Do You Eat a Gluten Free Diet?

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Gluten + Grains Description

What is Gluten

Two of my goto’s, HealthLine and PubMed, indicates that “gluten” is a collective term that refers to many different types of proteins (prolamins) found in wheat, barley, rye, and triticale (a cross between wheat and rye).

• The gluten or prolamins for wheat include gliadin and glutenin.
• The barley has one called hordein.

Gluten Forms Bread

To make raised, yeast bread we combine gluten flour, liquid (water, milk), sugar, yeast, and salt. The flour and liquid provides an environment for the yeast, and sugar provides the food. The gluten in the initial dough (flour and liquid) forms a sticky, stretchy network that supports the dough raising. Additionally, the yeast emits alcohol and carbon dioxide gas as a byproduct of eating and growth, which is contained in that gluten-based fibrous network and thus allows bread to become light and fluffy. The kneading of the dough reinforces the gluten structures.

• In modern day, people with Western-type diets may consume ~5-20 grams of gluten grains/foods per day.
• Whereas people with celiac disease can safely tolerate only up to ~20 ppm of gluten (1).

Where is Gluten

Gluten is found in some grains, and extracts.

• Wheat and types of wheat: durum, emmer, semolina, spelt, einkorn, Khorasan wheat, farro, wheat berries
• Milled wheat: farina, graham
• Barley and malt: malt extract, malt vinegar, and brewer’s yeast
• Rye
• Triticale: a cross between wheat and rye

Grains and gluten show up in processed foods as: starch, modified food starch, hydrolyzed vegetable protein, hydrolyzed plant protein, textured vegetable protein, dextrin, maltodextrin, glucose syrup, caramel, malt flavoring, malt extract, malt vinegar, and brown rice syrup.

Gluten Still a Scientific Question

Gluten + Wheat Under Research

The issue here is that studies indicate many ailments are self-identified as gluten-related, but in fact can be caused by all sorts of aspects of grains or other causes that are not gluten related. This ”overuse” of gluten, named as the cause of illnesses, has resulted in confusion on exactly what is happening within a person’s body. Meanwhile, scientists are looking into all sorts of areas to find out what is happening regarding wheat and gluten.

Some current scientists are specifically researching glycolipids, and others are looking into FODMAPS, as the cause of digestive discomfort.

• FODMAPS (oligosaccharides, disaccharides, monosaccharides, and polyols) are short chain carbohydrates that are poorly absorbed in the small intestine and are prone to absorb water and ferment in the colon (2).
• Glycolipids are lipids with a carbohydrate attached by a glycosidic (covalent) bond. Their role is to maintain the stability of the cell membrane and to facilitate cellular recognition, which is crucial to the immune response and in the connections that allow cells to connect to one another to form tissues (3).

But right now, science considers the vast majority of people are symptomatic free, showing no sensitivity. After-all, the argument goes, we have been consuming bread for ages. But, at the same time, science shows obvious allergies, sensitivities, and disease that requires some people to avoid grains and gluten. The ongoing question is why?

Gluten is Evil?

There are millions of words written on “gluten,” in part, because of the diseases some say it causes. Harvard explains that for people with celiac disease, even one small crouton in a salad can set off a reaction that leads to: gluten in the bloodstream trigger[ing] an immune response that damages the lining of the small intestine. This can interfere with the absorption of nutrients from food, cause a host of symptoms, and lead to other problems like osteoporosis, infertility, nerve damage, and seizures.

Additionally, many medical professionals and scientists insist that the majority of people eating gluten-free do not have an issue with any aspect of wheat or gluten and are either being misled or are jumping onto the newest diet fad. In fact, given how few people actually have a gluten-related disease, Harvard writes that: according to a survey by the Consumer Reports National Research Center published in 2014 a full 63% of Americans believe that a gluten-free diet could improve their mental or physical health. 

Important Stats

Of the 7.8B people on earth, only 1% of the world’s population has celiac disease (4), while 0.5% have wheat allergies (5), and .5% to .13% people have non-celiac gluten sensitivity (6). Whereas, the number of USA people with celiac disease is 2M (7), but well over 30% of people (or ~84M) avoid gluten in the USA.

