Gluten-free diet
Encyclopedia
A gluten-free diet is a diet
that excludes foods containing gluten
. Gluten is a protein found in wheat
(including kamut and spelt
), barley
, rye
, malts and triticale
. It is used as a food additive
in the form of a flavoring, stabilizing or thickening agent, often as "dextrin". A gluten-free diet is the only medically accepted treatment for celiac disease, the related condition dermatitis herpetiformis
, and wheat allergy
.
Additionally, a gluten-free diet may exclude oat
s. Medical practitioners are divided on whether oats are an allergen to celiac disease sufferers or if they are cross-contaminated in milling facilities by other allergens.
The term gluten-free is generally used to indicate a supposed harmless level of gluten rather than a complete absence. The exact level at which gluten is harmless is uncertain and controversial. A recent systematic review
tentatively concluded that consumption of less than 10 mg of gluten per day is unlikely to cause histological abnormalities, although it noted that few reliable studies had been done. Regulation of the label gluten-free varies widely by country. In the United States, the FDA
issued regulations in 2007 limiting the use of "gluten-free" in food products to those with less than 20 ppm of gluten. The current international Codex Alimentarius
standard allows for 20 ppm of gluten in so-called "gluten-free" foods.
sources are considered acceptable for a gluten-free diet. The most frequently used are corn
, potato
es, rice
, and tapioca
(derived from cassava
). Other grains and starch sources generally considered suitable for gluten-free diets include amaranth
, arrowroot
, millet
, montina
, lupin
, quinoa
, sorghum
(jowar), taro
, teff
, chia seed, and yam
. Various types of bean
, soybean
, and nut
flour
s are sometimes used in gluten-free products to add protein
and dietary fiber
. Almond flour is a low-carbohydrate alternative to flour, with a low glycemic index. In spite of its name, buckwheat
is not related to wheat; pure buckwheat is considered acceptable for a gluten-free diet, although many commercial buckwheat products are actually mixtures of wheat and buckwheat flours, and thus not acceptable. Gram flour
, derived from chickpea
s, is also gluten-free (this is not the same as Graham flour
made from wheat).
Gluten is also used in foods in some unexpected ways, for example as a stabilizing agent
or thickener in products like ice-cream and ketchup
.
People wishing to follow a completely gluten free diet must also take into consideration the ingredients of any over-the-counter or prescription medications and vitamins. Also, cosmetics such as lipstick, lip balms, and lip gloss may contain gluten and need to be investigated before use. Glues used on envelopes may also contain gluten.
Most products manufactured for Passover
are gluten free. Exceptions are foods that list matzah as an ingredient, usually in the form of cake meal.
In the US, the FDA considers foods containing less than or equal to 20 ppm to be gluten-free. The finding of a current study indicates that some inherently gluten-free grains, seed, and flours not labeled gluten-free are contaminated with gluten. The consumption of these products can lead to inadvertent gluten intake.
The use of highly sensitive assays is mandatory to certify gluten-free food products. The European Union, World Health Organization, and Codex Alimentarius require reliable measurement of the wheat prolamins, gliadins rather than all-wheat proteins.
There is still no general agreement on the analytical method used to measure gluten in ingredients and food products.
The official limits described in the Codex Draft are 20 ppm for foodstuffs naturally gluten-free and 200 ppm for foodstuffs rendered gluten-free.
The ELISA method was designed to detect w-gliadins but it suffered from the setback that it lacked sensitivity for barley prolamins.
Cross Contamination Issues in Canada
A growing body of evidence suggests that a majority of people with celiac disease and following a gluten-free diet can safely consume pure oats in moderate amounts. But, previous studies have indicated that the commercial oat supply in other countries and in Canada is contaminated with other grains.
Special care is necessary when checking product ingredient lists since gluten comes in many forms: vegetable proteins and starch, modified food starch (when derived from wheat instead of maize), malt flavoring, including maltodextrine, dextrine , unless specifically labeled as corn malt. Many ingredients contain wheat or barley derivatives. However, dextrose is gluten free since it is highly modified, no matter what the source.
Although many foods contain gluten, it is not always included in ingredients lists. This lack of inclusion is because gluten is not used in the formulation of the product, but in the preparation (or manufacturing) of listed ingredients. One example is the dusting of the conveyor belts in the production facilities with gluten products to prevent the foods from sticking during processing. "Natural Flavoring" is also suspected to contain gluten. This type of gluten contamination may not be labeled; information confirming whether this form of gluten is present in a given product may only be available by contacting the food manufacturer directly.
s in the gluten-free diet is still somewhat controversial. Some research suggests that oats in themselves are gluten free, but that they are virtually always contaminated by other grains during distribution or processing. However, recent research indicated that a protein naturally found in oats (avenin) possessed peptide sequences closely resembling wheat gluten and caused mucosal inflammation in significant numbers of celiac disease sufferers. Some examination results show that even oats that are not contaminated with wheat particles are nonetheless dangerous, while not very harmful to the majority. Such oats are generally considered risky for celiac children to eat, but two studies show that they are completely safe for celiac adults to eat. People who are merely gluten-sensitive may be able to eat oats without adverse effect,
even over a period of five years.
Given this conflicting information, excluding oats appears to be the only risk-free practice for celiac disease sufferers of all ages. However, medically approved guidelines exist for those celiacs who do wish to introduce oats into their diet.
Unless manufactured in a dedicated facility and under gluten-free practices, all cereal grains, including oats, can be cross-contaminated with gluten. Grains become contaminated with gluten by sharing the same farm, truck, mill, or bagging facility as wheat and other gluten-containing grains. Therefore, removing all flours and grains from the diet may be the only way to guarantee a complete absence of gluten in the diet.
