Gluten-free restaurants and gluten-free foods are getting more and more common. And we all have at least one friend that has gone gluten-free and can’t quit talking about how great they feel. But what is gluten? Is being gluten-free healthy or just trendy?
Gluten is the name given to specific proteins found in barley, rye, triticale, and wheat. These proteins are what give grains their structure and their chewiness. Gluten acts as a glue, binding together other ingredients when cooked.
Individuals diagnosed with celiac’s disease should avoid gluten altogether. When a person with this disease consumes gluten, it leads to permanent damage of the small intestine, causing poor nutrient absorption. According to the Celiac Disease Foundation, approximately 1 in 100 people worldwide have this serious autoimmune disorder. Make no mistake, celiac disease is a severe gluten allergy, in every sense.
But, celiac sufferers aren’t the only ones who experience side effects when they eat foods with gluten. There is also a recognized condition called non-celiac gluten sensitivity, or NCGS, that is far more prevalent than celiac disease. NCGS can cause digestive system symptoms such as abdominal pain, bloating, cramping, constipation, and diarrhea. And, when NCGS sufferers go gluten-free, often the troubling symptoms abate.
What Is Gluten?
Gluten is a type of protein found in certain grains, including barley, wheat, and rye. It can also be found in oats due to cross-contamination. Gluten gives bread its delightfully soft and chewy texture and pasta its firm structure and ability to absorb sauces.
While the vast majority of people can eat foods containing gluten without side effects, those diagnosed with celiac’s disease or gluten sensitivity would do best on a gluten-free diet.
What Is Celiac Disease?
Celiac disease is an autoimmune disorder that causes gluten to damage the small intestine. This disease is considered rare, as it affects perhaps 1% of the global population. The first symptoms of celiac disease can occur in childhood, or the symptoms may not present until adulthood.
When a person with celiac’s disease eats gluten, the immune system launches an attack inside the digestive tract that physically damages the villi that line the small intestine. The villi are slender finger-like projections that increase the surface area of a membrane and are essential for nutrient absorption. Inside each villi is an artery, a vein, a muscle, and connective tissue that all work together to transport carbohydrates and proteins efficiently.
When you have celiac’s disease and eat gluten, the villi’s ability to absorb and distribute nutrients diminishes substantially. In addition to temporary digestive distress, eating gluten can lead to the development of severe long-term health problems including:
- Additional autoimmune diseases (including MS)
- Intestinal cancers
- Vitamin and mineral deficiencies
- Early onset osteoporosis or osteopenia
- Lactose intolerance
- Central nervous system disorders
- Peripheral nervous system disorders
- Pancreatic insufficiency
- Gallbladder malfunction
- Epileptic seizures
Celiac Disease Symptoms
Children and adults often experience the symptoms of celiac disease differently. Celiac disease can be incredibly difficult to diagnose because there are more than 200 recognized symptoms of this autoimmune disease, many of which are not related to digestive distress.
Celiac disease symptoms in children may include:
- Abdominal bloating
- Abdominal pain
- Chronic diarrhea
- Unexplained weight loss
- Behavioral issues
- Delayed growth and puberty
- Defects in dental enamel
- Short stature
In adults, celiac disease causes digestive symptoms less often than in children. Adults are more likely to experience more widespread symptoms including:
- Unexplained anemia
- Bone and joint pain
- Osteoporosis or osteopenia
- Fatty liver disease
- Primary sclerosing cholangitis
- Peripheral neuropathy
- Missed menstrual periods
- Canker sores in the mouth
Testing for Celiac Disease
According to the Celiac Disease Foundation, screening for celiac disease is quite simple. A blood test is the first step to determine the level of antibodies in the blood that points to an autoimmune system disorder. It is important to note here that you must be eating gluten for this test to be accurate.
In addition to the blood test, your physician will discuss the symptoms you are experiencing in-depth and may order additional tests to check for nutrient deficiencies, bone density, liver and kidney function, and more. In some cases, your doctor may want to do a biopsy of the lining of your small intestine.
As celiac disease does have a genetic link, your physician may suggest a genetic test for you or your child. Some insurance plans in the United States will cover this expensive testing, while others won’t. Talk to your doctor about the pros and cons of a genetic test and payment options.
What Is Gluten Intolerance?
