Part 1: Should I go gluten free?
Gluten-free diets can be helpful but must be managed properly to be healthy.
Released: Feb. 12, 2016
MANHATTAN, Kan. – “New year, new you.” That seems to be the theme of many wanting to start fresh and live healthier lives. However, before jumping aboard the “gluten-free diet” train, check out these facts from Kansas State University assistant professor Sandy Procter.
What is gluten?
Gluten is a protein in wheat, rye, barley, and some related grains that provides the elastic, chewy properties in breads and other baked products. The word “gluten” comes from a Latin origin meaning “glue.” This glue-like characteristic allows bread dough to stretch, but not break, as it rises.
“Bakers and producers select flours for the amount of gluten they contain,” said Procter, who is a nutrition specialist and registered dietitian with K-State Research and Extension. “For example, high-protein durum flour works well for pasta, while low-protein flour is used for tender cakes or pastries.”
In 2013, the U.S. Food and Drug Administration published a new regulation defining the term “gluten free” for voluntary food labeling. The federal definition standardizes the meaning of gluten-free claims across the food industry and allows people requiring the special diet to make healthful food choices with confidence. When “gluten free” is used on the label, a food is required to contain less than 20 parts per million of gluten. The rule also requires foods claiming “no gluten,” “free of gluten” and “without gluten” to meet the definition for “gluten free.”
Gluten may also be used in some prescription drugs, as well as some cosmetics, multivitamins and mineral supplements.
“If you require a gluten-free diet, you will want to ask the pharmacist if your prescribed medications contain gluten,” Procter said. “Products available over the counter are required to be labeled so consumers can determine if they contain gluten.”
Is a gluten-free diet right for me?
Procter said gluten has long been considered part of a sound diet for healthy people; however, it isn’t essential.
“The body doesn’t need gluten to be healthy,” she said. “Products have been developed that contain alternative ingredients and can accomplish many of the same characteristics we attribute to gluten, without the negative effects that some people experience when they eat gluten-containing foods.”
For some people, good health depends on the elimination of gluten and wheat foods from the diet, she said. People with celiac disease and others who are intolerant of gluten must adopt a gluten-free diet to control symptoms. Here are more details about the medical conditions that require a gluten-free diet:
- Celiac disease — Celiac disease (sometimes spelled “coeliac” and formally known as “celiac sprue”) affects about 1 percent of the North American population — approximately 3 million people in the United States, alone. Celiac disease is an autoimmune disorder — the only one where the trigger (in this case, gluten) is known. Celiac damages the villi (the finger-like projections) of the small intestine where nutrients are absorbed. This may result in decreased absorption of nutrients from food, which in turn can lead to dietary deficiencies. The disease may become apparent when an infant begins eating cereals containing gluten, or it may not appear until later in life. About half of celiac patients experience gastrointestinal symptoms, including bloating, gas and/or diarrhea. The symptoms vary from one person to another, which makes an accurate diagnosis difficult.
- Dermatitis herpetiformis — This is a type of celiac disease that not only results outwardly in a painful skin rash when gluten is eaten, but it also damages the small intestine of most people with this condition. Diagnosis is made through a skin biopsy and blood tests.
- Non-celiac gluten sensitivity — This response differs from celiac, because it is not an allergy or autoimmune disease. People with NCGS may have gastrointestinal symptoms similar to people with celiac disease, including diarrhea, constipation, bloating and excess gas, though symptoms can vary widely from one person to another. There are no tests at this time that determine NCGS, but a diagnosis is made by the physician once celiac disease and other conditions are ruled out. Research continues on NCGS, because much about it is unknown. Eating certain carbohydrates as well as other parts of wheat (besides gluten) may also trigger symptoms, so some people with this diagnosis must avoid additional foods and ingredients beyond gluten.
Procter said people diagnosed with gluten-related disorders should follow a gluten-free diet.
“The recent popularity of gluten-free diets is due in part to increased diagnosis of such conditions,” she said, “and also because of the dramatic health benefits noted by some who eliminate gluten from their diet in a personal effort to relieve symptoms. Still, others consider adopting a gluten-free diet for reasons unrelated to celiac disease or gluten intolerance, as they believe it to be a healthful eating plan that helps them to lose weight and improve their nutrition.”
Procter said it’s important for people to check with their health care provider before eliminating gluten from their diet.
“The diagnosis of celiac disease, based on blood tests and a biopsy of the small intestine, may not be accurate if a gluten-free diet is started before testing,” she said. “A strict gluten-free diet, without substitution for the important nutrients found in grain foods, could over time lead to dietary deficiencies.”
While it is not considered dangerous to eat gluten free, Procter warns consumers to not omit any entire food group from their meals unless advised by their health care provider. Gluten-free diets have not been shown to be effective weight-loss programs. But, if gluten avoidance is needed, she encourages including other grains that don’t contain gluten so important nutrients such as iron, folic acid and other B vitamins are not limited in the diet.
“There are many gluten-free grain foods available,” she said, “and many of the choices are enriched with important nutrients and good sources or fiber.”
Procter’s publication, “Gluten and Your Gut’s Good Health” is available online.
Part 2: Should I go gluten free?
Differences between wheat allergies and gluten intolerances, and what it takes to live a gluten-free life
MANHATTAN, Kan. – Many of us are doing what we can to be healthier, and some have determined that eliminating gluten from their diet is part of that, but K-State Research and Extension nutrition specialist and registered dietitian Sandy Procter wants people to educate themselves before making that leap.