Standards for "gluten-free" labelling have been set up by the "Codex Alimentarius
"; however, these regulations do not apply to "foods which in their normal form do not contain gluten".
The legal definition of the phrase "gluten-free" varies from country to country. Current research suggests that for persons with coeliac disease the maximum safe level of gluten in a finished product is probably less than 0.02% (200 parts per million) and possibly as little as 0.002% (20 parts per million).
Australian standards reserve the "gluten free" label for foods with less than 5 parts per million of gluten, as this is the smallest amount currently detectable. In the processing of gluten-containing grains, gluten is removed (shown in the processing flow below)
Since ordinary wheat flour contains approximately 12% gluten, even a tiny amount of wheat flour can cross-contaminate a gluten-free product. Therefore, considerable care must be taken to prevent cross-contamination in both commercial and home food preparation.
This diet rules out all ordinary bread
s, pasta
s, and many convenience food
s; it also excludes gravies, custards, soups and sauces thickened with wheat, rye, barley or other gluten-containing flour. Many countries do not require labeling of gluten containing products, but in several countries (especially Australia
and the European Union
) new product labeling standards are enforcing the labeling of gluten-containing ingredients. Various gluten-free bakery and pasta products are available from specialty retailers.
In the United States, gluten may not be listed on the labels of certain foods because the U.S. Food and Drug Administration
has classified gluten as GRAS
(Generally Recognized As Safe). Requirements for proper labeling are being formulated by the USDA. It is currently up to the manufacturers of "gluten free" food items to guarantee such a claim. "A final rule that defines the term gluten-free and identifies the criteria that would enable the food industry to use that term" was scheduled to be released by the FDA on August 2, 2008. This final rule has not yet come to fruition. For now, many individuals who must eat gluten free use sources online to search the gluten free content of products.
Many so-called gluten free products, such as chicken bouillon, corn cereal, and caramel ice cream topping, have been found to have been contaminated with gluten. For example, in an investigation reported by the Chicago Tribune
on November 21, 2008, Wellshire Farms chicken nuggets labeled "gluten-free" were purchased and samples were sent to a food allergy lab at the University of Nebraska. Results of the testing indicated gluten was present in levels exceeding 2,000 ppm. After the article was published, the products continued to be sold. However, after receiving customer inquiries, Whole Foods Market
removed the product from their shelves over a month later. Wellshire Farms has since replaced the batter used in their chicken nuggets.
In the United Kingdom
, only cereals currently need to be labeled, while other products are voluntary. For example, most British sausage
s contain Butcher's Rusk, a grain-derived food additive
. Furthermore, while UK companies selling food prepared on their own premises are given guidance by the Food Standards Agency
, they are not required to meet any labeling requirements.
Lastly, some non-foodstuffs such as medication
s and vitamin
supplements
, especially those in tablet
form, may contain gluten as an excipient
or binding agent. People with gluten intolerances may therefore require specialist compounding
of their medication.
Several celiac groups report that according to the American Dietetic Association
's "Manual of Clinical Dietetics" many types of alcoholic beverages are considered gluten free, provided no colourings or other additives have been added as these ingredients may contain gluten. Although most forms of whiskey are distilled from a mash
that includes grains that contain gluten, distillation
removes any proteins present in the mash, including gluten. Although up to 49% of the mash for Bourbon
and up to 20% of the mash for corn whiskey
may be made up of wheat, or rye, all-corn Bourbons and corn whiskeys do exist, and are generally labeled as such. Spirits made without any grain such as brandy
, wine
, mead
, cider
, sherry
, port
, rum
, tequila
and vermouth
generally do not contain gluten, although some vineyards use a flour paste to caulk the oak barrels in which wine is aged, and other vineyards use gluten as a clarifying agent (though it's unclear whether gluten remains at the end of the clarification process). Therefore, some coeliacs may wish to exercise caution. Liqueur
s and pre-mixed drinks should be examined carefully for gluten-derived ingredients.
While many spirits were traditionally made without grain, such as tequila, rum and vodka, today they are more commonly made with barley, wheat or rye (instead of agave, sugar or potatoes, et cetera). Often, only high-end specialty alcoholic brands are made with what are considered the traditional ingredients. In addition, many people diagnosed with celiac disease still experience symptoms when drinking distilled alcoholic beverages. Therefore, it is advised that a person with celiac disease check with a manufacturer about the ingredients that have been used in a hard liquor, and to proceed with caution if choosing to drink a liquor that is made with wheat, barley, oats or rye.
Almost all beers are brewed with malted barley
or wheat
and will contain gluten. Sorghum
and buckwheat
-based gluten-free beers are available, but remain a niche market. Some low-gluten beers are also available, however there is disagreement over the use of gluten products in brewed beverages: Some brewers argue that the proteins from such grains as barley
or wheat
are converted into amino acid
s during the brewing
process and are therefore gluten-free; however, there is evidence that this claim is false.
, which is a staple in the Western diet, is typically made from grains such as wheat that contain gluten. Wheat gluten contributes to the elasticity of dough and is thus an important component of bread. Gluten-free bread is made with ground flours from a variety of materials such as rice
(rice bread
), sorghum
(sorghum bread), corn
(cornbread
), or legumes like beans (bean bread) , but since these flours lack gluten it can be difficult for them to retain their shape as they rise and they may be less "fluffy". Additives such as xanthum gum, hydroxypropyl methylcellulose (HPMC), corn starch, or eggs
are used to compensate for the lack of gluten.
