For thousands of years, gluten has been an essential part of the human diet. However, lots of people these days are switching to gluten-free diet believing it is damaging their health. Supermarkets are exploded with gluten-free products, and even many restaurants now offer gluten-free food.
No doubt for a small group of people with gluten sensitivity and celiac diseases it’s a blessing. But, even mainstream people without gluten-related disorders are switching to a gluten diet to boost energy, lose weight and stay healthy.
Is gluten-free diet a right choice for everyone?
Do everybody need to go gluten-free or its going to do more harm for individuals without celiac disease?
What Is Gluten
Gluten is a general name for a mixture of many distinct proteins found in grains such as wheat, barley, rye and spelt. It acts like glue, holds the food together, maintains the shape of food and affects the chewiness of baked goods.
Gliadin and Glutenin are the primary proteins in gluten. When flour is moisture and mixed, the long strands of glutenin aligns in the direction of combining and associated with gliadin to form an elastic and uniform complex termed as gluten that envelopes the granule of starch in the dough.
Glutenin is responsible for the elasticity, toughness and rubberiness of the dough and Gliadin gives the bread ability to rise during baking.
Sources Of Gluten
Whenever we talk about sources of gluten the first thing that comes to our mind is wheat. Wheat is not the only grain containing gluten. Below I have listed gluten-containing grains and its derivates. Have a look.
Grains that are the primary source of gluten are:
- Wheat- Includes all varieties as well as derivatives of wheat such as:
- Semolina (Suji)
- KAMUT® Khorasan Wheat
- Einkorn Wheat
- Wheat Bran
- Wheat germ
- Triticale- It is a hybrid of rye and wheat.
*Oats is naturally gluten-free but is grown and processed alongside gluten-rich grains. Thus, there is an increased risk of cross-contamination.
Foods Rich In Gluten
Any food product labelled wheat free may not be gluten-free. Food containing any form of wheat, rye and barley as an ingredient has gluten. Today gluten is ubiquitous in the food supply and is almost found in everything. Practically any processed food is likely to have gluten. Always refer to the ingredient list of the product before buying.
Listed below are the common foods that contain gluten:
- Bread- naan, pita, flatbreads, donuts, rolls, potato bread bagels, flour tortillas, cornbread, croutons.
- Pasta- dumplings, gnocchi, ravioli, couscous
- Noodles- chow mein, egg noodles, udon, ramen, soba made up with the percentage of buckwheat flour
- Crackers– pretzels, ice cream cones, graham, crackers, goldfish,
- Cereal & Granola- corn flakes, rice puffs that contain malt extract, not gluten-free oats, granola made with regular oats,
- Baked Goods- cakes, pie crusts, cookies, brownies, cupcakes, baking mixes, scones, muffins, croissants.
- Breakfast Foods- pancakes, French toast, waffles, crepes, and biscuits.
- Gravies and sauces in which wheat flour is used as a thickener- sauces made with a roux, soy sauces.
- Brewers yeast
- Malt beverages
- Beer ( gluten-free beer is an exception)
Many times gluten is used as a thickening ingredient for coating or to bind the products and add texture.
Other foods that may contain gluten are:
- French fries- It often contain a coating that is made from wheat flour. Also, it may be cross-contaminated from fryers.
- Battered or breaded foods like popcorn shrimp or chicken nuggets
- Potato chip seasonings may contain wheat starch or malt vinegar
- Ice cream
- Candy bars
- Rice cakes
- Energy bars
- Barbeque or Marinara sauce
- Soup, stew, and chilli as they may use flour as a thickener. Also, many soups contain barley
- Processed meats that include hot dogs, sausages, bacon, bologna, deli meats.
- Marinades and salad dressings containing malt vinegar, flour or soy sauce.
- Multi-grain tortilla chips that may not be entirely corn-based.
- Pre-seasoned meat
- Brown rice syrup made with barley enzymes.
