What is Gluten? | what is gluten intolerance

Gluten is a controversial topic. Most sources claim that it is safe for everyone except people who have celiac disease. However, some health experts believe that gluten is harmful to most individuals.

What is gluten?

Gluten is a protein naturally found in some grains including wheat, barley, and rye. It acts like a binder, holding food together and adding a “stretchy” quality—think of a pizza maker tossing and stretching out a ball of dough. Without gluten, the dough would rip easily.

Other grains that contain gluten are wheat berries, spelt, durum, emmer, semolina, farina, farro, graham, khorasan wheat, einkorn, and triticale (a blend of wheat and rye). Oats—though naturally gluten free—often contain gluten from cross-contamination when they are grown near, or processed in the same facilities as the grains listed above. Gluten is also sold as wheat gluten, or seitan, a popular vegan high-protein food. Less obvious sources of gluten include soy sauce and modified food starch, however gluten-free options of these products are available and labeled as such to comply with the U.S. Food and Drug Administration’s gluten-free labeling rule. 

The Big 3: Wheat, Barley, Rye

Wheat

Wheat is commonly found in:

·        breads

·        baked goods

·        soups

·        pasta

·        cereals

·        sauces

·        salad dressings

·        roux

Barley

Barley is commonly found in:

·        malt (malted barley flour, malted milk and milkshakes, malt extract, malt syrup, malt flavoring, malt vinegar)

·        food coloring

·        soups

·        beer

·        Brewer’s Yeast

Rye

·        Rye is commonly found in:

·        rye bread, such as pumpernickel

·        rye beer

·        cereals

·        Other Grain

Triticale

Triticale is a newer grain, specifically grown to have a similar quality as wheat, while being tolerant to a variety of growing conditions like rye. It can potentially be found in:

·        breads

·        pasta

·        cereals

Oats

Oats can add diversity and offer many nutritional benefits to the gluten-free diet. Celiac Disease Foundation’s medical experts recommend only oats labeled gluten-free as cross-contact may occur when oats are grown side-by-side with wheat, barley or rye.

Patients eating oats from any source may complain of symptoms. This could be due to one or more of several factors, including intolerance to the increase in fiber, food intolerances, contamination with gluten, or, rarely, the development of an immune response to oat protein, similar to that occurring due to gluten. 

Where does gluten come from?

In addition to wheat, gluten also comes from rye, barley and triticale (a cross between rye and barley). Sometimes it’s in oats, but only because the oats may have been processed with other foods that contain gluten. Oats themselves don’t contain gluten.

What does gluten do to your body?

Humans have digestive enzymes that help us break down food. Protease is the enzyme that helps our body process proteins, but it can’t completely break down gluten. Undigested gluten makes its way to the small intestine. Most people can handle the undigested gluten with no problems. But in some people, gluten can trigger a severe autoimmune response or other unpleasant symptoms.

Research suggests that some people could have small intestines that don’t work properly. The lining might be too permeable, allowing some undigested gluten, bacteria or other substances to go through the lining and into the bloodstream, causing inflammation.

Gluten and Health Benefits

Gluten is most often associated with wheat and wheat-containing foods that are abundant in our food supply. Negative media attention on wheat and gluten has caused some people to doubt its place in a healthful diet. There is little published research to support these claims; in fact, published research suggests the opposite.

Many studies have linked whole grain consumption with improved health outcomes. For example, groups with the highest intakes of whole grains including wheat (2-3 servings daily) compared with groups eating the lowest amounts (less than 2 servings daily) were found to have significantly lower rates of heart disease and stroke, development of type 2 diabetes, and deaths from all causes.

Gluten may also act as a prebiotic, feeding the “good” bacteria in our bodies. Arabinoxylan oligosaccharide is a prebiotic carbohydrate derived from wheat bran that has been shown to stimulate the activity of bifidobacteria in the colon. These bacteria are normally found in a healthy human gut. Changes in their amount or activity have been associated with gastrointestinal diseases including inflammatory bowel disease, colorectal cancer, and irritable bowel syndrome.

