Gluten-free diet. What is a gluten-free diet?

What is a gluten-free diet?

Gluten is a protein found in wheat, barley and rye. Going gluten-free means avoiding all of these foods, which are commonly found in everyday foods such as bread and pasta, as well as sauces and many processed foods. A gluten-free diet is not the same as a wheat-free diet, where wheat alone must be excluded, but the gluten-containing barley and rye can still be eaten freely.

Gluten is wheat gum, the insoluble component of grains (such as wheat, barley, and rye). It is a mixture of gliadin, glutenin, and other proteins. Gluten causes allergy-like reactions in certain people. While a gluten-free diet is the primary therapeutic treatment for celiac disease, this diet may also help a host of other conditions, including dermatitis herpetiformis, psoriasis, rheumatoid arthritis, HIV enteropathy, and schizophrenia.

Why do people follow this diet?

When someone has celiac disease the lining of their intestine is actually damaged by gluten, but their symptoms should disappear on a gluten-free diet. People with IBS who find that gluten can be a trigger will not be damaging the lining of their intestine if they eat gluten, just exacerbating their symptoms.

Celiac disease (also called gluten enteropathy) is a disorder of the small intestine characterized by sensitivity to gluten. In people with celiac disease, eating gluten causes inflammation in and damage to the lining of the small intestine, resulting in diarrhea, malabsorption, fat in the stool, and nutritional and vitamin deficiencies.

Oats are somewhat controversial on a gluten-free diet, because some people who have celiac disease seem to be able to eat them without symptoms, and others do not. Oats do contain a protein which is similar to gluten, which may cause the problem, or it could be that oats are often processed in a factory alongside wheat and other gluten-containing foods, and so become contaminated with small amounts of gluten.

A gluten-free diet is the primary treatment for celiac disease. Strict avoidance of wheat, barley, and rye (the three most abundant sources of gluten) usually improves gastrointestinal symptoms within a few weeks, although in some cases improvement may take many months. Some people with celiac disease must remove all gluten-containing foods from their diets in order to relieve symptoms. Following a gluten-free diet has been shown to reduce the incidence of cancer, low bone mineral density, and infertility in persons with celiac disease.

What foods are avoided?

Patients avoid all wheat, barley and rye (and sometimes oats as well), but they must also take care to avoid gluten in a wide range of other foods.

People with dermatitis herpetiformis may benefit from following a gluten-free diet. The cause of dermatitis herpetiformis is mainly an allergic-type reaction. Gluten-sensitivity enteropathy is found in 75 to 90% of people with dermatitis herpetiformis. Unlike celiac disease, however, gastrointestinal symptoms are mild or absent. Strict adherence to a lifelong gluten-free diet can eliminate dermatitis herpetiformis symptoms and intestinal abnormalities, as well as reduce or eliminate the need for medication in most people.

Some food items which may contain gluten include:

• soups;
• sausages;
• processed meats such as slices of ham;
• ready meals;
• crisps and potato chips.

However, an average of 8 to 12 months of dietary restriction may be necessary before symptoms resolve. Not all people with dermatitis herpetiformis improve on a gluten-free diet. Preliminary studies indicate sensitivity to other dietary proteins may be involved.

Anecdotal evidence suggests that people with psoriasis may improve on a hypoallergenic diet. Three trials have reported that eliminating gluten (as found in wheat, rye, and barley) improved psoriasis for some people. A doctor can help people with psoriasis determine whether gluten or other foods are contributing to their skin condition.

Some people find that they can eat small amounts of gluten without any problems, and so would not need to worry about things such as potato chips which would probably only use gluten in the flavorings.

Preliminary evidence suggests that a gluten-free diet may help improve symptoms of rheumatoid arthritis. In one trial, 14 weeks of a gluten-free (no wheat, rye or barley), pure vegetarian diet, gradually changed to a lactovegetarian diet (permitting dairy), led to significant improvement in rheumatoid arthritis as evidenced by associated symptoms as well as by objective laboratory measures of disease.

Are there any long-term problems with this diet?

Totally eliminating gluten from the diet is not easy, and it does require vigilance to make sure that gluten does not sneak into the diet. However, many patients do benefit from a gluten-free diet and so it can be worth the effort.

HIV enteropathy, a complication of AIDS that is characterized by weight loss and chronic diarrhea, may respond to a gluten-free diet. In a preliminary trial, men with HIV enteropathy experienced a reduction in the number of episodes of diarrhea as well as significant weight gain while following a gluten-free diet.

For many years, researchers have been speculating that certain dietary proteins, including gluten, may contribute to the symptoms of schizophrenia.

