intolerance may not truly reflect intolerance to gluten but to other wheat components. Because of these contradictions, the term gluten intolerance should not be used and gluten-related disorders is preferred term.
There is no cure for gluten-related disorders and the only treatment is a life-long gluten-free diet. Grains like amaranth, quinoa, rice, corn and buckwheat are an alternative for people with celiac disease and/or who are allergic to wheat and other gluten-containing grains.
People with gluten sensitivity can experience many different types of symptoms intermittently. Some of the symptoms reported with gluten sensitivity include: bloating, diarrhea, constipation, abdominal pain, bone or joint pain, chronic fatigue, headache, depression, “foggy mind”, and even ADHD-like behavior.
While these are also common symptoms of celiac disease, these individuals do not test positive for celiac disease or for a wheat allergy and do not have the abnormal small bowel biopsy abnormality or develop the tissue transglutaminase (tTG) antibodies found in celiac disease. Those with gluten sensitivity do not have an autoimmune disease and those with it have a less serious condition than celiac disease.
Celiac disease: a much more serious disease chronic immune-mediated disorder that develops in genetically susceptible persons and may present with diarrhea, fatty stools (steatorrhea), and malabsortion. An abnormal genetic test can confirm this diagnosis. Recent estimates are it affects 1% of the worldwide population and in the United States an increase in the prevalence of the disease by four-fold since 1950 has been reported. Malabsorption can causes anemia, bone loss, and weight loss or growth failure. It is now defined as ‘a chronic small intestinal immune-mediated enteropathy brought on by exposure to dietary gluten in genetically predisposed individuals. A rare form of dermatitis has been associated with celiac disease.
- A diagnosis can be reached by undergoing an out-patient procedure called an endoscopic biopsy performed by a gastroenterologist. People with celiac disease who eat gluten have higher than normal levels of gluten antibodies and a simple blood test can often screen for celiac disease. Genetic testing can also be used to rule out celiac disease especially when one is already on a gluten-free diet. The medical and scientific community now believes celiac disease is an autoimmune condition triggered by the consumption of gluten (-a more common autoimmune illness is rheumatoid arthritis).
People with celiac disease can have deficiencies in iron, calcium and vitamin D, zinc, B6, B12, and folate before therapy with a gluten-free diet. Gluten-free grains and other starch-containing foods are: rice, cassava, corn (maize), soy, potato, tapioca, beans sorghum, quinoa, millet, buckwheat groats (also known as kasha), arrowroot, amaranth, teff, flax, chia, yucca gluten-free oats, nut flours.
Gluten is an important protein component of wheat and other plant-based foods. A relatively rare disease called celiac disease is an autoimmune condition triggered by the consumption of gluten.
The Oslo definitions for coeliac disease and related terms. Gut. 2013 January ; 62(1): 43–52.