When Gluten Is a Problem

What’s not great about gluten is that it can cause serious side effects in certain individuals. Some people react differently to gluten, where the body senses it as a toxin, causing one’s immune cells to overreact and attack it. If an unknowingly sensitive person continues to eat gluten, this creates a kind of battle ground resulting in inflammation. The side effects can range from mild (fatigue, bloating, alternating constipation and diarrhea) to severe (unintentional weight loss, malnutrition, intestinal damage) as seen in the autoimmune disorder celiac disease. Estimates suggest that 1 in 133 Americans has celiac disease, or about 1% of the population, but about 83% of them are undiagnosed or misdiagnosed with other conditions. Research shows that people with celiac disease also have a slightly higher risk of osteoporosis and anemia (due to malabsorption of calcium and iron, respectively); infertility; nerve disorders; and in rare cases cancer. The good news is that removing gluten from the diet may reverse the damage. A gluten-free diet is the primary medical treatment for celiac disease. However, understanding and following a strict gluten-free diet can be challenging, possibly requiring the guidance of a registered dietitian to learn which foods contain gluten and to ensure that adequate nutrients are obtained from gluten-free alternatives. Other conditions that may require the reduction or elimination of gluten in the diet include: 

• Non-celiac gluten sensitivity, also referred to as gluten sensitive enteropathy (GSE) or gluten intolerance—An intolerance to gluten with similar symptoms as seen with celiac disease, but without the accompanying elevated levels of antibodies and intestinal damage. There is not a diagnostic test for GSE but is determined by persistent symptoms and a negative diagnostic celiac test.
• Wheat allergy—An allergy to one or more of the proteins (albumin, gluten, gliadin, globulin) found in wheat, diagnosed with positive immunoglobulin E blood tests and a food challenge. Compare this with celiac disease, which is a single intolerance to gluten. Symptoms range from mild to severe and may include swelling or itching of the mouth or throat, hives, itchy eyes, shortness of breath, nausea, diarrhea, cramps, and anaphylaxis. People who test negative for this condition may still have gluten sensitivity. This condition is most often seen in children, which most outgrow by adulthood.
• Dermatitis herpetiformis (DH)—A skin rash that results from eating gluten. It is an autoimmune response that exhibits itself as a persistent red itchy skin rash that may produce blisters and bumps. Although people with celiac disease may have DH, the reverse is not always true.

It is important to note that gluten is a problem only for those who react negatively to it, or test positive for celiac disease. Most people can and have eaten gluten most of their lives, without any adverse side effects.

Is gluten bad for you?

“There’s a lot of confusion about gluten being an evil food. Gluten isn’t inherently bad for most people,” says Rajagopal. “We, as humans, have consumed gluten for as long as people have been making bread. For centuries, foods with gluten have been providing people with protein, soluble fiber and nutrients.”

Gluten in itself, especially gluten found in whole grains, is not bad for healthy people whose bodies can tolerate it. However, grains like wheat are often stripped down to make processed foods such as snack crackers and potato chips. “These refined products have very little resemblance to the actual wheat plant, which is actually highly nutritious,” explains Rajagopal. “They tend to contain things like white rice flour and starches, but not whole grains.”

Many people who adopt a gluten-free diet but still eat processed foods find they continue to have weight gain, blood sugar swings and other health issues. So it’s not the gluten in foods that’s causing their health issues, but the sodium, sugar and other additives in processed foods. 

Who should avoid gluten?

Rajagopal says gluten can be harmful to people with:

Celiac disease, an autoimmune disease that causes damage to the small intestine in people who consume gluten.

Non-celiac gluten sensitivity (gluten intolerance), which is gastrointestinal irritation caused by gluten in people who don’t have celiac disease.

Wheat allergy, an allergy to wheat, but not to all grains or to gluten itself.

Gluten ataxia, a rare neurological autoimmune disorder that causes your body to attack parts of your brain in response to gluten.

What should I do if I think I have a gluten problem?

Talk to a physician if you think gluten could be affecting your health. Your doctor may suggest blood tests to detect celiac disease or a wheat allergy. Before cutting gluten out of your diet, work with a registered dietitian to build an eating plan that’s right for you.

Gluten-free diet

Some people may find starting a gluten-free diet rather challenging.

The first thing a person needs to do is read the labels on everything they eat and drink.

Gluten, especially wheat, is an ingredient in a surprising number of foods. Gluten is also present in barley, rye, and any products that contain these ingredients, such as rye bread.

