Gluten is a protein found in grains, including wheat, barley, and rye. It's common in foods such as bread, pasta, pizza, and cereal, without providing any essential nutrients.
People with celiac disease have an immune reaction that is triggered by eating gluten. They develop inflammation and damage in their intestinal tracts and other parts of the body when they eat foods containing gluten. Current estimates suggest that up to 1% of the population has this condition. If you do have celiac disease, a gluten-free diet is necessary to eliminate the inflammation and the symptoms. Grocery stores and restaurants routinely offer gluten-free options that rival conventional foods in taste and quality; in years past, it was much harder to maintain a gluten-free diet.
So, maybe it should come as no surprise that even people who haven’t been diagnosed with celiac disease might embrace the gluten-free mantra. And embrace it they have (although no research supports that): estimates suggest that 20% to 30% of the US population follows a gluten-free diet (or has done so in the past).
Who should avoid gluten?
According to Dr. Robert Shmerling of Harvard Health, people with celiac disease avoid sickness and maintain much better health if they follow a gluten-free diet. For them, a gluten-free diet is nothing short of essential.
And then there are people described as gluten-sensitive. Their tests for celiac disease are negative (normal), yet whenever they eat food containing gluten, they experience symptoms like bloating, diarrhea, or crampy abdominal pain. One cause is wheat allergy, a disorder that can be diagnosed by skin testing. But for many others, the diagnosis remains uncertain. Some have begun calling this non-celiac gluten hypersensitivity, a poorly defined condition about which we have much to learn.
Avoiding gluten makes sense for people with celiac disease, wheat allergy, or those who feel unwell whenever they consume gluten.
Rethink your grains:
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Avoid all products with barley, rye, triticale (a cross between wheat and rye), farina, graham flour, semolina, and any other kind of flour, including self-rising and durum, not labeled gluten-free.
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Be careful of corn and rice products. These don’t contain gluten, but they can sometimes be contaminated with wheat gluten if they're produced in factories that also manufacture wheat products. Look for such a warning on the package label.
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Go with oats. Recent studies suggest you can eat oats as long as they are not contaminated with wheat gluten during processing. You should check with your healthcare provider first.
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Substitute potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour for wheat flour. You can also use sorghum, chickpea or Bengal gram, arrowroot, and corn flour, as well as tapioca starch extract. These act as thickeners and leavening agents.
Become a label expert:
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Know terms for hidden gluten. Avoid einkorn, emmer, spelt, kamut, wheat starch, wheat bran, wheat germ, cracked wheat, and hydrolyzed wheat protein. Stay away from emulsifiers, dextrin, mono- and di-glycerides, seasonings, and caramel colors because they can contain gluten.
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Check the labels of all foods. Gluten can be found in food items you’d never suspect. Here are some likely to contain gluten:
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Beer, ale, and lagers
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Bouillon cubes
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Brown rice syrup
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Candy
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Chips, potato chips
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Cold cuts, hot dogs, salami, and sausage
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Communion wafers
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French fries
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Gravy
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Imitation fish
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Matzo
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Rice mixes
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Sauces
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Seasoned tortilla chips
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Self-basting turkey
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Soups
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Soy sauce
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Vegetables in sauce
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More strategies for a gluten-free lifestyle
Here are ideas to better make the transition to a gluten-free diet:
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Separate all kitchen items used for preparing gluten and gluten-free foods. These include cooking utensils, cutting boards, forks, knives, and spoons.
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When eating out, if you’re not sure about the ingredients in a particular dish, ask the chef how the food was prepared. You can also ask whether a gluten-free menu is available. Most restaurants have a website where you can review the menu in advance.
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Ask your pharmacist if any of your medicines contain wheat or a wheat byproduct. Gluten is used as an additive in many products from medicines to lipstick. Manufacturers can provide a list of ingredients on request if they are not named on the product. Many herbals, vitamins, supplements, and probiotics contain gluten.
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Watch your portion sizes. Gluten-free foods may be safe and good for you, but they're not calorie-free.
If you still feel symptoms on your gluten-free diet, double check that you're not still consuming small amounts of gluten hidden in sauces, salad dressings, and canned soups or through additives, such as modified food starch, preservatives, and stabilizers made with wheat. Even some medicines can contain gluten. Tablets and capsules can be sources of gluten contamination. The risk of your medicines containing gluten is very small but, if you are concerned, you should discuss this with your healthcare provider.
As you and your family become experts in reading food and product labels, you’ll be able to find hidden sources of gluten before they can cause a problem. You might also get more ideas from joining a support group, in person or online, that can help you adjust to your new way of life. These are great forums for learning a wealth of delicious recipes for everything from gluten-free cookies and banana bread to biscuits, trail mix, and grits.