The Gluten-Free Diet: What You Need to Know

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You can’t turn on the television, read a paper, or surf online these days without seeing the terms “gluten” and “gluten-free”. But what exactly is gluten and why are so many people avoiding it? Gluten is the collective term for the proteins found in the grains wheat, rye and barley and their various forms. It is best known for giving baked goods their doughy, elastic structure, however many foods contain gluten for other purposes, including as a thickening agent or flavor enhancer.

Did You Know?

The flours in gluten-free grain-based products are not required to be enriched with iron and B vitamins. Some manufacturers are beginning to fortify their gluten-free products. Choose fortified options when appropriate.

Common Gluten-Containing Foods

Wheat

Barley

Rye

  • Durum
  • Einkorn
  • Spelt
  • Farro
  • Kamut®
  • Triticale
  • Graham flour
  • Matzoh meal/flour
  • Semolina
  • Bulgur
  • Couscous
  • Farina
  • Wheat berries
  • Wheat starch
  • Wheat flour
  • Wheat bran
  • Wheat germ
  • Barley malt
  • Barley extract
  • Malt extract, syrup, flavoring
  • Malt vinegar
  • Brewer’s yeast
  • Malt beverages, ale, lager and beer

 

  • Rye flour
  • Rye extract and flavoring
  • Rye berries

What About Oats?

While oats are inherently gluten-free, they often come in contact with gluten during harvesting, shipping and manufacturing. People with celiac disease should avoid regular oats and any foods containing them. Some people with celiac disease can tolerate moderate amounts of pure, uncontaminated or certified gluten-free oats, however others are highly sensitive and cannot. It is recommended that people with celiac disease should introduce certified gluten-free oats into their diet only under the supervision of their physician and/or registered dietitian (RD).

Is Corn Gluten Safe?

The protein in corn is often erroneously referred to as corn gluten. The protein in corn is not harmful to people with celiac disease and does not have to be restricted in a gluten-free diet.

Testing Tips:

Get tested for celiac disease before going gluten-free, as removing gluten from the diet prior to testing can lead to inaccurate test results. There is no reliable test for non-celiac gluten sensitivity. To confirm a diagnosis, celiac disease and wheat allergy should first be ruled out through proper testing conducted by a physician knowledgeable in gluten- and/or allergy-related disorders. An elimination diet is conducted next to see if symptoms subside and return when removing and adding gluten back into the diet. For best results, elimination diets should be performed under the supervision of a registered dietitian.

What Foods are Naturally Gluten-Free?

Living gluten-free can be challenging, but there is a bright side. Many of the foods recommended as part of a healthful diet are naturally gluten-free, including fruits, vegetables, beans, nuts, seeds, low-fat dairy, fish, meat and poultry.* Here is a partial list of gluten-free grains, starches and flours that are safe to eat.

Gluten-Free Grains

Gluten-Free Starches

Gluten-Free Flours

  • Amaranth
  • Buckwheat (does not contain wheat/gluten)
  • Corn (maize)
  • Millet
  • Oats (pure/uncontaminated or certified gluten-free)
  • Quinoa
  • Rice (white, brown, wild)
  • Sorghum
  • Teff
  • Arrowroot
  • Corn
  • Potato
  • Tapioca (cassava, manioc)
  • Yucca
  • Flour forms of the gluten-free grains mentioned above
  • Legume flours (e.g., chickpea, fava, lentil, pea)
  • Nut flours (e.g., almond, hazelnut, peanut)
  • Soy

* Read food labels to determine if gluten containing ingredients have been added.

Who is Eating Gluten-Free and Why?

The effects of gluten are not the same for everyone. While the vast majority of Americans consume gluten and experience no side effects, some must avoid gluten due to specific medical conditions.

Gluten-related disorders

  • Celiac disease (CD) is an autoimmune disorder in which the immune system creates antibodies to gluten and the intestines become damaged when gluten is eaten. Over time, the intestines become so damaged that they cannot absorb nutrients, leading to diseases of malnutrition and other long-term health issues. A life-long strict gluten-free diet is medically necessary.
  • Non-celiac gluten sensitivity (NCGS) is the diagnosis given to people who experience symptoms when eating gluten, but have tested negative for celiac disease and/or wheat allergy. While the symptoms overlap with celiac disease, the body does not create antibodies to gluten nor are the intestines damaged. A gluten-free diet is medically necessary to reduce symptoms and optimize health. However, it’s unknown if there are long-term health risks to ingesting small amounts of gluten, so each individual chooses how strictly they follow a gluten-free diet.
  • Wheat allergy – Some with severe allergic reactions to wheat choose to strictly avoid all gluten in order to reduce their risk of ingesting wheat through cross contact.