Despite vigorous marketing, a variety of studies, including a study by the University of Rochester found that the "Popular Autism Diet Does Not Demonstrate Behavioral Improvement", have failed to support any genuine benefit to children diagnosed with Autism who do not also have a known digestive condition which benefits from a gluten free diet.
GF foods are raw foods including rice, potatoes, soybeans, maize, millet, buckwheat, amaranth and quinoa. The diet may be low in fiber, iron, folate, calcium, magnesium, zinc, vitamin D, B-complex vitamins ( thiamin, riboflavin, niacin, and vitamin B12)
Celiacs adhering to a GFD (gluten free diet) may be at risk for inadequate calcium, non-starch polysaccharides and Vitamin D.
Oats can increase intakes of vitamin B1, magnesium, and zinc in celiac patient in remission.
Diet (nutrition)
In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...
that excludes foods containing gluten
Gluten
Gluten is a protein composite found in foods processed from wheat and related grain species, including barley and rye...
. Gluten is a protein found in wheat
Wheat
Wheat is a cereal grain, originally from the Levant region of the Near East, but now cultivated worldwide. In 2007 world production of wheat was 607 million tons, making it the third most-produced cereal after maize and rice...
(including kamut and spelt
Spelt
Spelt is a hexaploid species of wheat. Spelt was an important staple in parts of Europe from the Bronze Age to medieval times; it now survives as a relict crop in Central Europe and northern Spain and has found a new market as a health food. Spelt is sometimes considered a subspecies of the...
), barley
Barley
Barley is a major cereal grain, a member of the grass family. It serves as a major animal fodder, as a base malt for beer and certain distilled beverages, and as a component of various health foods...
, rye
Rye
Rye is a grass grown extensively as a grain and as a forage crop. It is a member of the wheat tribe and is closely related to barley and wheat. Rye grain is used for flour, rye bread, rye beer, some whiskeys, some vodkas, and animal fodder...
, malts and triticale
Triticale
Triticale is a hybrid of wheat and rye first bred in laboratories during the late 19th century. The grain was originally bred in Scotland and Sweden. Commercially available triticale is almost always a second generation hybrid, i.e., a cross between two kinds of primary triticales...
. It is used as a food additive
Food additive
Food additives are substances added to food to preserve flavor or enhance its taste and appearance.Some additives have been used for centuries; for example, preserving food by pickling , salting, as with bacon, preserving sweets or using sulfur dioxide as in some wines...
in the form of a flavoring, stabilizing or thickening agent, often as "dextrin". A gluten-free diet is the only medically accepted treatment for celiac disease, the related condition dermatitis herpetiformis
Dermatitis herpetiformis
Dermatitis herpetiformis , or Duhring's disease,Freedberg, et al. . Fitzpatrick's Dermatology in General Medicine. . McGraw-Hill. ISBN 0-07-138076-0. is a chronic blistering skin condition, characterised by blisters filled with a watery fluid...
, and wheat allergy
Wheat allergy
Wheat allergy is a food allergy, but can also be a contact allergy resulting from occupational exposure. Like all allergies wheat allergy involves IgE and mast cell response. Typically the allergy is limited to the seed storage proteins of wheat, some reactions are restricted to wheat proteins,...
.
Additionally, a gluten-free diet may exclude oat
Oat
The common oat is a species of cereal grain grown for its seed, which is known by the same name . While oats are suitable for human consumption as oatmeal and rolled oats, one of the most common uses is as livestock feed...
s. Medical practitioners are divided on whether oats are an allergen to celiac disease sufferers or if they are cross-contaminated in milling facilities by other allergens.
The term gluten-free is generally used to indicate a supposed harmless level of gluten rather than a complete absence. The exact level at which gluten is harmless is uncertain and controversial. A recent systematic review
Systematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...
tentatively concluded that consumption of less than 10 mg of gluten per day is unlikely to cause histological abnormalities, although it noted that few reliable studies had been done. Regulation of the label gluten-free varies widely by country. In the United States, the FDA
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
issued regulations in 2007 limiting the use of "gluten-free" in food products to those with less than 20 ppm of gluten. The current international Codex Alimentarius
Codex Alimentarius
The Codex Alimentarius is a collection of internationally recognized standards, codes of practice, guidelines and other recommendations relating to foods, food production and food safety. Its name derives from the Codex Alimentarius Austriacus...
standard allows for 20 ppm of gluten in so-called "gluten-free" foods.
Gluten-free food
Several grains and starchStarch
Starch or amylum is a carbohydrate consisting of a large number of glucose units joined together by glycosidic bonds. This polysaccharide is produced by all green plants as an energy store...
sources are considered acceptable for a gluten-free diet. The most frequently used are corn
Maize
Maize known in many English-speaking countries as corn or mielie/mealie, is a grain domesticated by indigenous peoples in Mesoamerica in prehistoric times. The leafy stalk produces ears which contain seeds called kernels. Though technically a grain, maize kernels are used in cooking as a vegetable...
, potato
Potato
The potato is a starchy, tuberous crop from the perennial Solanum tuberosum of the Solanaceae family . The word potato may refer to the plant itself as well as the edible tuber. In the region of the Andes, there are some other closely related cultivated potato species...
es, rice
Rice
Rice is the seed of the monocot plants Oryza sativa or Oryza glaberrima . As a cereal grain, it is the most important staple food for a large part of the world's human population, especially in East Asia, Southeast Asia, South Asia, the Middle East, and the West Indies...