Part of that education is knowing the difference between a wheat allergy and gluten intolerance. She explained the difference and gave tips for living a gluten-free life.
Wheat allergy vs. gluten intolerance
Different from both celiac disease and non-celiac gluten sensitivity, a wheat allergy is an allergic reaction to wheat or its components, such as starches, proteins and even fat. A true wheat allergy will bring about near-immediate or slightly delayed symptoms following a wheat-containing meal, said Procter.
“Like other allergies, wheat allergy symptoms are often respiratory in nature (nasal congestion, wheezing, watery eyes), but may escalate to breathing difficulty and shock,” she said. “People diagnosed with a wheat allergy need to avoid foods that contain wheat ingredients. It is important to note that some gluten-free foods may contain other wheat components, especially in Europe.”
In short, a wheat allergy and gluten intolerance are two completely different problems with similar, but not identical, treatments.
Living the gluten-free lifestyle
Procter provided tips in an online publication, “Gluten and Your Gut’s Good Health” for those with a medical condition that requires living gluten free.
1. Identify foods you enjoy now that are gluten free.
Going gluten free may be challenging. Initially you may think of all the foods you must avoid, which can feel overwhelming. Instead of feeling deprived, focus on the foods you can eat, including those that don’t have gluten naturally and the growing number of gluten-free products available.
2. Read labels, and check them carefully each time you shop.
Make label reading a priority for your health. For those following a gluten-free diet, it is essential to read product labels of foods not labeled “gluten free” each time you shop.
Gluten-free labels may be hidden in unexpected places (e.g., located in one place on one brand of pasta sauce but in another place on a product that looks similar), and product recipes may change from one purchase to the next.
3. Beware of cross contact – when gluten-free foods come in contact with those that contain gluten.
Cross contact can occur when a gluten-free food comes in contact with a food that contains gluten. Similar to how germs can spread from dirty hands to clean food, gluten-free foods may pick up gluten anywhere from field to factory to fork.
For example, a gluten-free grain might be grown next to a field of wheat, barley or rye. A factory must follow good safety practices to prevent gluten-containing foods from contaminating gluten-free foods. Even at home, it is important to keep gluten-free foods separate from those containing gluten during storing, cooking and serving.
4. Understand the difference between gluten-free and wheat-free foods, and know your restrictions.
Some products are labeled gluten free but contain the word “wheat” in the ingredient label. This is allowed, because some wheat-based ingredients may be included in foods labeled gluten free, as long as the final product contains less than 20 parts per million (ppm) of gluten.
Examples of this type of ingredient include wheat starch, modified food starch (wheat), and ingredients that may be made from wheat starch, including dextrin (wheat), maltodextrin (wheat), glucose syrup (wheat) and caramel (wheat).
The U.S. Food and Drug Administration’s gluten-free labeling rule states that a food labeled gluten free that also contains the word “wheat” in the ingredients label must also have this statement: “The wheat has been processed to allow this food to meet the Food and Drug Administration requirements for gluten-free foods.”
5. If you need a gluten-free diet, follow it closely, as it is important to your symptom relief and well-being.
“Less is best,” Procter said. “If you or someone you know has been diagnosed with celiac disease, you may think that ‘just a little won’t hurt’ when it comes to breaking your gluten-free diet. Wrong! Eating even small amounts of gluten can damage the small intestine. And, the amount of gluten in a regular slice of wheat bread is 7,000 times that in a slice of gluten-free bread — hardly just a little.
6. Check out available websites and apps to help you live gluten free.
If you need assistance at the grocery store, try investigating the list of available apps for your phone or tablet. Look for those with high ratings from users and recent content updates. There are many options, and the field of available, allowable foods changes constantly.
Procter provided examples.
- Is That Gluten Free? by Garden Bay Software, available on iTunes.
- Find Me Gluten Free, by Gluten Free Classes, LLC, available on iTunes.
- Glutenology – Gluten Free Guide, by David Ramsey, available on iTunes.
If your health care provider advises you or a family member to follow a gluten-free diet, there are many reputable resources available, Procter added. She recommended:
- Academy of Nutrition and Dietetics. This site includes information on celiac disease and how to find a registered dietitian or nutritionist in your area.
- Celiac Now. This site offers instruction on managing celiac disease and living with a gluten-free diet. Topics are addressed on three levels (from introductory to complex) to match the reader’s interest and understanding.
- Celiac Disease Foundation. The mission of the foundation includes advocacy and awareness, and this site provides educational information to help celiac disease patients and those who support them.
- Celiac Disease, 2nd Edition: A guide to living with gluten intolerance (2014) by Sylvia Llewelyn Bower, RN; Mary Kay Sharrett, SM, RD, LD, CNSD; and Steve Plogsted, PharmD. This book discusses how to safely alter the diet, manage symptoms and adjust to living gluten free. It is available on Amazon.
For more information, Sandy Procter’s publication, “Gluten and Your Gut’s Good Health” is available online.
K‑State Research and Extension is a short name for the Kansas State University Agricultural Experiment Station and Cooperative Extension Service, a program designed to generate and distribute useful knowledge for the well‑being of Kansans. Supported by county, state, federal and private funds, the program has county Extension offices, experiment fields, area Extension offices and regional research centers statewide. Its headquarters is on the K‑State campus in Manhattan.
K-State Research and Extension
For more information:
Sandy Procter – 785-532-1675 or firstname.lastname@example.org