- Meat substitutes that are made with seitan, for example, veggie burgers, imitation bacon, vegetarian sausage, or imitation seafood
- Soy sauce
- Spice blends
- Pre-marinated or pre-seasoned meats
- Seasoned nuts
- Cheesecake filling
- Omelettes or scrambled egg with pancake batter.
*Before buying any food item verify by reading the label and also check with kitchen staff and manufacturer.
Hidden Resources Of Gluten
Always carefully read the label. The terms wheat, barley or rye may not be used in the list of ingredients so also look for ingredients that are listed below that may contain gluten:
- Dextin or starch
- Modified starch
- Gelatinized starch
- Modified food starch
- Cereal extract
- Vegetable starch
- Hydrolyzed wheat protein
Many other products besides food, contain gluten, and if you have gluten sensitivity, you must be aware of such items.
Items that may contain gluten:
- Lip balm, lip gloss, lipstick
- Cosmetics and makeup
- Adhesive tapes
- Communion wafers.
- Vitamins, drugs, over the counter medications and herbal supplements.
Side Effects Of Gluten
Most of the people can tolerate gluten, but in some people with specific health issues, it causes problems.
Health problems with gluten:
1. Celiac disease- Celiac disease is severe gluten intolerance. This condition affects about 1% of the population. It is an autoimmune disease where body’s immune system starts recognising gluten as an invader and starts attacking it. The lining of guts is also attacked and damaged in this process. As a result, there is digestive issues, anaemia, nutrient deficiency and risk of many other diseases increase.
The symptom of celiac disease includes digestive discomfort, constipation, bloating, diarrhoea, tiredness, headache, depression, skin rashes, weight loss and foul-smelling faeces.
In some people with celiac disease, digestive symptoms are not displayed, but they may have other symptoms such as anaemia and tiredness. This is why it is tough to diagnose celiac disease, and about 80% of its victims are unaware that they are suffering from it. About 30 to 40% of people suffering from celiac disease have a genetic background. In others, the cause is not apparent, but it is considered that gut microbiome may be responsible.
2. Non-celiac gluten sensitivity- Gluten intolerance is not just restricted to patients with celiac disease. There are also a small group of people who react negatively to gluten even if they do not test positive for celiac disease. This condition is termed as non-celiac gluten sensitivity. Its symptoms include stomach pain, bloating, depression and diarrhoea. There is no test to diagnose NCGS, and so for proper diagnosis, there is a need to establish a clear connection between the consumption of gluten and your symptoms. For this, you need to maintain a food and symptoms journal. However, there are also a bunch of experts who believe that NCGS is not a real health issue and the adverse effects are due to substances other than gluten such as FODMAPs (A short chain carbohydrate found in many foods including wheat) or are just imaginary. The bottom line is that non-celiac gluten sensitivity is controversial and some people who self-diagnose themselves as gluten intolerant may have different causes for the symptoms.
3.Irritable bowel syndrome- Studies show that individuals neither diagnosed with gluten sensitivity or celiac disease may also experience adverse symptoms in consuming gluten. Studies show that gluten can cause intestinal inflammation. Gut proteases insufficiently degrade gluten protein, and undigested peptides are left that may trigger innate immune mechanism causing IBS symptoms. It may also hurt the barrier function of the intestine allowing the unwanted substance to leak into the bloodstream. IBS is a common digestive disorder. It is a chronic condition with characteristics symptoms such as bloating, abdominal pain, gas, diarrhoea and cramping. It is a functional gastrointestinal disorder that affects the large intestine, and no physical disease is present. IBS victims have often reported worsening of their symptoms after consuming gluten diet. However, more research is being done on this topic. Many of IBS patients can manage the signs through a change in lifestyle, diet and stress management therapies.
4. Increased intestinal permeability- Gluten acts as a gut irritant and also accelerates gut permeability by stimulating the release of Zonulin. Zonulin is a protein that loses the junction between the guts cells. Increased gut permeability is a big issue as it is a significant factor responsible for the development of autoimmune disease.