, and tapioca
Tapioca
Tapioca is a starch extracted Manihot esculenta. This species, native to the Amazon, Brazil, Colombia, Venezuela, Cuba, Puerto Rico, Haiti, the Dominican Republic, Honduras, and most of the West Indies, is now cultivated worldwide and has many names, including cassava, manioc, aipim,...
(derived from cassava
Cassava
Cassava , also called yuca or manioc, a woody shrub of the Euphorbiaceae native to South America, is extensively cultivated as an annual crop in tropical and subtropical regions for its edible starchy tuberous root, a major source of carbohydrates...
). Other grains and starch sources generally considered suitable for gluten-free diets include amaranth
Amaranth
Amaranthus, collectively known as amaranth, is a cosmopolitan genus of herbs. Approximately 60 species are recognized, with inflorescences and foliage ranging from purple and red to gold...
, arrowroot
Arrowroot
Arrowroot, or obedience plant , Bermuda arrowroot, araru, ararao, is a large perennial herb found in rainforest habitats...
, millet
Millet
The millets are a group of small-seeded species of cereal crops or grains, widely grown around the world for food and fodder. They do not form a taxonomic group, but rather a functional or agronomic one. Their essential similarities are that they are small-seeded grasses grown in difficult...
, montina
Montina
Montina is a type of flour created from milled Indian rice grass , a type of grass native to the Western United States. Indian rice grass was grown and used by Native Americans as much as 7,000 years ago. The flour is gluten-free. Montina was determined to be gluten-free by Dr...
, lupin
Lupin
Lupinus, commonly known as Lupins or lupines , is a genus in the legume family . The genus comprises about 280 species , with major centers of diversity in South and western North America , and the Andes and secondary centers in the Mediterranean region and Africa Lupinus, commonly known as Lupins...
, quinoa
Quinoa
Quinoa , a species of goosefoot , is a grain-like crop grown primarily for its edible seeds. It is a pseudocereal rather than a true cereal, or grain, as it is not a member of the grass family...
, sorghum
Sorghum
Sorghum is a genus of numerous species of grasses, one of which is raised for grain and many of which are used as fodder plants either cultivated or as part of pasture. The plants are cultivated in warmer climates worldwide. Species are native to tropical and subtropical regions of all continents...
(jowar), taro
Taro
Taro is a common name for the corms and tubers of several plants in the family Araceae . Of these, Colocasia esculenta is the most widely cultivated, and is the subject of this article. More specifically, this article describes the 'dasheen' form of taro; another variety is called eddoe.Taro is...
, teff
Teff
Eragrostis tef, known as teff, taf , or khak shir , is an annual grass, a species of lovegrass native to the northern Ethiopian Highlands of Northeast Africa....
, chia seed, and yam
Yam (vegetable)
Yam is the common name for some species in the genus Dioscorea . These are perennial herbaceous vines cultivated for the consumption of their starchy tubers in Africa, Asia, Latin America and Oceania...
. Various types of bean
Bean
Bean is a common name for large plant seeds of several genera of the family Fabaceae used for human food or animal feed....
, soybean
Soybean
The soybean or soya bean is a species of legume native to East Asia, widely grown for its edible bean which has numerous uses...
, and nut
Nut (fruit)
A nut is a hard-shelled fruit of some plants having an indehiscent seed. While a wide variety of dried seeds and fruits are called nuts in English, only a certain number of them are considered by biologists to be true nuts...
flour
Flour
Flour is a powder which is made by grinding cereal grains, other seeds or roots . It is the main ingredient of bread, which is a staple food for many cultures, making the availability of adequate supplies of flour a major economic and political issue at various times throughout history...
s are sometimes used in gluten-free products to add protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
and dietary fiber
Dietary fiber
Dietary fiber, dietary fibre, or sometimes roughage is the indigestible portion of plant foods having two main components:* soluble fiber that is readily fermented in the colon into gases and physiologically active byproducts, and* insoluble fiber that is metabolically inert, absorbing water as it...
. Almond flour is a low-carbohydrate alternative to flour, with a low glycemic index. In spite of its name, buckwheat
Buckwheat
Buckwheat refers to a variety of plants in the dicot family Polygonaceae: the Eurasian genus Fagopyrum, the North American genus Eriogonum, and the Northern Hemisphere genus Fallopia. Either of the latter two may be referred to as "wild buckwheat"...
is not related to wheat; pure buckwheat is considered acceptable for a gluten-free diet, although many commercial buckwheat products are actually mixtures of wheat and buckwheat flours, and thus not acceptable. Gram flour
Gram flour
Gram flour is a cereal flour made from ground chickpeas. It is also known as chickpea flour, garbanzo flour, or besan . Used in many countries, it is a staple ingredient in Indian, Pakistani and Bangladeshi cuisines, and, in the form of a paste with water or yoghurt, a popular facial exfoliant in...
, derived from chickpea
Chickpea
The chickpea is a legume of the family Fabaceae, subfamily Faboideae...
s, is also gluten-free (this is not the same as Graham flour
Graham flour
Graham flour is a type of whole wheat flour named after the American Presbyterian minister Rev. Sylvester Graham , an early advocate for dietary reform...
made from wheat).
Gluten is also used in foods in some unexpected ways, for example as a stabilizing agent
Food additive
Food additives are substances added to food to preserve flavor or enhance its taste and appearance.Some additives have been used for centuries; for example, preserving food by pickling , salting, as with bacon, preserving sweets or using sulfur dioxide as in some wines...
or thickener in products like ice-cream and ketchup
Ketchup
Ketchup is a sweet-and-tangy condiment typically made from tomatoes, vinegar, sugar or high-fructose corn syrup and an assortment of...
.
