By John Hoeber, MS, RD
From celebrities who swear by it to the menu at the hot new restaurant in town, gluten-free is all the rage. Your grocery store may even have a whole aisle dedicated to gluten-free fare. But what exactly is gluten? Is it really that bad for your body? And who needs to worry about it?
Let's start with the basics. Gluten is a protein found in certain grains, specifically in wheat, rye, barley, spelt and kamut. Going "g-free," as some call it, means eliminating these grains and any foods made with them from your diet. Most types of bread, bagels, pasta, muffins, flour tortillas, pizza crust, hot dog and hamburger buns, couscous, tabbouleh, bulgar, cookies, brownies and cereals that contain wheat shreds or flakes are off-limits to those avoiding gluten.
But there are other, unexpected, gluten-containing foods that you need to avoid, too. These include: beer (it's made with malt, which comes from barley), malt vinegar and other items made with malt or malt flavoring, soy sauce, teriyaki sauce, many gravies (gravy is typically thickened with flour), many fried foods (which are typically coated in flour before frying), brewer's yeast and imitation crab meat, among others. It is also recommended to avoid oats that don't specifically say "gluten-free," as they are often contaminated with wheat during processing.
Gluten is also used in lipstick and some medications, according to the National Institute of Diabetes and Digestive and Kidney Diseases. If you are truly allergic to gluten or have been diagnosed with celiac disease, speak with your pharmacist to see if your prescription medications contain wheat and read all product labels carefully.
What is safe to eat on a gluten-free diet? Any product made with potato, rice, soy, amaranth, quinoa, buckwheat or bean flour (instead of wheat flour).
Gluten sensitivity can range from simple gluten intolerance, which can cause mild but fleeting discomfort, to serious gluten intolerance, also known as celiac disease. These are both different than having a wheat or gluten food allergy.
Unlike celiac disease, where gluten is the source of symptoms, a wheat allergy can be caused by any number of proteins, including albumin, globulin, gliadin and gluten. Wheat allergies are commonly found in children and are typically outgrown before adulthood, whereas celiac disease can develop and be diagnosed at any age. While celiac disease can be successfully managed through dietary changes, it is a chronic condition that a person will have to deal with for the rest of his or her life (in other words, there is no cure yet for celiac disease).
Some have suggested that the increase in gluten intolerance in our society is a result of genetically-modified varieties of wheat and other grains being introduced in increasing quantities into our diet. But I suspect that the increase in gluten sensitivity is due to improved diagnosis and wider acceptance of this problem.
Gluten intolerance has been blamed for more than 250 symptoms. Most of those are digestive and include gas, bloating, nausea, abdominal pain, diarrhea, constipation and vomiting. Other common, non-digestive symptoms include weight gain, dermatitis (a broad term for several types of skin rashes), joint pain, tendonitis, headaches, migraines, depression, anxiety and irritability.
Celiac disease presents with different symptoms in children than in adults. In children, most symptoms are digestive, such as abdominal pain and bloating, chronic diarrhea, constipation, foul-smelling or fatty stool, or vomiting.
In adults, celiac disease symptoms vary widely and can include fatigue, bone or joint pain, bone loss, depression, anxiety, missed periods, canker sores or an itchy rash.
Clinical diagnosis is often tricky, but checking to see if you're sensitive to gluten is relatively easy by way of an elimination-challenge diet. As its name suggests, you start by completely eliminating gluten from your diet for at least three weeks. This means not eating one crumb of wheat bread or drinking one sip of beer.
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