These days there are a wide variety of specially-made gluten-free foods including breads, cakes and pasta. These are often more expensive than their gluten-filled equivalents and may not taste quite the same, but they can still be useful. You can also buy gluten-free flour to bake with... [read more]

People with schizophrenia are more likely to have immune-system reactions to gluten than the general population, according to some studies. While clinical research findings have been inconsistent, some, but not all, people with schizophrenia may benefit from a gluten-free (and dairy-free) diet.

What are the symptoms?

Allergy to wheat gluten is quite common. One way to determine if gluten is causing problems is to avoid it strictly for several weeks to see if any change occurs. Another method is to have a blood sample taken and tested for gluten antibodies. While a blood test for wheat allergy could be negative, there may be reactivity to digestive by-products of wheat.

The gluten-free diet requires a completely new approach to eating. With practice, screening for gluten becomes second nature and people learn to recognize which foods are safe and which are not.

A gluten-free diet means avoiding foods that contain wheat (including spelt, triticale, and kamut), rye, barley, and possibly oats or, in other words, most grain, pasta, cereal, and many processed foods. Despite these restrictions, people with celiac disease can eat a varied, well-balanced diet, including bread and pasta. Instead of wheat flour, for example, people can use potato, rice, soy, or bean flour. Gluten-free bread, pasta and other products are available from specialty food companies.

Some celiacs are able to eat oats without having a reaction but others are not. Plain meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can eat as much of these foods as they like. Examples of foods that are safe to eat and those that are not are provided below.

Individuals who are sensitive to gluten may have the following symptoms:

• Abdominal cramping and pain,
  
  
• Bloating and flatulence,
  
  
• Bone and joint pain,
  
  
• Canker sores,
  
  
• Chronic diarrhea,
  
  
• Delayed growth or short stature,
  
  
• Dyspepsia,
  
  
• Emotional disturbances, such as anxiety and depression,
  
  
• Fatigue,
  
  
• Infertility,
  
  
• Painful skin rash,
  
  
• Weight loss.
  
  

What do I need to avoid?

Examples of a gluten-free diet.

The following list shows examples of many foods that are allowed or avoided, but it is not a complete list. It is important to read all food ingredient lists carefully to make sure that the food does not contain gluten.

To avoid gluten, ask about ingredients at restaurants and others’ homes, and read food labels. Avoid questionable products until the manufacturer guarantees they are gluten-free. Recheck products regularly as ingredients may change.

Beginning in 2006, food labels in the US must accurately declare in a special “allergy statement” if wheat protein, even in small amounts, is present in an ingredient used in that food. However, this regulation does not pertain to other gluten-containing grains, so labels must still be checked carefully for those sources.

Beverages.

• Allowed: Coffee, tea, carbonated drinks, wine made in U.S., rum, some root beer.
• Avoid: Ovaltine, malted milk, ale, beer, gin, whiskey, flavored coffee, herbal tea with malted barley.

At home, care should be taken to keep gluten-containing itemsfoods used by other members of the household from contaminating cooking appliances, food-preparation surfaces, utensils, shared condiment jars, and so forth.

The following list is not complete. Consult with a healthcare professional before making any significant changes to your diet. Grains and grain products to avoid (check ingredients of breads, breading, cereals, coating mixes, crackers, croutons, fried snacks, muffins, pasta, pastries, stuffing, and so on):

Milk.

• Allowed: Fresh, dry, evaporated, or condensed milk; cream; sour cream; whipping cream; yogurt.
• Avoid: Malted milk, some commercial chocolate milk, some nondairy creamers.

• Barley,
  
  
• Bulgar,
  
  
• Couscous,
  
  
• Dinkle,
  
  
• Einkorn,
  
  
• Emmer,
  
  
• Farina,
  
  
• Faro,
  
  
• Flour: any made from grains on this list; bread, brown, durum, granary, strong, and whole-meal flour usually indicate flours containing gluten,
  
  
• Kamut,
  
  
• Malt,
  
  
• Matzo,
  
  
• Oats and oat bran*,
  
  
• Orzo,
  
  
• Panko,
  
  
• Rye,
  
  
• Seitan,
  
  
• Semolina,
  
  
• Spelt,
  
  
• Triticale,
  
  
• Udon,
  
  
• Wheat,
  
  
• Wheat bran,
  
  
• Wheat germ.
  
  

Meat, Fish, Poultry.

• Allowed: Fresh meats, fish, other seafood, and poultry; fish in canned oil, brine, or water; some hot dogs and lunch meats.
• Avoid: Prepared meat containing wheat, rye, oats, or barley; tuna canned in vegetable broth.

*While oats contain a substance similar to gluten, modern research has found that eating moderate amounts of oats does not appear to cause problems for people with celiac disease or dermatitis herpetiformis. However, oats may be contaminated with gluten from other grains during processing; therefore only useing only oat products tested and guaranteed to be free of gluten is recommended.

Other food products and ingredients that may contain gluten (check labels or manufacturer for ingredients from the list above):

Cheese.

