Gluten Free Diet (Step 1)

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 tool.
• 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 period.
• 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 diet?
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.

Grains and Ingredients	Foods
Barley	Barley is found in commercial products like malt, flavorings, colorings, and beer. Barley is also part of hydrolyzed plant proteins and vegetable proteins.
Bulgar	Bulgar is a quick cooking form of whole wheat and is found in Middle Eastern cuisine like tabbouleh, pilafs, breads, and soups.
Couscous	Couscous is made from semolina of hard wheat and is usually found in packaged grain products.
Durum	Durum has a high gluten content and is used primarily in pasta.
Food starch	Food starch is sometimes wheat starch which is a by-product of wheat processing and is added to some food items during processing.
Graham flour	Graham flour is wheat flour (not to be confused with gram flour from chickpeas).
Kamut	Kamut is found in whole grain flour, breads, cereals, pastas and chips.
Matza	Matza is found in traditional Jewish unleavened bread made from wheat.
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	Rye is used as flour for bread and also fermented to produce alcoholic beverages.
Semolina	Semonlina is a coarsely ground durum wheat that is used primarily in pastas.
Spelt	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	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, pretzels, etc.

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:
Modified food starch: it may be made with corn, wheat, potato, or tapioca
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!