In this diet, people should eat mainly healthy whole foods, as most whole foods are naturally gluten-free. Avoid processed food, cereals, and grains that contain gluten.

Gluten-free grains

Several grains and seeds are naturally gluten free and available to purchase online. These include:

rice

oats

quinoa

flax

millet

sorghum

tapioca

buckwheat

arrowroot

amaranth

However, while oats are naturally gluten free, cross-contamination can occur if a facility processes oats alongside other gluten-containing grains such as wheat. Therefore, it is safest only to consume oats with a gluten-free label.

Gluten-free foods

There are plenty of healthy whole foods that are naturally gluten free, including:

·        meat

·        fish and seafood

·        eggs

·        dairy products

·        fruits

·        vegetables

·        legumes

·        nuts

·        tubers

·        fats, such as oils and butter

It is generally better for people to choose naturally gluten-free food rather than processed gluten-free products. These tend to be low in nutrients and high in added sugar or refined grains.

Most beverages are also gluten free, except beer unless labeled gluten free. 

Foods high in gluten

Sources of gluten in the diet include:

·        wheat

·        spelt

·        rye

·        barley

·        bread

·        pasta

·        cereals

·        beer

·        cakes, cookies, and pastries

Many processed foods may also contain gluten. Anyone who wants to avoid gluten will need to read labels carefully.

Who should avoid gluten?

Avoiding gluten is not necessary.

However, for people with certain health conditions, removing gluten from the diet can make a huge difference.

If people cut out gluten products and do not properly replace them with other carbs in the diet, they could be at risk for inadequate fiber, calories, and B-vitamin intake. A person should always consult with a healthcare professional before trying a gluten-free diet.

People should also make sure to choose healthy foods. A gluten-free label does not automatically mean that a food is healthy, and gluten-free processed food is still processed food.

What does a gluten-free label mean?

If you’re working on eliminating gluten from your diet, it can be challenging to know whether a product was supplemented with a gluten-containing ingredient or inadvertently contaminated during processing.

This is why many government health authorities have implemented gluten-free food labeling regulations.

While these labels can make gluten elimination much easier, they don’t necessarily mean that gluten is completely absent from the item.

In the United States, the European Union, and Canada, a product can carry a gluten-free label as long as gluten makes up fewer than 20 parts per million (ppm) of the product. That means that for every million parts of the food, up to 20 of them can be gluten

The 20 ppm threshold was set due to some evidence that suggested that the majority of people with gluten-related disorders are unlikely to experience adverse reactions at this level. However, some countries have opted to set the limit as low as 3 ppm

Certain medical conditions may require a gluten-free diet

Though gluten is safe for most people, certain medical conditions require a gluten-free diet as part of the treatment protocol. 

Celiac disease

Celiac disease is a serious autoimmune condition in which a person’s immune system attacks cells of their small intestine when they ingest gluten It’s one of the most well-researched causes of gluten intolerance and estimated to affect approximately 1% of the global population

Like many other autoimmune conditions, the exact cause of celiac disease remains unclear, but there is strong evidence of a genetic component

Medicinal treatments for celiac disease are currently being researched, but the most widely accepted and utilized treatment is a strict gluten-free diet.

Non-celiac gluten sensitivity

Non-celiac gluten sensitivity (NCGS) describes several negative symptoms that are resolved when gluten is eliminated from the diets of people who do not test positive for celiac disease or wheat allergy.

At this point, very little is known about NCGS, but current treatment includes adherence to a gluten-free diet.

Irritable bowel syndrome

There’s a bit of an overlap between NCGS and irritable bowel syndrome (IBS), as some people who suffer from IBS report wheat as a food they can’t tolerate.

Within the scientific community, it’s unclear why wheat can be problematic for some people with IBS but not others.

Either way, some research suggests that a gluten-free diet may be appropriate for some people with IBS, and especially for those with IBS-D, or irritable bowel syndrome-diarrhea.

Wheat allergy

A wheat allergy is not a gluten-related disorder, but it’s a closely related condition.

Wheat allergies are an intolerance to wheat itself, not just the gluten protein. Thus, someone with a wheat allergy must avoid wheat but may still safely consume gluten from nonwheat sources like barley or rye.

