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Christine Zellers, MPP, FCHS Educator, Cape May County, Jacki Fuscellaro, FCHS Consultant Cape May County, Nam Phuong Pommier ,FCHS Consultant Cape May County
In recent years, gluten-free diets have gained attention, but what is gluten, and why has there been so much attention drawn to eating gluten-free? Gluten is an insoluble composite protein made up of two types of wheat prolamins, gliadin and glutenin, which are naturally found in grains, particularly wheat. This protein gives elasticity and consistency to the dough and chewiness to foods made from wheat flour, like bread and pasta. Some foods also use gluten/wheat as an ingredient to extend their shelf-life. For some people, these foods cause problems, namely wheat allergy, celiac disease, and non-celiac gluten sensitivity. Individuals, who are clinically diagnosed with these conditions, need to carefully monitor their diet to avoid gluten foods to prevent reactions and illness.
Gluten disorders may present as an intolerance, sensitivity, or a wheat allergy. A wheat allergy is the most severe since it is an immune response to a wheat protein causing the body to have an inflammatory response that may cause rashes, swelling, breathing problems, or anaphylaxis. Gluten intolerance is caused by a lack of enzymes that break down gluten in the body, while gluten sensitivity is an immune response to food and is much more common than intolerance. Symptoms of gluten sensitivity can be similar to those of celiac disease and could include bloating, abdominal pains, gas, nausea, headaches, tiredness, depression, anxiety, and eczema. If you suspect you might have a gluten sensitivity or celiac disease consult with a healthcare provider who might recommend an elimination diet of foods such as wheat, rye, barley, and foods derived from these ingredients. The elimination diet will usually be prescribed for 2-4 weeks and should not be undertaken without a physician’s recommendation and oversight as grain foods are a necessary part of a healthy eating pattern. Celiac is a genetic auto-immune disease which is the result of a hypersensitivity to gluten. Celiac disease is an inherited immune-mediated systemic disorder caused by a permanent sensitivity to gluten. When a person has celiac disease, eating glutenous foods can cause structural damage to the small intestine which then interferes with nutrient absorption. Some common digestive signs and symptoms are lethargy, bloating, diarrhea, unexplained weight loss, abdominal pain, nausea, and vomiting. However, some individuals, mostly adults, can present non-digestive symptoms such as anemia, arthritis, joint pain, liver problems, biliary tract disorders, depression or anxiety, seizures, or migraines. Celiac disease will be established by your doctor after tests have been run to determine if the disease is present. If you think you might have wheat-related diseases, it is best to see your healthcare provider before following a gluten-free diet. Since wheat allergy, celiac disease, and non-celiac gluten sensitivity are different diseases, they require similar but not identical treatments. Depending on the prognosis, these conditions are determined by genetic testing, blood testing, skin test, food challenge, and biopsy of the small intestine, starting a gluten-free diet before testing could negate the accuracy of the diagnosis.
Since gluten-containing products are so ubiquitous in our food chain, following a gluten-free diet can be challenging. However, alternatives made from gluten-free grains have become much more common, with some basic understanding of the food labels, gluten-diet can be manageable and enjoyable. Bread, pasta, cereals, and beer are some of the most common products containing gluten. Salad dressings, soy sauce, sauces, chips, and candy may also contain gluten. Checking the ingredients on food labels is the best way to confirm if the products are gluten-free. While there are some packaged foods explicitly labeled contain wheat, some others state May Contain Wheat, or list wheat, malt, rye, barley, spelt, bulgur, seitan, or farina, as ingredients. Look for those indicators to determine whether or not the food product is safe for individuals who follow a strict gluten-free diet. The advisory statement processed in a facility with wheat or may contain wheat is another helpful indicator to identify the potential presence of wheat ingredients in food products. Some alternatives to wheat flour include flours made from rice, corn, potato, bean, almond, quinoa, or gluten-free oats. It is important to remember that grains are part of a well-balanced healthy diet and eating whole grains like brown rice, quinoa and oats could contribute to the body’s need for grains. Grains give our bodies energy and replacing wheat grains with a gluten-free grain will ensure the body’s proper function.