Gluten Free

Basic Information
Gluten is the protein part of wheat, rye, barley, and other related grains. Some people cannot tolerate gluten when it comes in contact with the small intestine. This condition is known as celiac disease (sometimes called non-tropical sprue or gluten sensitive enteropathy). There is also evidence that a skin disorder called dermatitis herpetiformis is associated with gluten intolerance.

In patients with celiac disease, gluten injures the lining of the small intestine. This injury results in weight loss, bloating, diarrhea, gas, abdominal cramps, or vitamin and mineral deficiencies. When patients totally eliminate gluten from the diet, the lining of the intestine has a chance to heal.

Removing gluten from the diet is not easy. Grains are used in the preparation of many foods. It is often hard to tell by an ingredient's name what may be in it, so it is easy to eat gluten without even knowing it. However, staying on a strict gluten-free diet can dramatically improve the patient's condition. Since it is necessary to remain on the gluten-free diet throughout life, it will be helpful to review it with a registered dietitian.

Oats is a grain the merits special attention. Oats are believed safe in patients with celiac disease although this was not always the case. The problem with oat products is not the grain but rather the manufacturing process. When oats are processed in the same facilities as wheat, contamination can occur even with the best cleaning protocol. Oat products can now be found that are not cross contaminated. These can be tried after an initial period of 6 months to see if they can be tolerated. Most, but not all patients can tolerate pure oat products.

Nutrition Facts
Depending on the foods selected, the gluten-free diet can meet the Dietary Reference Intakes (DRI's) of the Institute of Medicine.

Special Considerations
The person who prepares the patient's food must fully understand the gluten-free diet. Read food labels carefully.

  • Do not eat anything that contains the following grains: wheat, rye, and barley.

  • The following can be eaten in any amount: corn, potato, rice, soybeans, tapioca, arrowroot, carob, buckwheat, millet, amaranth and quinoa.

  • Distilled white vinegar does not contain gluten.

  • Malt vinegar does contain gluten.

  • Grains are used in the processing of many ingredients, so it will be necessary to seek out hidden gluten.

The following terms found in food labels may mean that there is gluten in the product.

  • Hydrolyzed Vegetable Protein (HVP), unless made from soy or corn

  • Flour or Cereal products, unless made with pure rice flour, corn flour, potato flour, or soy flour

  • Vegetable Protein unless made from soy or corn

  • Malt or Malt Flavoring unless derived from corn

  • Modified Starch or Modified Food Starch unless arrowroot, corn, potato, tapioca, waxy maize, or maize is used

  • Vegetable Gum unless vegetable gums are carob bean gum, locust bean gum, cellulose gum, guar gum, gum arabic, gum aracia, gum tragacanth, xanthan gum, or vegetable starch

  • Soy Sauce or Soy Sauce Solids unless you know they do not contain wheat

Any of the following words on food labels usually means that a grain containing gluten has been used

  • stabilizer

  • starch

  • flavoring

  • emulsifier

  • hydrolyzed

  • plant protein

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© Jatinder S. Sekhon, M.D.