• Down syndrome
• Turner syndrome
• Williams syndrome.

Who Needs a GF Diet

The MayoClinic and HealthLine indicate that people with these conditions should consider a GF diet:

• Confirmed celiac disease: This is an inflammatory autoimmune disease caused by both genetic and environmental factors. The worldwide prevalence of celiac disease is 1.4% based on blood tests and 0.7 % based on biopsy results and 60%-70% are female (8).
• A gluten-sensitivity or allergy: Anyone with an abnormal immune response to specific proteins in wheat and wheat products. Research has shown this is mainly a child’s problem, not adults, and is more a wheat allergy rather than a gluten issue; in fact, 1% of USA children have a wheat allergy (9).
• Non-celiac gluten sensitivity (10): This condition is where there is no celiac disease, yet there is a negative biologic response to gluten. Between 1% – 13% of USA people have non-coeliac gluten sensitivity.
• The skin disorder dermatitis herpetiformis (11): A chronic, very itchy skin rash made up of bumps and blisters, unknown causes but some suggest gluten is a probability.

Then there are some issues that a GF diet MAY or MAY NOT help with, and those include many commonly known diseases and conditions. The scientific thinking is that autoimmune diseases may share common genes and immune pathways with celiac disease (12, 13, 14) .

• People with irritable bowel syndrome.
• The neurological disorder gluten ataxia.
• Enteropathy related to Type 1 diabetes or HIV.
• Hashimoto’s thyroiditis, Grave’s disease, and rheumatoid arthritis.

Myths About Gluten Free

Many myths are being shared among my peers and friends, where anecdotes are rated almost as important as direct research. Whereas to me, anecdotes are only one stream of information, another is scientific research, another would be counter opinions (and I have very vocal friends who are anti-Western medicine), and last would be my own experience. So here are what I consider gluten myths.

• Gluten free equates to low carbohydrates or low calorie consumption. So this is not true, and going gluten-free is not a weight loss program.
• A gluten free diet automatically means a healthy diet. While not true, given how many fast and processed foods have hidden wheat, getting off gluten could mean eating a healthier diet. USANews writes: 41 percent of U.S. adults believe “gluten-free” foods are beneficial for everyone, especially when many of those foods are often lower in nutrients and higher in sugars, sodium and fat than their gluten-free counterparts. And much of the growth in the category is coming from cookies, crackers, snack bars and chips.
• Gluten free grains are more healthy than gluten-containing whole grains (15). A whole grain contains all three of the main parts of the grain (endosperm, bran, and germ). It has not, in other words, been refined and stripped of important nutrients. Gluten free grains are only whole grains if they are labeled as such.
• Gluten is a toxin. This is only true to people who have allergies or diseases where gluten triggers a response. A recently published study in the journal Digestion found that 86% who believed they were gluten sensitive, could in fact tolerate it.
• Anyone can tell when a food has gluten. Some foods with “hidden gluten” are made with “natural flavorings,” which is also true for vitamins and mineral supplements, some medications, beauty products, and even toothpaste.
• Gluten-Free means free of gluten. The reality is that current testing methods for gluten will only go to 3-5 parts per million (ppm) at the lowest (16). What this means is a “gluten-free” label means there could still be gluten in the food. For some people this may not be low enough and many processed foods will have to be avoided.

Skills to Go GF

• Learn to read food packaging labels, not just the obvious “wheat”: watch for barley, rye, brewer’s yeast, spelt, farro, oatmeal, wheat germ, wheat bran, soy sauce, malt, and barley malt, among others.
• Be aware of food processing cross-contamination: many processed foods will indicate if the product was made in a plant that also processes wheat, soy, shrimp, nuts, and other allergens.
• Some GF flours may not be as healthy as others: rice flour is carb rich, others like coconut flour, buckwheat flour, almond meal, chickpea flour, and sorghum flour are better. 
• Avoid too many GF packaged or bakery foods. When looking at the ingredients, most GF products happen to be unusually and highly processed as they attempt to replicate the effects of gluten. So eat them in moderation.
• Be well-fed and well-nourished. Celiac and other diseases or food-habits can cause malnourishment. You need to remember to eat a variety of in-season, colorful, vegetables and fruit. But also your doctor may recommend supplements in some severe cases.
• Separate out cookware and eating utensils. Hopkins suggests keeping the cooking areas completely gluten free if you have celiac disease or are highly allergic to gluten.
• For food items, when in doubt leave it out according to ClevelandClinic.

