GLUTEN. An elastic protein found in wheat and some other grains that gives cohesiveness to bread dough. Some people are allergic to gluten and cannot digest products containing wheat. A gluten-free diet is a diet that is completely free of gluten, which is a generic term for storage proteins found in grains.
Structure of gluten
Gluten is an enormous composite protein the largest known that consists of a strong, stretchy mesh of smaller proteins linked by molecular bonds. These smaller proteins are glutenin, which has a long, chainlike shape, and gliadins, which are shorter and round. The glutenin is what gives gluten its elasticity, whereas the gliadins give it strength. It is this combination of stretchiness and strength, together with its mesh like structure that can trap bubbles of gas, that makes gluten important in bread-making.
Gluten is a resilient, rubbery substance that forms when glutenin and gliadin molecules in flour are mixed with water. The molecules bond together to form a mesh that can trap bubbles of gas as occurs when dough is kneaded. Because the mesh is stretchy, the gas bubbles can expand without breaking it.
Gluten sensitivity
A significant number of people cannot tolerate gluten in the diet and experience health problems from eating it .One of these problems is Celiac disease, which is due to the body’s immune system reacting abnormally to gluten.
The other main problem is non-celiac gluten sensitivity (NCGS), the cause of which is not known. Both conditions produce similar symptoms, including stomach pain, diarrhoea or constipation, headaches, and tiredness. Celiac disease is more serious and causes permanent damage to the intestines.
When a person with celiac disease consumes gluten, the villi of the small intestine (The tiny, finger-like projections on the surface of the small intestine that help absorb nutrients ) , where absorption of key nutrients takes place, becomes damaged. It result in nutrients passing through the digestive system without being absorbed. The person exhibits gastrointestinal distress and eventually malnutrition. In infancy, celiac disease manifests itself as diarrhoea, abdominal distention, developmental delay, and in some infants, as severe malnutrition. After infancy, the symptoms of celiac disease are less dramatic. Older children may be short or exhibit dental enamel defects.
Women comprise about 75% of newly diagnosed adult cases of celiac disease. Symptoms of celiac disease include diarrhoea, constipation alternating with diarrhoea, intestinal gas, fatty, greasy, foul-smelling stools, bloating, nausea, vomiting, skin irritation, weight loss, anemia, neurological effects (including seizures, and possibly migraine headaches),fatigue, concentration and memory problems. In some cases, there may be intestinal damage without significant gastrointestinal symptoms.
Celiac disease is diagnosed by blood tests for certain antibodies and small intestine biopsy. A positive small intestine biopsy,followed by an improvement in health after following a gluten-free diet, is confirmation of celiac disease.
A gluten-free diet should not be started before diagnosis is confirmed. A gluten-free diet may also be helpful for persons with multiple sclerosis and other autoimmune disorders, as well as for persons with autism spectrum disorders, Attention Deficit Hyperactivity Disorder (ADHD), and some behavioral problems.
Gluten containing foods
The foods of concern for individuals susceptible to celiac disease are the cereal grains that contain the storage proteins as listed below :
- Wheat :proteins prolamin and glutelin (commonly referred to as glutens in wheat) found in all varieties of wheat (e.g., durum, spelt, kamut).
- Barley :where the storage proteins are called hordeins .
- Rye :where the storage proteins are called secalins, and their cross-bred hybrids (such as triticale).
In addition to gluten-containing grains, gluten can be found in a large variety of foods including
- Soups, salad dressings, processed foods, candy .
- Seafood, marinades, processed meats, sauces and gravies.
- Soy sauce or soy sauce solids, thickeners, wafers, and natural flavourings.
- Starch, binders and fillers in medications. supplements, or vitamins
- Adhesives in stamps and stickers can also be unsuspected sources of gluten.
- Ingredients that may contain hidden sources of gluten include starch, modified food starch, hydrolysed vegetable or plant protein (HVP or HPP), texturized vegetable protein (TVP), and binders, fillers, and extenders.
Gluten free foods
- Grains and starches that are allowed in a gluten free diet include: rice, corn, soy, potato, sweet potato, tapioca, beans, garfava, sorghum, quinoa, millet, arrowroot, amaranth, nut flours, and buckwheat.