People wishing to follow a completely gluten free diet must also take into consideration the ingredients of any over-the-counter or prescription medications and vitamins. Also, cosmetics such as lipstick, lip balms, and lip gloss may contain gluten and need to be investigated before use. Glues used on envelopes may also contain gluten.
Most products manufactured for Passover
Passover
Passover is a Jewish holiday and festival. It commemorates the story of the Exodus, in which the ancient Israelites were freed from slavery in Egypt...
are gluten free. Exceptions are foods that list matzah as an ingredient, usually in the form of cake meal.
Cross-contamination issues
A gluten-free diet allows for fresh fruits, vegetables, meats and many dairy products. The diet allows rice, corn, soy, potato, tapioca, beans, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, Montina and nut flours and prohibits the ingestion of wheat, barley, rye and related components, including triticale, durum, graham, kamut, semolina, spelt, malt, malt flavouring or malt vinegar.In the US, the FDA considers foods containing less than or equal to 20 ppm to be gluten-free. The finding of a current study indicates that some inherently gluten-free grains, seed, and flours not labeled gluten-free are contaminated with gluten. The consumption of these products can lead to inadvertent gluten intake.
The use of highly sensitive assays is mandatory to certify gluten-free food products. The European Union, World Health Organization, and Codex Alimentarius require reliable measurement of the wheat prolamins, gliadins rather than all-wheat proteins.
There is still no general agreement on the analytical method used to measure gluten in ingredients and food products.
The official limits described in the Codex Draft are 20 ppm for foodstuffs naturally gluten-free and 200 ppm for foodstuffs rendered gluten-free.
The ELISA method was designed to detect w-gliadins but it suffered from the setback that it lacked sensitivity for barley prolamins.
Cross Contamination Issues in Canada
A growing body of evidence suggests that a majority of people with celiac disease and following a gluten-free diet can safely consume pure oats in moderate amounts. But, previous studies have indicated that the commercial oat supply in other countries and in Canada is contaminated with other grains.
Special care is necessary when checking product ingredient lists since gluten comes in many forms: vegetable proteins and starch, modified food starch (when derived from wheat instead of maize), malt flavoring, including maltodextrine, dextrine , unless specifically labeled as corn malt. Many ingredients contain wheat or barley derivatives. However, dextrose is gluten free since it is highly modified, no matter what the source.
Although many foods contain gluten, it is not always included in ingredients lists. This lack of inclusion is because gluten is not used in the formulation of the product, but in the preparation (or manufacturing) of listed ingredients. One example is the dusting of the conveyor belts in the production facilities with gluten products to prevent the foods from sticking during processing. "Natural Flavoring" is also suspected to contain gluten. This type of gluten contamination may not be labeled; information confirming whether this form of gluten is present in a given product may only be available by contacting the food manufacturer directly.
Controversy over oats
The suitability of oatOat
The common oat is a species of cereal grain grown for its seed, which is known by the same name . While oats are suitable for human consumption as oatmeal and rolled oats, one of the most common uses is as livestock feed...
s in the gluten-free diet is still somewhat controversial. Some research suggests that oats in themselves are gluten free, but that they are virtually always contaminated by other grains during distribution or processing. However, recent research indicated that a protein naturally found in oats (avenin) possessed peptide sequences closely resembling wheat gluten and caused mucosal inflammation in significant numbers of celiac disease sufferers. Some examination results show that even oats that are not contaminated with wheat particles are nonetheless dangerous, while not very harmful to the majority. Such oats are generally considered risky for celiac children to eat, but two studies show that they are completely safe for celiac adults to eat. People who are merely gluten-sensitive may be able to eat oats without adverse effect,
even over a period of five years.
Given this conflicting information, excluding oats appears to be the only risk-free practice for celiac disease sufferers of all ages. However, medically approved guidelines exist for those celiacs who do wish to introduce oats into their diet.
Unless manufactured in a dedicated facility and under gluten-free practices, all cereal grains, including oats, can be cross-contaminated with gluten. Grains become contaminated with gluten by sharing the same farm, truck, mill, or bagging facility as wheat and other gluten-containing grains. Therefore, removing all flours and grains from the diet may be the only way to guarantee a complete absence of gluten in the diet.
Accuracy of "gluten-free" labels
Codex Alimentarius
The Codex Alimentarius is a collection of internationally recognized standards, codes of practice, guidelines and other recommendations relating to foods, food production and food safety. Its name derives from the Codex Alimentarius Austriacus...
"; however, these regulations do not apply to "foods which in their normal form do not contain gluten".
The legal definition of the phrase "gluten-free" varies from country to country. Current research suggests that for persons with coeliac disease the maximum safe level of gluten in a finished product is probably less than 0.02% (200 parts per million) and possibly as little as 0.002% (20 parts per million).
Australian standards reserve the "gluten free" label for foods with less than 5 parts per million of gluten, as this is the smallest amount currently detectable. In the processing of gluten-containing grains, gluten is removed (shown in the processing flow below)
Since ordinary wheat flour contains approximately 12% gluten, even a tiny amount of wheat flour can cross-contaminate a gluten-free product. Therefore, considerable care must be taken to prevent cross-contamination in both commercial and home food preparation.