That said, many people who have a wheat allergy end up following a mostly gluten-free diet because the two ingredients are so closely linked and coexist in many of the same foods.

Children with a wheat allergy often outgrow it and are able to incorporate wheat into their diet around school age. 

Common symptoms

Symptoms of gluten intolerance can manifest very differently depending on the individual.

The range of possible symptoms that may be caused by gluten-related disorders is vast and not always intuitive. Some people have no obvious symptoms at all, and conditions like celiac disease or NCGS often go untreated or misdiagnosed.

Symptoms of gluten-related disorders may include.

·        Digestive issues: diarrhea, bloating, abdominal pain, constipation, inflammation of digestive tissue

·        Skin problems: rash, eczema, skin inflammation

·        Neurological issues: confusion, fatigue, anxiety, numbness, depression, lack of focus, difficulty speaking

·        Other: weight loss, nutrient deficiencies, diminished immune function, osteoporosis, headaches, anemia

If you suspect that you have a gluten-related disorder, you should consult a healthcare professional — even before attempting to eliminate gluten from your diet.

Some testing procedures for certain gluten-related conditions like celiac disease may give inaccurate results if you’re already adhering to a strict gluten-free diet.

What’s more, certain symptoms that may seem like a reaction to gluten could be a reaction to something else.

Thus, the best first-line approach is to discuss your symptoms with a healthcare professional before attempting to diagnose or treat yourself.

What to eat on a gluten-free diet

A large number of foods are naturally gluten-free, such as fresh fruits and vegetables, most unprocessed or fresh animal meats and seafood, many fats and oils, and more.

Here is some guidance on what you can eat within each of the main food groups if you have a gluten-related disorder.

Fruits and vegetables

All fresh fruits and vegetables are gluten-free. However, gluten-containing ingredients are sometimes added to processed fruits and vegetables, particularly if they’re flavored.

Produce that’s plain and frozen, canned in just water or juice, or unsweetened and dried are typically gluten-free, too, but check labels just to be sure.

Proteins

Most fresh, plain, and unflavored proteins are naturally gluten-free. For instance, red meat like fresh beef, pork, lamb, and bison; fresh chicken, turkey, and seafood; nuts and seeds; legumes; and traditional soy foods, such as tofu, tempeh, and edamame.

Breaded proteins should be avoided. Check any proteins that are processed (e.g., hot dogs, deli meats, etc.) or combined with any sauces or seasonings, as well as ground meats.

Dairy products

Many dairy products, particularly those that are plain or unflavored and/or don’t contain additives, are inherently gluten-free. 

Be sure to check flavored milks and yogurts, processed cheese products — especially spreads and sauces, and ice cream to ensure the one you’re purchasing is gluten-free.

Fats and oils

Nearly all fats and oils, from butter and ghee to oils made from nuts and seeds, are naturally gluten-free. Double-check all cooking sprays, though, as well as any flavored or spiced oils.

Does gluten cause brain fog?

Some evidence shows that people who eat gluten but have a severe intolerance to it, such as with celiac disease, have a slightly higher risk of developing cognitive impairment. Reports of “brain fog” are not uncommon in people just prior to a diagnosis of celiac disease or in those who have been diagnosed but mistakenly ate foods containing gluten.

But does this side effect occur in people without a true gluten intolerance, and can the reverse be suggested in that the avoidance of gluten might sharpen the mind? A large cohort study disagrees. Almost 13,500 middle-aged women from the Nurses’ Health Study II without celiac disease were followed for 28 years to observe any potential links between gluten intake and mental ability. [15] No significant differences were found in cognitive scores (measuring reaction time, attention, memory, etc.) comparing women with the highest and lowest gluten intakes. The lack of association remained even after excluding women with a dementia or cancer diagnosis.

Unless a person has diagnosed celiac disease, a wheat allergy, or a gluten sensitivity, current evidence does not support that eating gluten increases inflammation in the brain or negatively affects brain health.

Conclusion

Gluten is a group of proteins found in grains. Many popular foods often contain gluten, including bread and pasta.

In recent years, many people have become concerned about consuming gluten and may believe it can cause health problems.

However, research suggests that gluten is safe for most people and that other conditions may cause the symptoms that some may attribute to consuming gluten.

A person should always consult with a healthcare professional before adopting a gluten-free diet.

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