Other conditions

Some people with autism and certain autoimmune disorders—such as multiple sclerosis, rheumatoid arthritis and thyroid disease—may experience reduced symptoms on a gluten-free diet. However, the medical literature does not support the gluten-free diet as an effective treatment for all people with these conditions. As a result, the gluten-free diet is not considered medically necessary for these conditions. RDs and physicians should work with each patient individually to determine if a gluten-free diet is beneficial.

Lifestyle

Many celebrities, professional athletes and even book authors say that going gluten-free is a healthier way to live or is an effective weight-loss diet. There is no evidence to show that removing gluten from the diet, in and of itself, leads to weight loss. Nor is there a health benefit to eating gluten-free if you don’t have CD, NCGS, or another condition in which symptoms are improved when removing gluten from the diet.

Be Healthy and Gluten-Free

Just because a food is gluten-free does not automatically mean it is healthful or helps with weight loss. While the influx of glutenfree packaged foods on the market has made it easier and more enjoyable to stick to a gluten-free diet, some products (not all) are high in starches, refined grains, fats and sugars and low in nutrients, particularly iron, B vitamins and fiber. Those on a gluten-free diet can best meet their nutrient needs by eating mostly whole foods, saving treats for special occasions and convenience foods for when they are truly needed.

The good news is that the gluten-free market is still in its infancy and food companies are working to make gluten-free products more nutritious through whole food ingredients and fortification.

“Gluten-Free” on Food Labels

The U.S. Food and Drug Administration (FDA) issued a final rule defining “gluten-free” for food labeling, meaning that any food product making a gluten-free claim on its package must adhere to the defined standard. Any food product with a label making the claim “gluten-free,” “no gluten,” “free of gluten,” or “without gluten” must contain less than 20 ppm (parts per million) of gluten, the limit considered safe for most people with CD.

For more information on the ruling, please visit the FDA web site.

All manufacturers must be in compliance with the labeling ruling by August 5, 2014.

Did You Know?

Gluten-free labeling is voluntary. There may be foods that contain <20ppm of gluten that do not make a “gluten-free” claim.

Hidden Sources of Gluten

Gluten is often found in unexpected places. Be sure to read food labels each and every time while shopping, as food manufacturers can change their formulations without warning. While not a complete list, here are examples of common foods that may contain gluten.

  • Deli meats
  • Gravies, sauces and marinades
  • Seasoning blends
  • Egg substitutes
  • Imitation seafood and bacon bits
  • Soups, stocks, broths and bouillon
  • Flavored snacks, chips and nuts
  • Licorice and confections
  • Soy sauce
  • Flavored grain dishes
  • Meat substitutes
  • Miso and tempeh
  • Flavored hot chocolate, coffee and tea mixes
  • Salad dressings
  • Veggie burgers and other vegetable protein products

Resources

1. Case, S. (2010, December). Gluten-free diet: A comprehensive resource guide (revised and expanded ed.). Case Nutrition Consulting Inc.
2. Food Allergy Research & Education. (2013). Retrieved from www.foodallergy.org
3. National Foundation for Celiac Awareness. (2013, October 4). Retrieved from www.celiaccentral.org
4. National Foundation for Celiac Awareness GREAT Kitchens Training Manual
5. U.S Food and Drug Administration. (2013, August 2). Glutenfree labeling of foods. Retrieved from http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryIn...
6. USDA Food Safety Inspection Service. (2013, August 5). About FSIS. Retrieved from http://www.fsis.usda.gov/wps/portal/informational/aboutfsis
7. Whole Grains Council. (2013). Gluten free whole grains. Retrieved from http://wholegrainscouncil.org/wholegrains-101/gluten-free-whole-grains
8. “Food Labeling; Gluten-Free Labeling of Foods.” Federal Register 78 (5 August 2013): 47154. Print.

Additional Resouces: 

The effects of gluten are not the same for everyone. While the vast majority of Americans consume gluten and experience no side effects, some must avoid gluten due to specific medical conditions.