5. Dermatitis Herpetiformis– Dermatitis Herpetiformis is an autoimmune gluten intolerance skin disease linked to celiac disease. It is characterised by itchy, burning and watery blisters. Blisters develop on scalp, knees, elbows, buttock and back. Rashes are found to clear with a gluten-free diet.
6. Brain disorders associated with gluten- Many neurological illnesses are considered to be caused or exacerbated by gluten consumption. This condition is medically termed as gluten-sensitive idiopathic neuropathy. Studies conducted on patients with neurological disorders showed that about 57% of the patients had antibodies against gluten in their blood. Cerebellar ataxia is a severe brain disease that is believed to be at least partly caused due to gluten consumption. It involves a problem in talking, inability to coordinate movement and balance. It has been found that many cases of ataxia have a direct link with consumption of gluten and is termed as gluten ataxia. It causes irreversible damage to the cerebellum. Controlled trial done with restricting gluten showed improvement in such patients.
Other neurological disorders that positively respond to a gluten-free diet are autism, anxiety, a rare form of epilepsy and schizophrenia.
7. Hashimoto disease– It is an immune disease where the immune system starts attacking the thyroid gland. Wondering what gluten has to do with Hashimoto disease?
Link has been found between gluten and Hashimoto. The protein structure of gluten resembles thyroid tissues. When your immune system starts attacking gluten considering it a foreign invader it may also begin to react erroneously. Mistaking identity your immune system attacks and destroys the thyroid tissue. A strict gluten-free diet in such patients has been found to improve their condition. However, just going gluten-free may not help and many patients with Hashimoto disease may also need to go dairy free.
How To Check, You Are Intolerant To Gluten
It is estimated that more than 55 diseases are linked with gluten, and about 60-65% people having celiac disease or gluten intolerance are never diagnosed. Then how to check if you fall into that category. We suggest you to first look for the signs of gluten intolerance discussed below.
Signs of gluten intolerance:
- Digestive issues such as bloating, gas, diarrhoea and constipation. Constipation is generally seen in children after consuming gluten.
- Chicken skin or keratosis Pilaris- It is vitamin A and fatty acid deficiency that is caused due to fat malabsorption caused as a result of gut being damaged by gluten
- Diagnosis of rheumatoid arthritis, lupus, psoriasis, multiple sclerosis, Hashimoto Thyroiditis and scleroderma.
- Dizziness and feeling off balanced.
- Unexplained infertility, amenorrhea, PCOS and PMS.
- A migraine
- Chronic fatigue
- Pain and swelling in joints
- Mood swings, anxiety, depression.
Not all the symptoms mentioned above are experienced by everyone, but even if you are suffering from 2-3 of the above symptoms, you may have some gluten issue. To establish if you have gluten disorder, a blood test is available, but the best way to determine is the elimination test.
Tests to diagnose gluten intolerance
Blood test- Several blood tests are there to screen for antibodies. Most common one is a tTG-IgA test.
Tissue biopsy- If tTG-IgA test comes positive a tissue biopsy is done to confirm the result.
Elimination test- The best way to find out if you are gluten sensitive is to strictly consume a gluten-free diet for a few weeks. If your symptoms improve, you need to cross check by gain introducing gluten back and see if your symptoms return.
If in case you don’t find any relief after banning gluten and your symptoms do not get worse on reintroducing gluten in your diet the culprit is something else.
Benefits Of Gluten Elimination Diets
1. To ease digestive symptoms- If after consuming gluten you are experiencing the sign of gluten intolerance discussed in this article then cutting gluten from your diet will help to reduce the symptoms. But is it beneficial for others?
According to a study published by American Journal of Gastroenterology when adults with non-celiac gluten sensitivity were made to eat gluten for six weeks daily, they reported worsening of the symptoms such as pain, bloating, fatigue and poor stool consistency. So if you experience non-specific digestive issues, eliminate gluten from your diet. Maybe that would provide you long-term relief.
2. May provide extra energy- If you are among those who feel sluggish and tired after eating gluten, a gluten-free diet may provide you extra energy and prevent brain fog. However, make sure to fill your diet with nutrient-dense gluten-free foods.
