Tue07292014

Your Health

The gluten-free diet: What it is and how to adopt it


Photo By: Photos by Ellie Van Houtte/ Town Crier
Photo Photos By Ellie Van Houtte/ Town Crier

Flourchylde Bakery. pictured at the June 13 Los Altos Farmers’ Market, offers food selections for those who have adopted a gluten-free diet. Gluten is a protein found in wheat, barley and rye, as well as some crossbred grains. For those with celiac disease, gluten destroys the absorbing surface of the small intestine, causing abdominal distress.

Gluten-free products are everywhere. Customers who walk into any health-food store, or even a regular supermarket, will see an abundance of gluten-free items to choose from, perhaps even an entire aisle of choices.

More and more people are discussing a gluten-free diet and following its guidelines. But why? What exactly is the draw? What does it really mean, and should they be concerned about any nutritional issues?

What is gluten?

Gluten is a protein found in wheat, barley, rye and crossbred varieties of the grains. When the flours of these grains are mixed with water to make baked goods, it’s the gluten that becomes elastic during mixing and kneading, allowing bread products to develop their characteristic light, airy texture.

Wheat is among the top three field crops in the U.S. and as such is a major source of grain, therefore of gluten, in the American diet. When we search for whole-grain products to improve our diets, it’s easy to reach for whole-wheat breads, pastas and cereals as potential sources. An avoidance of gluten necessitates that these foods be eliminated from our plate.

For those with celiac disease, following a gluten-free diet is essential. This condition is characterized by an abnormal immune response to gluten. When a person with celiac disease ingests gluten, absorptive surfaces of the small intestine become damaged as their immune system destroys intestinal villi, causing malabsorption and symptoms including diarrhea and abdominal pain or discomfort.

For a diagnosis of celiac disease, you must still be consuming gluten and see your doctor for a series of screening blood tests and a biopsy of the intestine.

Many of us know people who have claimed that they are gluten-sensitive but who do not have celiac disease. They have chosen to follow the gluten-free diet for personal health reasons; they simply feel better on this type of diet. Some believe that a gluten-free diet helps them to improve blood sugars, or it simply leads to avoiding calories from tempting, gluten-rich carbohydrates like cakes and cookies. Whatever the reason for going gluten-free, individuals should be clear about their rationale – this is not an easy diet to follow.

Becoming a label-reader

Reading labels is a critical component to adopting a gluten-free diet. As anyone who has gone grocery shopping can attest, there are many types of wheat flour on the shelves – bromated, enriched, phosphated, plain and self-rising. All of them should be avoided, along with barley, rye, triticale (a cross between wheat and rye), bulgur, durum flour, farina, graham flour, kamut, semolina and smelt.

Grain and plant foods that are gluten-free include:

• Rice• Corn

• Amaranth• Quinoa

• Teff• Millet

• Sorghum• Arrowroot

• Buckwheat• Flax

• Job’s tears• Sago

• Potato• Soy

• Legumes• Mesquite

• Tapioca• Wild rice

• Cassava• Yucca

• Nuts• Seeds

Today, many products from pastas to flours are made from these sources. Keep in mind that it is important to make sure that the approved grains are not processed or mixed with gluten-containing grains, additives or preservatives, as many of them often are.

Wheat-free does not always mean gluten-free. To qualify as gluten-free, the final product must contain less than 20-ppm gluten. Many organic and health-food stores will help you decipher the labels, and organizations like the Celiac Disease Foundation (www.celiac.org) can provide tools to make your journey easier, such as a list of ingredients to be aware of when purchasing groceries.

There is always an accompanying risk that overall nutrition could suffer unless those following a gluten-free diet educate themselves about the best choices to make within the allowed foods.

Eliminating a commonly eaten group of grains from your diet might create a significant nutritional hole. Gluten-free diets have been known to fall short in fiber, calcium, iron and B vitamins. Some gluten-free products are left unenriched and are quite processed. That’s why it is important to check gluten-free product labels for enrichment with nutrients like B vitamins and iron, then make sure that you are replacing naturally – or with supplements – the vitamins that might be missing. This is especially true for women who are pregnant or nursing.

If done correctly, a gluten-free diet has the potential benefit of shifting your diet to a greater focus on plant foods that are naturally free from gluten and more “whole,” such as fruits, vegetables, beans, seeds and nuts. If you are nonvegetarian, be sure to choose unprocessed protein foods like fresh eggs, lean meats, fish and poultry to avoid potential sources of gluten. If lactose in foods is not a problem for you, most nonfat and low-fat dairy products can also be included.

One last important consideration: Cross-contamination can occur in your kitchen at home or in restaurants. All food preparation for those with celiac disease must be done in a dedicated area with pans used exclusively for the gluten-free diet.

You can make a variety of tasty gluten-free recipes at home easily, without paying a premium for special products. Consider spaghetti squash, for example, as a substitute for pasta. To prepare a gluten-free alternative, see the recipe in the sidebar above.

Jodi Bjurman, Registered Dietitian and Certified Diabetes Educator, is outpatient dietitian at El Camino Hospital.

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