So, what is the deal with gluten? Some people say they have celiac disease, some say they are allergic, some say they are intolerant… What does any of that even mean?
In this blog we will explore a what gluten is, gluten sensitivities and gluten intolerances, celiac disease. We will also go over what foods to avoid if you are avoiding gluten and the foods that are naturally gluten free.
What does it mean to have a gluten sensitivity or intolerance?
It is estimated that about six percent of the U.S. population has a gluten intolerance (12). When it comes to gluten intolerances and sensitivities, there is not a clear cut distinction between the two. In some realms, gluten sensitivities are considered to be less severe than gluten intolerances. Both mean that you experience symptoms when you eat gluten containing products, but gluten intolerances might involve more severe symptoms. I also want to be clear that neither a sensitivity nor an intolerance are gluten allergies or celiac disease.
When being diagnosed with a gluten intolerance your provider will rule out an allergy and celiac disease. There is not currently a gluten intolerance test that your provider can give you.
How do I know if I have a gluten sensitivity or intolerance?
Some symptoms to look out for are abdominal pain, gas, brain fog, bloating, diarrhea, fatigue, joint pain and headache. It is also common that people who have gluten intolerances are also diagnosed with Irritable Bowel Syndrome or IBS (12).
What is celiac disease?
Celiac disease is an autoimmune condition where a person experiences an allergic reaction to gluten. Gluten is naturally found in wheat, rye, barley, and triticale.
In the U.S., it’s estimated that 3 million people have celiac disease (1,2). Celiac disease is a reaction that occurs mainly in the digestive system when gluten is ingested or the body is exposed to gluten in another way (example - through skin contact).
Celiac disease can be inherited, tends to run in families, and is often seen in people with a Northern European background (3,4). People with celiac disease are more likely to develop other autoimmune conditions such as thyroid disease, type 1 diabetes, rheumatic diseases, and liver diseases (3,4).
Celiac disease occurs when the body’s own immune system, particularly the part located in the small intestine, reacts to gluten after it is consumed (3). This immune response causes inflammation which can damage the lining of the intestine, impairing its ability to absorb nutrients (3). This malabsorption can lead to malnutrition within the body, even when consuming adequate nutrients (3,5). Some long-term health concerns of malnutrition include slow growth, anemia, miscarriages and infertility, osteoporosis, intestinal cancers, nerve damage, and seizures (1,3).
How do I know if I have celiac disease?
Some of the common symptoms of celiac disease include abdominal pain, bloating, gassiness, nausea, vomiting, diarrhea, constipation, canker sores, and tooth discoloration (3,6,7). Sometimes symptoms go beyond the gut to include headaches, seizures, itchy or scaly skin, bone or joint pain, changes in menstruation, miscarriages, infertility, fatigue, and weight loss (3,6). There may also be some mental health symptoms, as people with celiac disease may experience irritability, mood changes, or even depression (3).
Celiac disease is different from having a gluten sensitivity or wheat intolerance, as those conditions do not damage the small intestine (4).
It can be difficult to diagnose celiac disease using symptoms alone because it has much in common with other conditions. Diagnosing celiac disease can involve blood tests and biopsies of the small intestine. These tests are more accurate if they’re done before starting a gluten-free diet (7), so it’s important to speak with your healthcare professional as soon as celiac disease is a concern.
The good news is that symptoms of celiac disease can be prevented by avoiding gluten (3). According to the American Gastroenterological Association, “A strict gluten-free diet is the only treatment available for celiac disease” (8).
After removing gluten from your diet, celiac disease symptoms may improve within a few weeks, and damage to the lining of the gastrointestinal tract can be reversed within a few months in many people (3).
What do I eat if I am avoiding gluten?
The challenge in avoiding gluten is that it’s found in very common foods and ingredients that are used to make a wide variety of prepared foods (3). Some of the most common grains are a huge source of gluten (wheat, rye, barley, and triticale) (2,3). This means that gluten is found in cereals and white and whole wheat flours, and therefore is in most breads and other baked goods, as well as pastas (2,3). Gluten is the protein that gives baked goods some of their texture and shape (2). In the case of celiac disease, it’s best to choose products that are labeled to be “gluten-free” or “without gluten.”
According to the U.S. FDA, a “gluten-free” claim is “a voluntary claim that can be used by food manufacturers on food labels if they meet all the requirements of the regulations” (1). These regulations state that foods must not contain any detectable traces of gluten (no more than 20 parts per million) (2).
In addition to avoiding the grain-containing foods we listed, gluten may also be found in some unexpected places:
Dairy products that contain fillers
Prepared soups, sauces, dressings, and gravies
Processed or cured meats
Creamed vegetables
Flavored coffee
Some french fry and potato chip seasonings
Soy sauce
Many cereals, granolas, and bars may use regular (not gluten-free) oats or malt extract
Beer, flavored liquors, malt beverages
There may even be gluten in lip balms, lipsticks, toothpaste, dietary supplements, and some medicines (4,5,9).
