Gluten Free: Is it a new fad diet?
Shawn H. Dolan, PhD, RD, CSSD
What is gluten?
Gluten is a storage protein in wheat, rye, barley, triticale (cross
between wheat and rye), and possibly oats. Gluten consists of two
proteins gliadin and glutenin. Gluten is formed when dough is made
from the kneading process of flour and water.
Why do people eliminate gluten from their diet?
There are a variety of reasons people follow a gluten free diet
(GFD). Some people choose to while others must in order to prevent
adverse effects on their gastrointestinal (GI) system. Consider
some of the following reasons people follow a GFD.
- Individuals who are diagnosed with celiac disease follow a
strict GFD as their treatment plan. Celiac disease is a permanent
intolerance to gluten. The walls of the small intestine, which are
necessary for absorbing and digesting nutrients, become inflamed
and interfere with absorption. Injury to the intestinal walls
usually resolves itself when gluten and gluten containing products
are eliminated. The disease affects as many as 1 in every 200-400
individuals in North America and Europe. However, many cases go
undiagnosed due to the vague nature of and wide variety of
symptoms. The disease is diagnosed with a biopsy of the small
intestine. A blood test can measure the level of antibodies to
gluten, but is limited as a screening tool rather than a diagnostic
- Some individuals have an intolerance or sensitivity to gluten,
but are not diagnosed with celiac disease. These people often
experience GI symptoms and begin to experiment by eliminating
different foods from their diet (e.g. lactose, gluten, sugar).
- Individuals who follow extended cleansing programs often are
instructed to eliminate gluten from their diet during this
- Athletes involved in weight class or aesthetic sports sometimes
choose to eliminate gluten surrounding competitions. The goal is
follow a low residue diet by eliminating gluten and minimizing
sodium and fiber 24-36 hours prior to competition. This minimizes
fluid retention and assists with emptying the gut of undigested
food and fiber. This method helps athletes “feel light” while still
fueling and hydrating adequately prior to competitions.
- Recently, there are individuals who experiment with GFD who do
not have an intolerance or sensitivity to gluten. These individuals
simply believe they feel better, perform better, or lose weight
easier when they do not eat gluten and gluten containing foods.
Keep in mind, by following a GFD, you often eliminate processed,
packaged, and fast foods. Be sure to ask yourself “Is it the
elimination of gluten or other qualities of the foods you
eliminated that makes you feel better?”
It is interesting to note that more products are developed and
marketed, than the amount of celiac disease consumers!
What foods should be avoided when following a gluten free
It is important to become “ingredient wise” if you need to or
choose to eliminate gluten from your diet. The following table
includes ingredients as well as foods to eliminate. Some foods are
obvious like breads, cereals, pastas, and cakes. However, there are
also less obvious foods that contain additives or thickeners in the
form of gluten like soups and sauces.
At this point, you may be asking yourself what are some
alternative grains and ingredients I can eat if I eliminate gluten
from my diet?
A few grains/foods are questionable:
|Grains and Ingredients
||Barley is found in commercial products like malt, flavorings,
colorings, and beer. Barley is also part of hydrolyzed plant
proteins and vegetable proteins.
||Bulgar is a quick cooking form of whole wheat and is found in
Middle Eastern cuisine like tabbouleh, pilafs, breads, and
||Couscous is made from semolina of hard wheat and is usually
found in packaged grain products.
||Durum has a high gluten content and is used primarily in
||Food starch is sometimes wheat starch which is a by-product of
wheat processing and is added to some food items during
||Graham flour is wheat flour (not to be confused with gram flour
||Kamut is found in whole grain flour, breads, cereals, pastas
||Matza is found in traditional Jewish unleavened bread made from
|Oats and oat bran, fiber, gum
||Oat bran, oat fiber, and oat gum are found in a variety of
processed products. There is conflicting evidence regarding oats
and GDF. Most people with celiac disease eliminate oats to avoid
cross-contamination of gluten from wheat products.
||Rye is used as flour for bread and also fermented to produce
||Semonlina is a coarsely ground durum wheat that is used
primarily in pastas.
||Spelt is found in whole grain and white flours as wells as
processed products like pastas, cereals, pre-packaged bread, and
muffin and pancake mixes.
||Triticale is a hybrid of wheat and rye. It is often included in
pre-prepared muffin mixes and cereals.
|Wheat (berry, germ, germ oil, nut, starch)
||Wheat berry is the kernel of wheat. Wheat germ is the embryo of
wheat. Wheat is found in breads, cereals, pastas, crackers,
Modified food starch: it may be made with corn, wheat, potato, or
Udon noodles: may be made from wheat or corn
What symptoms should I look for if I think I am sensitive or
intolerant to gluten?
As previously mentioned the symptoms can be vague and cross a wide
spectrum. The most common include diarrhea, anemia (due to poor
absorption of iron, vitamin B12, folate), bloating, weight loss,
fatigue, indigestion, abdominal pain, loss of appetite, decline in
athletic performance, abdominal pain, fertility, and mouth ulcers.
You will notice that many of these symptoms could easily be
associated with other conditions. Individuals commonly go
undiagnosed or may be misdiagnosed with other diseases such as
Chron’s disease, irritable bowel syndrome, eating disorder, anemia,
Addison disease, rheumatoid arthritis, lactose intolerance,
depression, and type I diabetes.
If you have celiac disease or choose to follow a GDF for other
reasons it is important to be aware of the nutrient quality of
wheat and grain alternatives you include. By eliminating gluten and
foods that contain gluten, you may also be compromising your intake
of B vitamins, iron, and dietary fiber. Some of the commercially
available gluten free products are enriched and fortified, however,
not all are. In addition, many of the gluten free products are made
from rice, corn, tapioca or potato starches which typically have
lower fiber content. Furthermore, in order to make up for lost
flavor, some gluten free products add fat to the ingredients.
Remember to read labels and become “ingredient wise” if you choose
to or need to follow a GFD!