This diet rules out all ordinary bread
Bread
Bread is a staple food prepared by cooking a dough of flour and water and often additional ingredients. Doughs are usually baked, but in some cuisines breads are steamed , fried , or baked on an unoiled frying pan . It may be leavened or unleavened...
s, pasta
Pasta
Pasta is a staple food of traditional Italian cuisine, now of worldwide renown. It takes the form of unleavened dough, made in Italy, mostly of durum wheat , water and sometimes eggs. Pasta comes in a variety of different shapes that serve for both decoration and to act as a carrier for the...
s, and many convenience food
Convenience food
Convenience food, or tertiary processed food, is commercially prepared food designed for ease of consumption. Products designated as convenience foods are often prepared food stuffs that can be sold as hot, ready-to-eat dishes; as room-temperature, shelf-stable products; or as refrigerated or...
s; it also excludes gravies, custards, soups and sauces thickened with wheat, rye, barley or other gluten-containing flour. Many countries do not require labeling of gluten containing products, but in several countries (especially Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
and the European Union
European Union
The European Union is an economic and political union of 27 independent member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community and the European Economic Community , formed by six countries in 1958...
) new product labeling standards are enforcing the labeling of gluten-containing ingredients. Various gluten-free bakery and pasta products are available from specialty retailers.
In the United States, gluten may not be listed on the labels of certain foods because the U.S. Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
has classified gluten as GRAS
Gras
Gras is a commune in the Ardèche department in southern France.-Population:-References:*...
(Generally Recognized As Safe). Requirements for proper labeling are being formulated by the USDA. It is currently up to the manufacturers of "gluten free" food items to guarantee such a claim. "A final rule that defines the term gluten-free and identifies the criteria that would enable the food industry to use that term" was scheduled to be released by the FDA on August 2, 2008. This final rule has not yet come to fruition. For now, many individuals who must eat gluten free use sources online to search the gluten free content of products.
Many so-called gluten free products, such as chicken bouillon, corn cereal, and caramel ice cream topping, have been found to have been contaminated with gluten. For example, in an investigation reported by the Chicago Tribune
Chicago Tribune
The Chicago Tribune is a major daily newspaper based in Chicago, Illinois, and the flagship publication of the Tribune Company. Formerly self-styled as the "World's Greatest Newspaper" , it remains the most read daily newspaper of the Chicago metropolitan area and the Great Lakes region and is...
on November 21, 2008, Wellshire Farms chicken nuggets labeled "gluten-free" were purchased and samples were sent to a food allergy lab at the University of Nebraska. Results of the testing indicated gluten was present in levels exceeding 2,000 ppm. After the article was published, the products continued to be sold. However, after receiving customer inquiries, Whole Foods Market
Whole Foods Market
Whole Foods Market is a foods supermarket chain based in Austin, Texas which emphasizes "natural and organic products." The company has been ranked among the most socially responsible businesses and placed third on the U.S...
removed the product from their shelves over a month later. Wellshire Farms has since replaced the batter used in their chicken nuggets.
In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, only cereals currently need to be labeled, while other products are voluntary. For example, most British sausage
Sausage
A sausage is a food usually made from ground meat , mixed with salt, herbs, and other spices, although vegetarian sausages are available. The word sausage is derived from Old French saussiche, from the Latin word salsus, meaning salted.Typically, a sausage is formed in a casing traditionally made...
s contain Butcher's Rusk, a grain-derived food additive
Food additive
Food additives are substances added to food to preserve flavor or enhance its taste and appearance.Some additives have been used for centuries; for example, preserving food by pickling , salting, as with bacon, preserving sweets or using sulfur dioxide as in some wines...
. Furthermore, while UK companies selling food prepared on their own premises are given guidance by the Food Standards Agency
Food Standards Agency
The Food Standards Agency is a non-ministerial government department of the Government of the United Kingdom. It is responsible for protecting public health in relation to food throughout the United Kingdom and is led by a board appointed to act in the public interest...
, they are not required to meet any labeling requirements.
Lastly, some non-foodstuffs such as medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s and vitamin
Vitamin
A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. In other words, an organic chemical compound is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on...
supplements
Dietary supplement
A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet...
, especially those in tablet
Tablet
A tablet is a pharmaceutical dosage form. It comprises a mixture of active substances and excipients, usually in powder form, pressed or compacted from a powder into a solid dose...
form, may contain gluten as an excipient
Excipient
An excipient is generally a pharmacologically inactive substance used as a carrier for the active ingredients of a medication. In many cases, an "active" substance may not be easily administered and absorbed by the human body; in such cases the substance in question may be dissolved into or...
or binding agent. People with gluten intolerances may therefore require specialist compounding
Compounding
Compounding is the mixing of drugs by a compounding pharmacist to fit the unique needs of a patient...
of their medication.
Alcoholic beverages
American Dietetic Association
The American Dietetic Association is the United States' largest organization of food and nutrition professionals, with nearly 72,000 members. The American Dietetic Association is officially changing its name to the Academy of Nutrition and Dietetics. The announcement was made Saturday, September...
's "Manual of Clinical Dietetics" many types of alcoholic beverages are considered gluten free, provided no colourings or other additives have been added as these ingredients may contain gluten. Although most forms of whiskey are distilled from a mash
Mashing
In brewing and distilling, mashing is the process of combining a mix of milled grain , known as the "grain bill", and water, known as "liquor", and heating this mixture...
that includes grains that contain gluten, distillation
Distillation
Distillation is a method of separating mixtures based on differences in volatilities of components in a boiling liquid mixture. Distillation is a unit operation, or a physical separation process, and not a chemical reaction....
removes any proteins present in the mash, including gluten. Although up to 49% of the mash for Bourbon
Bourbon whiskey
Bourbon is a type of American whiskey – a barrel-aged distilled spirit made primarily from corn. The name of the spirit derives from its historical association with an area known as Old Bourbon, around what is now Bourbon County, Kentucky . It has been produced since the 18th century...
and up to 20% of the mash for corn whiskey
Corn whiskey
Corn whiskey is an American liquor made from a mash made of at least 80 percent corn.The whiskey is typically run off to high proof and cut to not less than 40 percent alcohol by volume. It does not have to be aged; but if so, it is aged in new uncharred oak barrels or in barrels previously used...
may be made up of wheat, or rye, all-corn Bourbons and corn whiskeys do exist, and are generally labeled as such. Spirits made without any grain such as brandy
Brandy
Brandy is a spirit produced by distilling wine. Brandy generally contains 35%–60% alcohol by volume and is typically taken as an after-dinner drink...
