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The Gluten Basics

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Gluten-free is a commonly used phrase many have heard of, whether it be from a food package, restaurant menu or given as a dietary recommendation. But many are not aware of the unique properties of gluten which can be enjoyed in the textures of baked goods, breads and pasta. Many still wonder, what is gluten and should I avoid it? 

European and American wheat 
Gluten is a protein found in grains—such as wheat, barley, rye—hybrids of these grains (such as triticale) and foods including these grains as ingredients, ranging from baked goods to soy sauce. Fortunately, most people can eat gluten without risk of any health issues.

Some have noted their digestive issues improve when traveling abroad to places such as Europe, leading them to conclude there must be something different with the food. But is this true? 

Due to climate, mostly soft wheat is grown in Europe while in America hard red wheat is grown, which is higher in gluten. Even though Europe mostly grows soft wheat, they still import a good deal of American wheat for use in their food supply. Medical conditions related to wheat such as celiac disease and wheat allergy also occur at the same rates in Europe and America.
  
To date there is no evidence that pesticide use, which is tightly controlled for safety, contributes in any way to health hazards in America or Europe. Genetically modified organisms (GMOs) are another concern for many, but there are no GMO wheat varieties approved for use in America or Europe. Corn and soy are most modified but safe to eat. Like pesticides, GMOs have posed no health risks after decades of rigorous testing. In fact, GMOs help reduce the amount of pesticide needed!

Differences in digestive experience while traveling could be due to many factors:

  • Less stress—while traveling or on vacation, you may be more relaxed, which is good for the gut
     
  • More physical activity—traveling by foot can increase your level of physical activity, which improves digestion
     
  • Smaller portions and leisurely meals—these are common in Europe, supporting digestion

Is gluten-free healthier?
As with any style of eating, a gluten-free (GF) diet has potential to be healthy or unhealthy depending on the balance of foods included. There are many nutrient-rich GF whole foods including:

  • Beans, nuts, seeds, fruits, vegetables, whole grains, fish, poultry, dairy, eggs, meats and most vegetable fats and oils
     
  • GF whole grains: teff, millet, packaged GF oats, sorghum, amaranth, rice, corn, buckwheat, rye and quinoa

Often, when GF grains have been processed, they are stripped of essential nutrients and are not always added back as they are with wheat products. By law, refined wheat products must be enriched with nutrients lost during processing. This multivitamin safety net isn’t required for packaged GF foods. Including the nutrient-rich GF whole grain foods listed above in your diet can help you obtain the right amount of nutrients.

Nutrients that could be missing or low in your diet can include:

  • Thiamin (vitamin B1)
  • Riboflavin (vitamin B2)
  • Niacin (vitamin B3)
  • Folic acid
  • Iron
  • Fiber

Health benefits of gluten
It is important to remember gluten is only one protein found in grains such as wheat, rye and barley. These grains contain several other important nutrients and health properties:

  • Seitan—a good source of protein used in vegetarian and vegan diets—100% pure wheat gluten
     
  • Beta-glucan fiber is in the grain barley and can lower cholesterol
     
  • Unique antioxidants that help prevent disease are found in wheat, barley and rye and are not found in other foods
     
  • When eaten as whole grains, wheat, barley and rye naturally have many vitamins and minerals such as B vitamins, vitamin E, magnesium, iron and folic acid
     
  • Gluten adds to fiber variety and prebiotic intake to improve overall gut health
     
  • More plants in the diet, including gluten-containing grains (wheat, barley and rye) supports gut health, immune health and prevention of disease such as colon cancer and heart disease 

Who should avoid gluten?
Those with celiac disease, wheat allergy and non-celiac gluten sensitivity should avoid gluten- or wheat-containing foods in their diets for an improved quality of life.

  • Celiac disease is a condition affecting about 1% of the population where the body’s immune system attacks itself when gluten is consumed. This affects the body’s ability to absorb nutrients and can lead to many other health problems.
     
  • Wheat allergy is an abnormal overreaction of the immune system to wheat, not just gluten. It can be life-threatening and affects 1-2% of the population. Some grains may be consumed such as amaranth, barley, corn, oat, quinoa, rice and rye.
     
  • Non-celiac gluten sensitivity is currently a symptom-based condition where the person has first ruled out celiac disease, then removes gluten-containing grains from their diet and symptoms improve and when reintroduced, symptoms re-occur. At this time, this condition is not thought to involve the immune system and causes no damage to the body or increased risk of developing other health issues. Currently, it is unclear if the individual is reacting to gluten or some other component of the grain and rates of the condition are unknown. 

Testing for celiac disease, wheat allergy or non-celiac gluten sensitivity
Celiac disease must be tested for while someone is still including gluten in their diet, otherwise results will be inaccurate. Your doctor will run blood tests for specific antibodies.  A positive diagnosis is confirmed with a procedure called an endoscopy where biopsies of the small intestine are taken and examined for damage caused by the disease. 

Wheat allergy should be tested for by a doctor who is a board-certified allergist. After discussing your health history with the allergist, they will decide if tests such as a skin-prick, patch or blood tests should be done for wheat. These tests look for specific antibodies to wheat that are different from those in celiac disease. If testing shows positive results, the allergist may perform an oral food challenge where wheat-containing food is eaten under their supervision so reactions can be treated in a safe environment. Some wheat allergies are life-threatening and require the individual to carry an Epi-Pen® to treat themselves if exposed. 

Non-celiac gluten sensitivity does not currently have any proven tests, though many food sensitivity tests are sold. This isn’t illegal; however, insurance companies will not cover them due to lack of evidence showing they work. This condition is diagnosed after diseases that share similar symptoms are ruled out, such as celiac disease. The presence of this condition is symptom-based and supported when eliminating wheat-containing grains from the diet improves symptoms and reintroduction of those grains causes a return of symptoms. 

Final thoughts
Differences in wheat from country to country pose no health risks to most people. While there are medical reasons for avoiding wheat and gluten-containing grains, they pose no risk to those without these conditions. There can be deficiencies of many nutrients in gluten-free diets many aren’t aware of and do not support optimal health. 

Overall, we see more health benefits than risks with gluten-containing grains! For those worried about health concerns related to wheat or gluten, specific tests can be used followed by diet manipulation to diagnose and treat medical conditions associated with wheat and gluten. Diets that focus on the removal of certain foods should be started with the guidance and support of a registered dietitian nutritionist, preferably one with expertise in digestive disorders or food allergies.

To schedule a one-on-one consultation with a Cooper Clinic Registered Dietitian Nutritionist or learn more about Cooper Clinic Nutrition, visit cooperclinicnutrition.com or call 972.560.2655.

Article provided by Gillian White, RDN, LD, CNSC, and Cooper Clinic Nutrition.