- Other foods include fresh, canned, and frozen fruit or fruit juices, fresh vegetables, canned and frozen vegetables without gluten-containing additives,
- milk, aged cheesed, all unprocessed meats, poultry, fish, eggs, dried beans, nuts, and seeds are Gluten free foods.
Diets to be followed to be Gluten Free
- A dietitian should be consulted to develop and monitor a gluten-free diet.
- It is recommended that an affected person keeps the diet simple at the beginning by eating fresh fruits and vegetables, milk, unprocessed protein foods such as fresh beef, pork, poultry, fish, and eggs, natural nuts, seeds, and vegetable oils without additives.
- Almost all beers are brewed with barley (some are brewed with wheat) and should not be consumed by a person following a gluten-free diet.
- Most distilled forms of alcohol are gluten-free, unless additives and colourings have been added, which may contain glutens.
- Wines are also usually gluten-free.
List of Food containing Gluten ,Foods to be avoided and Foods allowed
| Ingredients/foods to avoid | May contain gluten | Foods allowed |
| Barley | Baking powder | Amaranth |
| Bran (wheat or oat) | Beans, baked | Beans, dried, unprocessed |
| Bulgur | Bouillon cubes | Buckwheat |
| Cake meal | Candy | Cassava |
| Couscous | Cheese sauces and spreads | Cheese, aged |
| Emulsifier | Chips, potato and tortilla | Corn |
| Farina | Chocolate drinks and mixes | Eggs, unprocessed |
| Flavoring | Coffee substitutes | Fish, unprocessed |
| Flour, enriched, durum, graham, semolina | Cold cuts | Flax |
| Gluten | Communion wafers | Fruits and juices, fresh, frozen or canned |
| Hydrolyzed plant protein | Corn cakes, popped | Herbs and spices, pure |
| Kamut | Egg substitutes, dried eggs | Ketchup |
| Malt and malt flavoring | French fries | Legumes |
| Matzo meal | Fruits, dried | Meats, unprocessed |
| Oatmeal and oat bran | Fruit-flavored drinks | Milk |
| Oats, rolled | Fruit pie fillings | Millet |
| Rye | Gravy | Mustard |
| Semolina | Hot dogs and other processed meats | Nuts, unprocessed, and nut flours |
| Seitan | Matzo | Olives |
| Soy sauce or soy sauce solids | Mayonnaise | Pickles, plain |
| Soy | Milk drinks | Potatoes and sweet potatoes |
| Spelt | Nuts, dry roasted | Quinoa |
| Stablizer | Peanut butter | Rice, wild rice, Indian rice |
| Starch, modified, or modified food starch | Pudding mixes | Sago |
| Triticale | Rice, brown | Seeds, unprocessed |
| Vegetable gum | Rice crackers and cakes | Soy flour |
| Vegetable protein | Rice mixes | Soy sauce, gluten-free |
| Vinegar, malt | Salad dressings | Sorghum |
| Wheat | Sauces | Tapioca |
| Wheat berries | Seasoning mixes | Tomato paste |
| Wheat bran | Sour cream | Vegetables without gluten-containing additives |
| Wheat, cracked | Soy nuts | Vinegar, apple, cider, and distilled white |
| Wheat germ | Syrup | Yucca |
| Wheat protein and hydrolyzed wheat protein | Teas, flavored and herbal | |
| Wheat starch | Turkey, self-basting | |
| Whole wheat | Vegetables in sauces | |
| Yogurt, flavored or frozen |
Precautions for taking Gluten Free diet
- Since celiac disease is an inherited autoimmune disease, screening of family members is recommended. The chances of developing gluten-sensitive enteropathy increases to 10 to 20% in persons who have a first-degree relative with celiac disease. Celiac disease is also associated with other autoimmune syndromes such as Type 1 diabetes.
- A gluten-free diet is difficult to follow, and continued health problems are usually associated with problems with adhering to the gluten-free diet. A person can exhibit celiac-related symptoms for months after a single gluten intake. Persons with gluten-sensitivity who do not treat their disease are at a higher risk for enteropathy-associated T-cell lymphoma and other gastrointestinal cancers.