• Allowed: All aged cheese, such as cheddar, Swiss, edam, parmesan; cottage cheese; cream cheese; pasteurized processed cheese; cheese spreads.
• Avoid: Any cheese product containing oat gum, some veined cheeses (bleu, stilton, roquefort, gorgonzola).

• Ale, beer, stout, lager;
  
  
• Broth;
  
  
• Brown rice syrup;
  
  
• Candy;
  
  
• Cloudy lemonade;
  
  
• Curry mixes;
  
  
• Dried meals;
  
  
• Egg substitutes;
  
  
• Flavored instant coffee;
  
  
• Ginger beer;
  
  
• Grain spirits;
  
  
• Gravy cubes and mixes;
  
  
• Hot chocolate mixes;
  
  
• Hydrolyzed vegetable protein (also called hydrolyzed plant protein or protein hydrolysate) if made from wheat;
  
  
• Ice cream;
  
  
• Imitation bacon and seafood;
  
  
• Licorice;
  
  
• Malt vinegar (distilled vinegars are gluten-free);
  
  
• Marinades;
  
  
• Mustard powder;
  
  
• Nondairy cream substitutes;
  
  
• Nuts, dry roasted;
  
  
• Prepared meats (bologna, lunch ham, and so on);
  
  
• Rice paper;
  
  
• Root beer;
  
  
• Roux;
  
  
• Sauces and sauce mixes;
  
  
• Self-basting poultry;
  
  
• Soup and soup mixes;
  
  
• Soy sauce and shoyu tamari;
  
  
• Starch, when labeled as wheat starch, modified food starch, or vegetable starch;
  
  
• Stock cubes;
  
  
• Suet in packets;
  
  
• Thickeners.
  
  

Potato or Other Starch.

• Allowed: White and sweet potatoes, yams, hominy, rice, wild rice, gluten-free noodles, some oriental rice and bean thread noodles.
• Avoid: Regular noodles, spaghetti, macaroni, most packaged rice mixes, seminola, spinach noodles, frozen potato products with wheat flour added.

Be careful of the following personal and over-the-counter items, which may contain small amounts of gluten:

• Communion wafers;
  
  
• Glue (US-made envelope glue is reportedly gluten-free);
  
  
• Lipstick, gloss, and balms;
  
  
• Prescription and over-the-counter medications listing gluten, starch, flour, or dusting powder as excipients;
  
  
• Supplements listing gluten, starch, flour, or dusting powder as excipients.
  
  

Cereals.

• Allowed: Hot cereals made from cornmeal or other corn-based cereal, Cream of Rice, hominy, rice; Puffed Rice, cereals made without malt.
• Avoid: All cereals containing wheat, rye, oats, or barley; bran; graham; wheat germ; durum; kaska; bulgar.

Best bets.

• Amaranth;
  
  
• Arrowroot;
  
  
• Bean or pea flours;
  
  
• Buckwheat*;
  
  
• Corn;
  
  
• Flaxseed;
  
  
• Fruit, not dried or in commercial pie fillings;
  
  
• Meat, poultry, fish not processed with gluten-containing addititives, not breaded, and without gravies or sauces;
  
  
• Milk products, not malted or flavored;
  
  
• Millet;
  
  
• Montina;
  
  
• Nut and seed flours;
  
  
• Potato flour, potato starch;
  
  
• Quinoa;
  
  
• Rice and rice bran;
  
  
• Sago;
  
  
• Sorghum;
  
  
• Soy flour;
  
  
• Tapioca;
  
  
• Teff;
  
  
• Vegetables, not creamed or breaded;
  
  
• Wild rice.
  
  

Vegetables.

• Allowed: All plain, fresh, frozen, or canned vegetables; dried peas and beans; lentils; some commercially prepared vegetables.
• Avoid: Creamed vegetables, vegetables canned in sauce, some canned baked beans, commercially prepared vegetables and salads.

While wheat is one of the major gluten-containing grains, it is important to remember that “wheat-free” does not mean “gluten-free.” Make sure to carefully read food labels to determine if an item features gluten-containing items.

Prepare a note card with the foods that you need to avoid and bring this with you when food shopping or dining in restaurants. Communicate your special needs to the waiter or manager so that they can guide you to dishes that do not contain gluten.

Fruits.

• Allowed: All fresh, frozen, canned, or dried fruits; all fruit juices; some canned pie fillings.
• Avoid: Thickened or prepared fruits; some pie fillings; raisins and dried dates that have been dusted with flour... [read more]

Gluten allergies can often start in childhood as a result of early feeding of grains; consider breast-feeding your child for the first six months.

Be careful when buying grains from bulk bins. Make sure that the grains are adequately separated from the gluten-containing grains in order to avoid cross-contamination.