Gluten intolerance is not an autoimmune disorder that causes damage to the lining of your small intestine. Instead, it is a condition that causes troubling, sometimes debilitating, symptoms. If you have one or more celiac disease symptoms, but the blood tests come back negative, the medical community calls this “non-celiac gluten sensitivity.”
For many individuals with this condition, eating a strict gluten-free diet dramatically improves symptoms. If you notice that you experience digestive distress and other symptoms after a meal containing gluten or other common allergens, you may want to try an elimination diet to help you determine what is causing your symptoms.
Food allergies and severe food sensitivities do cause an immune system reaction that can trigger hives, swollen airways, and digestive upset. The most common food allergens according to the Mayo Clinic are:
- Cow’s milk
- Tree nuts, including walnuts
In an elimination diet, you remove all of these common food allergens, as well as all processed and pre-packaged foods. In three weeks, you start to slowly reintroduce each potential allergen back into your diet, one by one. If any symptoms occur, you can have a good idea of the foods that are causing an immune system response.
Foods with Gluten
If you are going on a gluten-free diet, it is imperative that you know where gluten hides. Yes, you will need to avoid all foods with wheat, rye, barley, and triticale, but there are derivatives of these foods that may not jump out at you on food labels. Here is a list of ingredients to avoid on a gluten-free diet.
|Graham flour||Hydrolyzed wheat protein||Kamut|
|Malt||Malt extract||Malt syrup|
|Malt vinegar||Matzo||MSG-monosodium glutamate|
|Oats, unless certified gluten-free||Rice malt||Rice syrup|
In addition to the ingredients above, it is essential to read the labels of the following foods carefully, as they often contain gluten under one or more names.
|Broth||Cereals and granola||Chocolate and chocolate bars|
|Condiments||Deli meats||Flavored coffees and teas (even “natural” varieties)|
|Frozen vegetables with sauce||Imitation bacon bits||Imitation seafood, common in sushi|
|Jerky||Lip balm and lipstick||Marinades|
|Medications (prescription and over-the-counter)||Pastas||Potato chips|
|Processed foods||Protein bars||Salad dressings|
|Sausages and hot dogs||Sauces||Seasoning mixes|
|Self-basting turkeys||Soups||Soup bases|
|Soy sauce||Toothpaste||Vegetarian meat alternatives|
Gluten-Free Diet Safe Foods
A list containing foods with gluten is overwhelming. Especially for individuals just starting a gluten-free journey. Fortunately, there are still tons of healthy foods you can safely consume if you have gluten sensitivity or celiac disease.
One of the most challenging categories people have giving up when they go gluten-free is baked goods. After all, as we mentioned above, gluten provides structure and chewiness to baked goods. Fortunately, there are great gluten-free grains and nut flours that are healthy.
- Almond flour
- Brown rice
- Coconut flour
- Chickpea flour
- Gluten-free oats
Another challenge for many individuals embarking on a gluten-free diet is giving up Japanese food, Chinese food, and Thai food. Gluten hides in rice wine vinegar, soy sauce, hoisin sauce, fish sauce, and oyster sauce. You can call around and see if there are gluten-free restaurants that offer these cuisines. Coconut aminos are often used as a soy sauce replacement, as is gluten-free tamari sauce.
And lastly, busy families can find it difficult to give up pre-packaged and prepared foods. There are new convenience foods and products coming to market every day to meet the growing need of gluten-free. But, as you will see below, just because a product is gluten-free, doesn’t mean it is safe, or healthy.
Hidden Dangers of Commercial Gluten-Free Products
Most of the commercial gluten-free products on the market today are highly processed and contain questionable ingredients according to the University of Wisconsin Hospitals and Gluten-Free Society. These products often include more sugar and salt, less fiber and protein, and more chemical stabilizers than their gluten-containing counterparts.
Tips for Living Gluten-Free
If you are going gluten-free, it is essential to understand that this is a lifestyle change and that there will be stumbles, falls, and fails. Being gluten-free makes attending parties, conventions, and business meetings difficult; you never want to be that person, but for your health, you may have to be.
You simply must be your best advocate. Learn about all the foods in which gluten hides, and speak to your doctor to understand your diagnosis. It may be wise to find a nutritionist with a specialty in gluten-free living to help you develop a healthy gluten-free diet you can stick with.