- Maintenance of a long-term gluten-free state reduces the risk of lymphoma to the level seen in the general population.
- Complications of gluten-sensitivity include decreased mineral bone density and iron-deficiency. Persons with celiac disease and dermatitis herpetiformis must maintain a gluten-free diet for the rest of their lives, for these diseases cannot be cured.
- As with any restrictive diet, the gluten-free diet has potential for nutritional inadequacy. Persons who are sensitive to gluten are at increased risk for osteoporosis and osteomalacia, due to malabsorption of calcium and vitamin D. Most persons with celiac disease have some degree of osteopenia or osteoporosis. Calcium and vitamin D supplementation along with strict adherence to a gluten-free diet usually results in remineralization of the skeleton.
- Iron or other vitamin deficiencies may also be present and must be treated appropriately. The consumption of gluten-free fibre rich foods (for example, brown rice, fruits, and vegetables) and adequate fluid intake is recommended to assist in the prevention of constipation.
Gluten free diet is good for people who have following disorders
Autoimmune Conditions –Some people have an autoimmune reaction to gluten. During an autoimmune reaction, the body mistakes its own tissue as a foreign invader and attacks itself. Gluten-related autoimmune diseases include the following :
A. Celiac disease (cd):
Celiac (sometimes spelled coeliac) disease is an inflammatory autoimmune disease triggered by ingesting gluten that causes damage to the small intestine. In a healthy person, hair like projections in the intestine called villi absorb nutrients into the body. A person with celiac disease, however, experiences an autoimmune reaction to gluten that results in villous atrophy, in which the body’s autoimmune response attacks the villi and they become damaged. After extended exposure to gluten, the villi become so tangled and flat that they can no longer effectively absorb nutrients from the foods you eat. At this point, the patient has developed celiac disease.
The most commonly known symptom of celiac disease is steatorrhea, a form of diarrhoea, or greasy, pale, foul-smelling stools. But only about a third of celiac patients experience this symptom.
Other symptoms of CD are as listed below :
- Severe abdominal pain, vomiting, bloating, and gas.
- Brain fog, delayed growth in children.
- Vitamin deficiencies and anemia.
- Inability to gain weight.
- Tooth decay, missed periods.
- Infertility in women,
- Low bone density.
- Some people experience no physical symptoms of the disease until it has progressed considerably. CD with no apparent symptoms is known as silent celiac disease.
Important Note : As celiac disease causes malnutrition by interfering with the complete absorption of vitamins, minerals, and nutrients. Hence gluten-free diet can improve companion diseases and symptoms, including osteoporosis, infertility, and severe and chronic anemia. The only treatment for CD is a strict, permanent gluten-free diet. With time, a person with celiac disease can be expected to make a full recovery.
Dermatitis herpetiformis (dh):
Dermatitis herpetiformis is an intensely itchy skin rash with characteristic red bumps or fluid-filled blisters. The rash most often appears on the buttocks, knees, and elbows but can also appear on the back of the neck, in the scalp, along the hairline, on the groin, or even on the face.
DH is not caused by skin contact with gluten, but it is an autoimmune response to ingesting gluten. DH is almost always a symptom of untreated celiac disease. Dermatitis herpetiformis is diagnosed with a simple skin biopsy. The itching can be treated with medication, but getting rid of DH completely requires eliminating gluten from your diet.
Gluten ataxia
Little is known about the condition gluten ataxia. Ataxia is characterized by damage to the cerebellum, which causes mental confusion and disorientation, and disorders in fine movement, balance, and posture. If somebody is experiencing any of these neurological symptoms and doctor can’t find the source, they may be related to an autoimmune reaction to gluten and you may have gluten ataxia.
Damage to brain is permanent and cumulative, because these cells do not regenerate, but an extremely strict gluten-free diet has been shown to stop gluten ataxia from progressing. Physical and occupational therapy may help restore some functionality.
Other autoimmune diseases:
The autoimmune aspect of celiac disease suggests a link to other autoimmune diseases, such as rheumatoid arthritis, lupus, thyroid disease, and type 1 diabetes.
It’s very important to be tested for celiac disease if you have any of these conditions because people with other autoimmune conditions seem to have an increased likelihood of having CD.