Gluten Free Cereals + Flours

Here are some of the starchy foods that are considered gluten free and GF flours:

• Amaranth seeds + flour
• Arrowroot
• Quinoa seeds
• Beans and bean flours like Garbanzo
• Buckwheat or groats (aka Kasha)
• Casava
• Chia
• Teff
• Millet
• Corn (in all its forms): grits, flour, polenta, tortillas, cornstarch, etc.
• Flax seeds
• Rice: white, brown, red, black, or green seeds, rich flour
• Oats (look for gluten free label)
• Sorghum
• Potato flour
• Nut flours like Almond flour
• Tapioca
• Yucca
• Plantains

Gluten is Hidden

What surprised my spouse was that gluten-based wheat or other gains are hidden in all sorts of processed food and medications.

Medication – Vitamins- Supplements

Wheat is often used as a filler for medications, vitamins, or supplements. This means you need to speak with your doctor or pharmacist to make sure you have GF pills.

Sweets

Watch out for flavored ice cream, actually ask if they have any GF products. Also candy (often uses malt), energy bars, and granola bars.

Chips + Fries

So while corn chips and potato fries, in the raw, are gluten free; once processed by manufacturers or estaurants they are mixed with gluten or doused in flour which makes them gluten products. Also remember, if the cooking of these things are not isolated from other items in the kitchen, the oil where gluten is fried becomes the same oil where gluten-free products are fried and cross contamination occurs. So consider fast food as contaminated unless they are advertised as GF.

This cross-contamination also occurs with oats in that they are processed in the same production facilities as other cereals. So unless oats specify GF do not assume they are.

Meat- Fish- Fowl

Be careful about hydrolyzed wheat protein in some meat products. All processed meat are capable of being made with wheat or gluten items so ask for ingredients. Especially look out for self-basting poultry or pre-seasoned turkey breast.

But similar to other processed food, veggie burgers, veggie sausage, veggie bacon, crumbles, imitation seafood (and seitan of course) almost always, in my experience, have gluten.

Drinks

Gluten may be in: flavored coffees, flavored teas, beer (there is gluten free beer, but honestly they taste terrible to me). Ale, lager and malt beverages may also contain gluten. 

Wine is naturally gluten-free. Distilled alcohol (e.g., gin and vodka) are considered safe for people with celiac disease.

Dressings + Sauces

Even if using homemade chicken broth, if the cook left the skins on from a fast food chicken (coated in flour and fried), they may have accidentally introduced gluten into their broth.

My Family Story

My spouse’s chiropractor suggested a gluten-free diet to address many smallish issues currently being discussed by the two. So we thought about a trial run to see how it went. Although trying hard, since the whole family is not going gluten-free, we are doing a so-so job at it. No separate cooking or eating spaces for example, but also my spouse is not consuming any obvious gluten-based foods. Luckily, my spouse is also not having any wheat or gluten-related disease, allergy or sensitivity ailments.

While not questioning my family and friends who are eating gluten-free, I tend to agree with USANews that just like celiac disease and wheat allergies, gluten sensitivity is not as prevalent as many believe. What’s more, eating a gluten-free diet isn’t necessarily healthier, nor is it recommended for weight loss. But I would add, if you have a sensitivity, allergy, or disease response to wheat or gluten, definitely avoid it! The issue is “quality of life” rather than what science is able to prove. Just pay attention to nutritional deficiencies and make necessary adjustments.

I know of someone who cannot eat gluten bread in the USA,, but once she moved to France, she could eat their bread. One idea is related to pesticides we may be using on our farms, or perhaps the flour is different. I will be doing a post on the different flours used in the USA and Europe, so keep reading. Meanwhile, what do you think?

—Patty

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