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Gluten-free diets seem to be the latest health craze. Many claiming to be on board tout how incredible they feel as a result. The obsession has drawn criticism and comedy alike. Late-night talk show “Jimmy Kimmel Live” hit the streets in May 2014 and asked fit and healthy looking pedestrians who claimed to live a gluten-free lifestyle if they knew what gluten was. Some fumbled; others confessed ignorance. Ultimately, nobody featured in the segment actually knew what it was they were giving up. Viewers likely laughed, rolled their eyes, and/or quickly headed to Google.
The truth is, all trendiness and humorous jabs aside, gluten-free diets can be a serious matter and there is much to know about living a gluten-free lifestyle. Books and websites are dedicated to the topic, but here are a few bits of basic information to help shed some light on gluten and gluten-free diets.
For starters, what is gluten? The Celiac Disease Foundation defines it as, “A general name for the proteins found in wheat (durum, emmer, spelt, farina, faro, KAMUT® khorasan wheat and einkorn), rye, barley and triticale.” It is present in many foods since and is used to help them maintain their shape.1
Eating gluten-free means giving up the obvious sources: breads, pastas, crackers, flour tortillas, beer, and baked goods. However, gluten may also be present in soups, French fries, salad dressing, candy, processed lunchmeats and meat substitutes. Reading labels and talking to restaurant servers is important in identifying which foods are truly gluten-free.
The Gluten Intolerance Group of North America reminds consumers that if a food label lists any of the following, it is not gluten-free2:
The Celiac Disease Foundation lists many naturally gluten-free grains on its website, including rice, cassava, quinoa, millet, flax, chia, and nut flours; click here to visit the Celiac Disease Foundation website for a more comprehensive list. The foundation also provides a more comprehensive list of foods containing gluten on celiac.org.
Adopting a gluten-free diet is necessary for many individuals with celiac disease and non-celiac gluten sensitivity. An estimated 1 in 133 Americans have celiac disease, and an estimated 83 percent of those who have it are undiagnosed or misdiagnosed with other conditions.3 Furthermore, an estimated 18 million have non-celiac gluten sensitivity—six times the amount of those with celiac disease.4
Celiac disease is defined by the National Foundation for Celiac Awareness as “an autoimmune digestive disease that damages the villi of the small intestine and interferes with absorption of nutrients.”
There are more than 300 known symptoms, including abdominal bloating and pain, chronic diarrhea, vomiting, constipation, weight loss, fatigue, short stature, and Attention Deficit Hyperactivity Disorder.5 Visit The University of Chicago Celiac Disease Center for a comprehensive list.
Untreated celiac disease can result in serious health problems, including the development of other autoimmune disorders. The only known cure, at this time, is a gluten-free diet.6
Non-celiac gluten sensitivity is, as defined by the NFCA, the term applied to those “cannot tolerate gluten and experience the symptoms similar to those with celiac disease but yet who lack the same antibodies and intestinal damage as seen in celiac disease.” In other words, with celiac disease, the body attacks and damages itself in response to consuming gluten. That is not the case for those with non-celiac gluten sensitivity, though they experience similar symptoms. As such, it is considered less severe.7
Those with non-celiac gluten sensitivity may experience symptoms for a few hours or days; however, they do not experience the intestinal damage and other long-term effects that those with celiac disease do. However, the treatment is the same; those with non-celiac gluten sensitivity must adhere to a gluten-free diet.
For both conditions, self-diagnosis is not recommended. Consult your physician for the proper tests and nutritional guidance.
On Aug. 5, 2013, the U.S. Food and Drug Administration published its rule on gluten-free labels and gave manufacturers one year from that date to comply. Per the FDA definition, manufacturers may label a food gluten-free if it does not contain any of the following:
1. An ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains
2. An ingredient derived from these grains and that has not been processed to remove gluten
3. An ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (ppm) gluten
Furthermore, the FDA states that “foods such as bottled spring water, fruits and vegetables, and eggs can also be labeled gluten-free if they inherently don't have any gluten.”
Visiting a restaurant can be frustrating to anyone new to a gluten-free diet. However, it can be an especially serious matter for those who have celiac disease and non-celiac gluten sensitivity because hidden gluten and cross contact in the kitchen can impact their wellbeing.
The Celiac Disease Foundation offers many tips, including calling the restaurant in advance, during non-peak hours, and asking the following questions:
Visit the CDF’s Dining Out page for more tips on going out to eat with celiac disease and non-celiac gluten sensitivity. Some restaurants have gone through the NFCA’s Gluten-Free Resource Education and Awareness Training (GREAT) program to learn how to implement safe gluten-free protocol—visit celiaccentral.org/kitchens to learn more.
Going gluten-free involves a bit of a learning curve, and it can be especially difficult at first. Those who do so out of medical necessity must be particularly cautious to avoid symptoms and additional health problems. They must also be sure to get enough of the nutrients they would normally get through foods containing gluten. These may include iron, calcium, fiber, thiamin, riboflavin, niacin and folate.9
Those who move to a gluten-free diet may want to work with their doctor and/or a Registered Dietician to identify new sources of these nutrients and ensure they are eating properly.
To learn more about gluten and gluten-free diets, visit theses sources, many of which were referenced in this article:
1 Celiac Disease Foundation. “Sources of Gluten.” n.d. Retrieved May 13, 2014.
2 Gluten Intolerance Group. “The Gluten Free Label Reading.” Revised May 2, 2014. Retrieved May 13, 2014.
3 National Foundation for Celiac Awareness. “Celiac Disease Facts & Figures.” Last revised May 14, 2014. Retrieved May 14, 2014.
5 Celiac Disease Foundation. “Celiac Disease Symptoms.” n.d. Retrieved May 14, 2014.
6 Celiac Disease Foundation. “What is Celiac Disease?” n.d. Retrieved May 13, 2014.
7 National Foundation for Celiac Awareness. “What is Non-Celiac Gluten Sensitivity?” Last revised May 14, 2014. Retrieved May 14, 2014.
8 U.S. Food and Drug Administration. “What is Gluten-Free? FDA Has an Answer.” Aug. 2, 2013. Retrieved May 14, 2014.
9 Mayo Clinic. “Gluten-Free Diet: What’s Allowed, What’s Not.” Last revised Dec. 20, 2011. Retrieved May 13, 2014.