And while gluten-free products including breads, pastries, pastas, and prepared meals are available, remember that they may contain other harmful ingredients. And they can be expensive.
Cooking more at home may be a good option. There are tons of recipes online that can make gluten-free cooking easier. For one, America’s Test Kitchen has great tips for gluten-free baking, including how to make your own gluten-free flour blend. And the chefs at America’s Test Kitchen have provided tested recipes to create pie crusts, pastas, breads, cookies, cakes, and even lasagna.
Even seasoned cooks can stumble when trying to replace wheat flour with gluten-free alternatives. It is going to take some trial and error to find the gluten-free substitutes that provide you with the texture and taste of your favorite recipes.
Restaurants are not required to test foods. Foods that are indicated as gluten-free on a menu should meet the same standards of packaged foods according to the FDA. When dining in a restaurant, if you have celiac’s disease, it is important to understand the dangers of cross-contamination. According to the Center for Celiac Research, 10 milligrams per day of gluten is considered safe for the “vast majority of individuals with celiac disease.” However, 10 milligrams of gluten is roughly 1/8th of a teaspoon of wheat flour.
For safety reasons, you may choose to eat only in gluten-free restaurants. If you are attending an event at a restaurant not of your choosing, be sure to call ahead and speak with a manager about gluten-free options and what protections they have for cross contamination.
Learn to read food labels and understand them. It may be tempting to just scan the labels for “wheat” but as we listed above, there are so many names for products with gluten, as well as products where gluten can hide. A label that says, “wheat-free” doesn’t necessarily mean it is gluten-free.
There are some products now that include an allergen listing. It is typically just under the ingredient list, and it may mention common allergens or possible cross-contamination possibilities. This warning is not required by the FDA.
FDA Gluten-Free Food Label Rules
As more and more gluten-free products come to market, it is essential to understand the Food and Drug Administration’s policy on labeling “gluten-free.” First, manufacturers do NOT have to test products to have a gluten-free label according to the Celiac Disease Foundation. But the manufacturer is responsible for making sure that their product meets all labeling requirements.
Second, if you have an adverse reaction after consuming a product labeled gluten-free, please report it. Contact the FDA’s Center for Food Safety and Applied Nutrition’s Adverse Event Reporting System by calling 240-402-2405 or emailing CAERS@cfsan.fda.gov.
Under the current FDA guidelines, a product can be labeled gluten-free if:
- It is inherently gluten-free—meaning it does not contain barley, rye, wheat, or hybrids like triticale.
- It does not contain any ingredient that is derived from a gluten-containing grain.
- It does not contain an ingredient derived from a gluten-containing grain that has had gluten removed.
- It is naturally gluten-free.
- Oats, and oat products containing less than 20 ppm of gluten.
Many people with celiac disease or gluten sensitivity wonder why the FDA adopted the standard of 20 ppm of gluten as the maximum for products labeled “gluten-free.” Dr. Peter Green, the Director of the Celiac Disease Center at Columbia University, explains, “The 20 ppm is a scientifically determined level of gluten that has been shown to be tolerated by those with celiac disease.” This measurement is in line with what other countries have ruled.
Concerns and Precautions
Giving up gluten-containing foods can lead to nutritional deficiencies according to Harvard Medical School. The reason is that in the United States breads and cereals are enriched and fortified with specific nutrients including several of the B vitamins.
Getting enough fiber can be a concern too, so if you go gluten-free be sure to boost your intake of high-fiber foods. It is important to include a balance of both insoluble fiber and soluble fiber in your diet.
Whole grains should not be avoided altogether. Nutritionally, whole grains provide essential health benefits as they are rich in antioxidants and dietary fiber and they can be helpful for weight management and keeping blood sugar levels balanced.
If you have not been diagnosed with celiac disease or non-celiac gluten sensitivity, talk to your doctor before giving up gluten. In a recent study funded by the National Heart, Lung, and Blood Institute, researchers found that diets higher in gluten are associated with lower risk of type 2 diabetes. The authors of the study also note that participants in the study who ate less gluten also ate less fiber. Fiber is essential for regulating cholesterol levels and glucose levels, normalizing bowel health, and helping you achieve a healthy weight.