Ten Things You Need to Know About Gluten

By Elisa Zied, MS, RD, CDN

Earlier this week, I wrote a brief article for MSNBC.com about how Miley Cyrus took to Twitter to credit a gluten-free diet for her recent weight loss. Because gluten-free diets have become ridiculously popular in recent years, are very challenging to follow, and aren’t always warranted, I turned to one of my colleagues, noted gluten expert Shelley Case, B. Sc., RD, author of “Gluten Free Diet: A Comprehensive Resource Guide,” to share what you need to know about gluten (and celiac disease). Here’s Case’s top 10 list:

1. Celiac disease is serious
Celiac disease is a serious autoimmune disorder that affects one in100 people, yet only about 5 to 10 percent with the disease are diagnosed. Symptoms of CD are variable, may occur at any age (including the elderly), and involve not only the gastrointestinal system but many other organ systems. Infants and young children can present with bloating, gas, diarrhea, weight loss, poor growth, irritability, dental enamel defects and/or anemia. In older children and adults, symptoms can be mild to severe.

Some may present with only a few symptoms while others can have many different symptoms. These include: Anemia, nausea, reflux, bloating, gas, diarrhea or constipation (or both), lactose intolerance, weight loss (CD can also occur in obese individuals), mouth ulcers, extreme fatigue, irritability, bone and joint pain, easy bruising of the skin, menstrual irregularities, miscarriage, infertility (in both women and men), migraines, depression, ataxia, seizures, neuropathy, elevated liver enzymes.

2. Test first, diet later
It is critical that you get tested for celiac disease before going on a gluten-free diet because once on the diet, it is difficult to get an accurate diagnosis. The blood and small intestinal biopsy tests require that you stay on a gluten-containing diet for at least 6 to 8 weeks. In some cases, you may need to be on it for months for the tests to be positive.

3. Get screened
If you feel better on a gluten-free diet, it’s possible you may actually have undiagnosed celiac disease. Without a confirmed diagnosis, you may not be motivated to follow the lifelong strict gluten-free diet to prevent complications of celiac disease such as anemia, osteoporosis, development of other autoimmune disease and cancer. Also, celiac disease affects between 5 to 15 percent of first-degree relatives, so it’s important for your family members be screened as well. This may not occur to you if you don’t have an official diagnosis.

4. See if you’re sensitive
If the tests come back negative for celiac disease, it is possible that you may have non-celiac gluten sensitivity (GS). New research from the Center for Celiac Research in Baltimore indicates that up to 6 percent of the population may have non-celiac gluten sensitivity. Symptoms of GS are often similar to those of celiac disease. Currently, the only way to diagnose GS is to rule out celiac disease. For more information about GS, see: http://www.biomedcentral.com/content/pdf/1741-7015-10-13.pdf

5. Gluten-free after diagnosis
The only treatment for celiac disease is a strict gluten-free diet for life. It is thought that those with GS also need to follow a gluten-free diet, but it is not known whether the diet needs to be followed as strictly or for life. More research about GS is needed.

6. Eat with caution
A gluten-free diet requires that all forms of wheat, rye and barley, including spelt, kamut, einkorn, emmer, faro, durum, couscous, semolina, bulgur and triticale, barley malt extract/flavoring, malt vinegar and brewer’s yeast must be avoided. The diet is very challenging to follow because gluten is found in such a wide variety of foods like breads and other baked products, cereals, pastas, soups, sauces such as soy sauce (which is often made from wheat and soy), seasonings, salad dressings, snack foods, prepared meats (e.g., deli meats, hot dogs, hamburger patties, imitation seafood), beer, flavored coffees and teas, some candies (e.g. licorice) and chocolate bars as well as some nutrition supplements and medications. Because of the complexity of the diet, it is essential that you consult with a registered dietitian for a nutritional assessment, education about the diet, and to ensure your diet is healthy.

7. Focus on naturally gluten-free foods
A wide variety of foods that are naturally gluten-free include plain meat, poultry, fish, eggs, pulses (legumes), nuts, seeds, milk, yogurt, cheese, fruits, vegetables, as well as many gluten-free flours, cereals and starches* that can be substituted for wheat, rye and barley. Distilled alcoholic beverages and wines are also allowed, however beer derived from barley must be avoided. There are a variety of gluten-free beers made from sorghum, buckwheat, rice and other grains. All vinegars are gluten-free except for malt vinegar (made from barley and is not distilled).

*Gluten-Free Flours, Cereals and Starches are amaranth, arrowroot, buckwheat, corn, flax, pulse flours (bean, chickpea/garbanzo, lentil, pea), mesquite flour, millet, nut flours (almond, hazelnut, pecan), potato flour, potato starch, quinoa, rice bran, rice polish, sago, sorghum, soy, sweet potato flour.

8. Don’t be fooled
A gluten-free diet is not always synonymous with a nutritious diet. Many gluten-free products are higher in fat, sugar and calories, lower in fiber, iron and B vitamins because they are often made with refined flours and starches (e.g. white rice flour, potato, corn and tapioca starch), and not enriched with vitamins and minerals as their gluten-containing counterparts.

9. Go for gluten-free grains
Incorporate more gluten-free whole grains in your diet. For tips and recipes see http://www.glutenfreediet.ca/img/WholeGrains2.pdf

10. Stay in the know
For more information about celiac disease, gluten sensitivity, and the gluten-free diet see www.glutenfreediet.ca

Elisa Zied, MS, RD, CDN is a nationally recognized Registered Dietitian and award-winning author of “ Nutrition at your Fingertips,” “Feed Your Family Right,” and “So What Can I Eat.” She is also a past national media spokesperson for the American Dietetic Association. For more information, go to www.elisazied.com

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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