Pro tips to avoiding gluten
Beyond simply looking for foods labeled to be gluten-free, and avoiding white or whole wheat, rye, barley, and triticale, below are some specific examples of ingredients to avoid, as well as naturally gluten-free foods to enjoy.
Here are examples of ingredients used in packaged and prepared foods to avoid (because they may be made from wheat, rye, barley, or triticale):
Flours (durum, emmer, kamut, semolina, spelt)
Food starches and thickeners
Hydrolyzed vegetable protein
Malt flavoring, extract, or vinegar
Brewer’s yeast
Preservatives and stabilizers
To be certain that a food does not contain any of these gluten-containing ingredients, check the ingredient listing on the label or contact the company directly.
One thing to note is that cross-contamination is possible. Cross-contamination can be dangerous if you do have celiac disease. Even a small amount of gluten can cause a reaction, so you want to be aware if if a gluten-containing food is packaged, stored, prepared, or served nearby or comes into contact with a gluten-free food (10). This can happen through the use of shared utensils, cutting boards, containers, and even toasters used for regular bread (9). It’s important to keep the possibility of cross-contamination in mind when eating at a restaurant, so look for ones that offer gluten-free menus, and let the server know if you have celiac disease (10). This also applies when attending social events or eating at someone’s home (10).
If you are gluten sensitive or have a gluten intolerance, cross contamination might not affect you. Keep an eye on your symptoms to know for sure. But, when in doubt, air on the safe side and avoid gluten cross contamination.
Here are examples of naturally gluten-free foods to enjoy.
Fresh, frozen, or canned fruits and vegetables (without sauce)
Fresh fish, poultry, or meat
Eggs
Plain, natural dairy products
Plain nuts and seeds
Rice and rice flour
Gluten-free grains such as amaranth, buckwheat, quinoa
Flours made from gluten-free foods (cassava, coconut, corn, potatoes, tapioca)
Oats that are labeled as being gluten-free**
Soybeans and edamame (but not soy sauce)
**Oats may come into contact with gluten-containing grains during processing or packaging, so look for a gluten-free label (10,11).
Your grocery store may have a gluten-free section. You can also look for gluten-free baked goods (made with alternative flours) in the freezer section (11).
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Final Thoughts
The good news about celiac disease, gluten intolerance and gluten sensitivities is that it can be successfully managed by avoiding gluten. Even though gluten is commonly found in pre-made, processed, and packaged foods, there is a growing number of options for gluten-free alternatives. Plus, knowing which foods are naturally gluten-free empowers you to manage your gluten intake and prevent symptoms of celiac disease.
Do you need help choosing or preparing gluten-free foods? As a registered dietitian, I’d love to help.
Need personalized recommendations for recipes, meal plans, and other ways to ensure you’re getting all of the necessary nutrients? Ready to start working with a professional who is invested in seeing you thrive, despite celiac disease, gluten intolerance or gluten sensitivity? Book a complimentary nutrition evaluation today!
References
(1) U.S. Food and Drug Administration (2022, March 7). Gluten-Free Labeling of Foods. https://www.fda.gov/food/food-labeling-nutrition/gluten-free-labeling-foods
(2) U.S. Food and Drug Administration. (2018, July 16). Gluten and Food Labeling. https://www.fda.gov/food/nutrition-education-resources-materials/gluten-and-food-labeling
(3) Harvard Health Publishing. (2023, April 7). Celiac disease (non-tropical sprue). https://www.health.harvard.edu/a_to_z/celiac-disease-non-tropical-sprue-a-to-z
(4) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Definition & Facts for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts
(5) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Treatment for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/treatment
(6) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Symptoms & Causes of Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/symptoms-causes
(7) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Diagnosis of Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/diagnosis
(8) Adelsberg, R. (2021, March). Gluten-free diet: nutritional value. American Gastroenterological Association, AGA GI Patient Center. https://patient.gastro.org/gluten-free-nutritious-diet/
(9) Celiac Disease Foundation. (n.d.). Sources of gluten. https://celiac.org/gluten-free-living/what-is-gluten/sources-of-gluten/
(10) National Institute of Diabetes and Digestive and Kidney Diseases. (2020, October). Eating, Diet, & Nutrition for Celiac Disease. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/eating-diet-nutrition
(11) Celiac Disease Foundation. (n.d.). Gluten-Free Foods. https://celiac.org/gluten-free-living/gluten-free-foods/
(12) Cleveland Clinic medical. (n.d.). Gluten intolerance: Symptoms, test, non-celiac gluten sensitivity. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21622-gluten-intolerance
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