3. Benefits children with autism– Autism is a developmental disorder, and it causes impairment in social interaction and communication. A study published in Nutritional Neuroscience says that along with the traditional treatment, casein free and gluten free diet improves the social behaviour and psychological symptoms of the children with autism.
*Some researchers claim that gluten-free diet causes weight loss, whereas some believe that if you don’t replace gluten-containing grains with gluten-free grains weight loss is due to cutting off the calories.
Experts Views On Gluten-Free Diets
Since the past few years, health effects of gluten has been a controversial topic. Some sources claim that except for people with celiac disease and gluten sensitivity it is safe for others to consume gluten. But on the other hand, many experts believe that gluten should be excluded from everyone’s diet as it is harmful to most of the people.
So, are there reasons for others even without celiac diseases to go gluten-free? Let’s see what the researchers all around the world have to say about this.
Dr Daniel A Leffler (director of clinical research at the Celiac Center at Beth Israel Deaconess Medical Center in Boston) says that those who are sensitive to gluten might feel better, but others will derive no significant benefit from the practice. They’ll waste their money because gluten-free products are expensive,”
According to Nunes report published in JMA, people are following the gluten-free diet for the following reasons:
- Gluten-free diet improves nonspecific gastrointestinal symptoms and so public perceive it as healthier.
- There is an increase in the number of people who have self-diagnosed themselves with gluten sensitivity and on cutting gluten from their diet they have experienced improvement in their symptoms.
- Also, gluten-free products are now quickly and widely available.
Research published in Expert Review of Gastroenterology and Hepatology in 2017 suggests that consumption of gluten even in people without celiac disease may cause altered gut function, IBS and changes in the gut microbiome.
Some researchers also say that unless you do not have celiac disease, you should not avoid gluten as it will derive them from heart-healthy whole grains. A study conducted over 100,000 participants without celiac disease in 2017, found no association between increased risk of heart diseases and long-term consumption of dietary gluten. The findings even suggested that non-celiac individuals avoiding gluten are at increased risk of heart diseases, due to reduced consumption of the whole grains.
Dr Christopher Heron (a family medicine physician at Penn State Medical Group in State College) says that wheat products provide nutrients that gluten-free foods do not contain. So instead of eliminating gluten from your diet those who do not suffer from gluten-related diseases should shift to a healthier diet and manage the proportion size. Also, there is a need to be aware of the nutritional content of the foods.
According to a study published in the journal ‘Gastroenterology’ reads that it is Fructan and not Gluten that causes intestinal symptoms in patients with non-celiac gluten sensitivity
What Should You Do
If you have gluten intolerance, a gluten-free diet is boon for you and will make a huge difference. Patients with celiac disease, have no choice than to go gluten-free. If people with celiac disease continue to consume gluten, there is a deficiency of nutrients leading to weight loss, anaemia, infertility, multiple sclerosis, osteoporosis and neurological disorders. Thus, for people with celiac disease, the effective treatment is lifelong strict gluten-free diet.
If you have self-diagnosed yourself with non-celiac gluten sensitivity there are some suggestions for you:
- First of all, discuss your gastrointestinal symptom with your doctor to access the cause.
- Better continue consuming gluten until tests are done as cutting gluten may give a negative test for celiac disease.
- Before eliminating gluten from your diet consult a dietician. Your dietician will make sure your diet includes all the essential nutrients.
Gluten-containing whole grains contain fibre and nutrients such as B vitamins, magnesium, calcium, and iron. Those who follow a gluten-free diet in the absence of gluten intolerance may face nutritional deficiencies so if you need or want to steer clear of gluten you will have to make up for these missing nutrients. Going gluten-free is harmless if you are getting the nutrients in gluten grains from other foods.
Consume natural, gluten-free foods in their whole forms like fruits, vegetables, legumes, nuts, seeds, fish, eggs, and poultry.
Whole grains that are inherently gluten-free are:
- Brown, black, or red rice
- Oats (when not contaminated during growing/processing)
Always remember gluten-free junk food is junk food so make wise choices.0