, wine
Wine
Wine is an alcoholic beverage, made of fermented fruit juice, usually from grapes. The natural chemical balance of grapes lets them ferment without the addition of sugars, acids, enzymes, or other nutrients. Grape wine is produced by fermenting crushed grapes using various types of yeast. Yeast...
, mead
Mead
Mead , also called honey wine, is an alcoholic beverage that is produced by fermenting a solution of honey and water. It may also be produced by fermenting a solution of water and honey with grain mash, which is strained immediately after fermentation...
, cider
Cider
Cider or cyder is a fermented alcoholic beverage made from apple juice. Cider varies in alcohol content from 2% abv to 8.5% abv or more in traditional English ciders. In some regions, such as Germany and America, cider may be termed "apple wine"...
, sherry
Sherry
Sherry is a fortified wine made from white grapes that are grown near the town of Jerez , Spain. In Spanish, it is called vino de Jerez....
, port
Port wine
Port wine is a Portuguese fortified wine produced exclusively in the Douro Valley in the northern provinces of Portugal. It is typically a sweet, red wine, often served as a dessert wine, and comes in dry, semi-dry, and white varieties...
, rum
Rum
Rum is a distilled alcoholic beverage made from sugarcane by-products such as molasses, or directly from sugarcane juice, by a process of fermentation and distillation. The distillate, a clear liquid, is then usually aged in oak barrels...
, tequila
Tequila
Tequila is a spirit made from the blue agave plant, primarily in the area surrounding the city of Tequila, northwest of Guadalajara, and in the highlands of the western Mexican state of Jalisco....
and vermouth
Vermouth
Vermouth is a fortified wine flavored with various dry ingredients. The modern versions of the beverage were first produced around the late 18th and early 19th centuries in Italy and France...
generally do not contain gluten, although some vineyards use a flour paste to caulk the oak barrels in which wine is aged, and other vineyards use gluten as a clarifying agent (though it's unclear whether gluten remains at the end of the clarification process). Therefore, some coeliacs may wish to exercise caution. Liqueur
Liqueur
A liqueur is an alcoholic beverage that has been flavored with fruit, herbs, nuts, spices, flowers, or cream and bottled with added sugar. Liqueurs are typically quite sweet; they are usually not aged for long but may have resting periods during their production to allow flavors to marry.The...
s and pre-mixed drinks should be examined carefully for gluten-derived ingredients.
While many spirits were traditionally made without grain, such as tequila, rum and vodka, today they are more commonly made with barley, wheat or rye (instead of agave, sugar or potatoes, et cetera). Often, only high-end specialty alcoholic brands are made with what are considered the traditional ingredients. In addition, many people diagnosed with celiac disease still experience symptoms when drinking distilled alcoholic beverages. Therefore, it is advised that a person with celiac disease check with a manufacturer about the ingredients that have been used in a hard liquor, and to proceed with caution if choosing to drink a liquor that is made with wheat, barley, oats or rye.
Almost all beers are brewed with malted barley
Barley
Barley is a major cereal grain, a member of the grass family. It serves as a major animal fodder, as a base malt for beer and certain distilled beverages, and as a component of various health foods...
or wheat
Wheat
Wheat is a cereal grain, originally from the Levant region of the Near East, but now cultivated worldwide. In 2007 world production of wheat was 607 million tons, making it the third most-produced cereal after maize and rice...
and will contain gluten. Sorghum
Sorghum
Sorghum is a genus of numerous species of grasses, one of which is raised for grain and many of which are used as fodder plants either cultivated or as part of pasture. The plants are cultivated in warmer climates worldwide. Species are native to tropical and subtropical regions of all continents...
and buckwheat
Buckwheat
Buckwheat refers to a variety of plants in the dicot family Polygonaceae: the Eurasian genus Fagopyrum, the North American genus Eriogonum, and the Northern Hemisphere genus Fallopia. Either of the latter two may be referred to as "wild buckwheat"...
-based gluten-free beers are available, but remain a niche market. Some low-gluten beers are also available, however there is disagreement over the use of gluten products in brewed beverages: Some brewers argue that the proteins from such grains as barley
Barley
Barley is a major cereal grain, a member of the grass family. It serves as a major animal fodder, as a base malt for beer and certain distilled beverages, and as a component of various health foods...
or wheat
Wheat
Wheat is a cereal grain, originally from the Levant region of the Near East, but now cultivated worldwide. In 2007 world production of wheat was 607 million tons, making it the third most-produced cereal after maize and rice...
are converted into amino acid
Amino acid
Amino acids are molecules containing an amine group, a carboxylic acid group and a side-chain that varies between different amino acids. The key elements of an amino acid are carbon, hydrogen, oxygen, and nitrogen...
s during the brewing
Brewing
Brewing is the production of beer through steeping a starch source in water and then fermenting with yeast. Brewing has taken place since around the 6th millennium BCE, and archeological evidence suggests that this technique was used in ancient Egypt...
process and are therefore gluten-free; however, there is evidence that this claim is false.
Gluten-free bread
BreadBread
Bread is a staple food prepared by cooking a dough of flour and water and often additional ingredients. Doughs are usually baked, but in some cuisines breads are steamed , fried , or baked on an unoiled frying pan . It may be leavened or unleavened...
, which is a staple in the Western diet, is typically made from grains such as wheat that contain gluten. Wheat gluten contributes to the elasticity of dough and is thus an important component of bread. Gluten-free bread is made with ground flours from a variety of materials such as rice
Rice
Rice is the seed of the monocot plants Oryza sativa or Oryza glaberrima . As a cereal grain, it is the most important staple food for a large part of the world's human population, especially in East Asia, Southeast Asia, South Asia, the Middle East, and the West Indies...
(rice bread
Rice bread
Rice bread is a type of bread that is made from rice flour rather than wheat flour. Being gluten free it can be much more digestible for those with gluten intolerance....
), sorghum
Sorghum
Sorghum is a genus of numerous species of grasses, one of which is raised for grain and many of which are used as fodder plants either cultivated or as part of pasture. The plants are cultivated in warmer climates worldwide. Species are native to tropical and subtropical regions of all continents...
(sorghum bread), corn
Corn
Corn is the name used in the United States, Canada, and Australia for the grain maize.In much of the English-speaking world, the term "corn" is a generic term for cereal crops, such as* Barley* Oats* Wheat* Rye- Places :...
(cornbread
Cornbread
Cornbread is a generic name for any number of quick breads containing cornmeal and leavened by baking powder.-History:Native Americans were using ground corn for food thousands of years before European explorers arrived in the New World...
), or legumes like beans (bean bread) , but since these flours lack gluten it can be difficult for them to retain their shape as they rise and they may be less "fluffy". Additives such as xanthum gum, hydroxypropyl methylcellulose (HPMC), corn starch, or eggs
Egg (food)
Eggs are laid by females of many different species, including birds, reptiles, amphibians, and fish, and have probably been eaten by mankind for millennia. Bird and reptile eggs consist of a protective eggshell, albumen , and vitellus , contained within various thin membranes...
are used to compensate for the lack of gluten.
Popular diets
Gluten-free diets (for reasons other than celiac disease) have become a recent trend. Evidence of the diet's efficacy as an autism treatment is "poor".Despite vigorous marketing, a variety of studies, including a study by the University of Rochester found that the "Popular Autism Diet Does Not Demonstrate Behavioral Improvement", have failed to support any genuine benefit to children diagnosed with Autism who do not also have a known digestive condition which benefits from a gluten free diet.
Deficiencies linked to maintaining a gluten-free diet
Many gluten-free products are not fortified or enriched and contain lower amounts of nutrients such as folate, iron, and fiber than other foods. Additionally, because gluten-free products are not always available, many Gluten-Sensitive Enteropathy (GSE) patients do not consume the recommended number of grain servings per day. A gluten-free diet may not meet the recommended intake for fiber, thiamine, riboflavin, niacin, folate, iron, or calcium. It is important for those who choose to avoid gluten in their diet to find more nutrient-dense food sources to prevent such deficiencies. People who change their standard gluten-free diet to implement gluten-free oats at breakfast, high fiber brown rice bread at lunch, and quinoa as a side at dinner have been found to have significant increases in protein (20.6 g versus 11 g), iron (18.4 mg versus 1.4 mg), calcium (182 mg versus 0 mg), and fiber (12.7 g versus 5 g). The B vitamin group did not have significant increases, but were still found to have improved values of thiamine, riboflavin, niacin, and folate. These dietary changes can greatly reduce a GSE patient's risk for anemia (especially Iron Deficiency Anemia) and low blood calcium levels or poor bone health.GF foods are raw foods including rice, potatoes, soybeans, maize, millet, buckwheat, amaranth and quinoa. The diet may be low in fiber, iron, folate, calcium, magnesium, zinc, vitamin D, B-complex vitamins ( thiamin, riboflavin, niacin, and vitamin B12)
Celiacs adhering to a GFD (gluten free diet) may be at risk for inadequate calcium, non-starch polysaccharides and Vitamin D.
Oats can increase intakes of vitamin B1, magnesium, and zinc in celiac patient in remission.
See also
- Gluten-free, casein-free dietGluten-free, casein-free dietA gluten-free casein-free diet eliminates dietary intake of the naturally occurring proteins gluten and casein .-Controversial autism diet:...
- Autism therapiesAutism therapiesAutism therapies attempt to lessen the deficits and abnormal behaviours associated with autism and other autism spectrum disorders , and to increase the quality of life and functional independence of autistic individuals, especially children. Treatment is typically tailored to the child's needs...
- GlutamateGlutamic acid (flavor)Glutamic acid and its ions and salts, called glutamates, are flavor-enhancing compounds which provide an umami taste to food. Glutamic acid is a natural constituent of many fermented or aged foods, including soy sauce, fermented bean paste, and cheese, and is also a component of hydrolyzed protein...
- Wheat gluten (food)Wheat gluten (food)Wheat gluten, also called seitan , wheat meat, mock duck, gluten meat, or simply gluten, is a food made from the gluten of wheat...
- Specific Carbohydrate DietSpecific Carbohydrate DietThe Specific Carbohydrate Diet is a nutritional regimen, created by Dr. Sidney V. Haas and popularized by biochemist and author Elaine Gottschall, which restricts the use of complex carbohydrates and eliminates refined sugar, all grains and starch from the diet...
External links
- Celiac Sprue Association: Gluten-Free Diet Self-Management and Basic Diet Choices
- Gluten Intolerance Group Frequently asked questions