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Who Needs a Gluten-Free Diet?


July 10, 2013


By Jody Paglia Tanzman
Brigham and Women's Hospital

Gluten has become a culprit for a growing list of conditions from osteoporosis to infertility. Some celebrities have endorsed gluten-free diets as a way to increase energy levels and lose weight.

So what's all the fuss about? Should you avoid foods with gluten? Here's what you need to know.

What Is Gluten?

Gluten is a protein found in grains such as wheat, barley, rye, and triticale (a cross between wheat and rye).

Gluten gives structure, elasticity and mouth-feel to breads, pastas, cakes, cookies, muffins and cereals. It is also used as a flavoring additive, a thickener and a stabilizing agent in foods such as ice cream, sauces and condiments.

These foods may have gluten:

  • Protein bars and beverages
  • Some ice creams, sour cream, chocolate milk, processed spreads and non-dairy creamers. Milk, buttermilk, cheese, whipping cream and processed cheese products such as Velveeta and Kraft American cheese are gluten free.
  • Foods with food starch, hydrolyzed vegetable protein, stabilizers or fat replacers. (Not all of these products are gluten-containing; some stabilizers and fat replacers are protein-based and some hydrolyzed vegetable proteins are made from corn, soy or beans.)
  • Baking powder
  • Vegan products such as soy hot dogs and burgers
  • Alcoholic beverages such as beer, gin, whiskey
  • Medications
  • Vitamins
  • Cosmetics

Oats don't have gluten. But they are sometimes harvested and processed in plants that make gluten-containing grains. They may contain trace amounts of gluten.

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What Does Gluten Do Inside the Body?

Gluten has amino acids that the body uses to build tissue such as muscles, skin and nails. Gluten acts differently in people who have celiac disease (an intestinal disorder in which the body can't tolerate gluten). When they ingest gluten, their small intestines become inflammed. This interferes with the absorption of nutrients. Following a strict gluten-free diet can help prevent or reverse many of gluten's effects.

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Should I Eat a Gluten-Free Diet?

Only people who are diagnosed with celiac disease, a gluten sensitivity or allergy, or dermatitis herpetiformis, (a very itchy chronic skin rash of bumps and blisters) need to eat a gluten-free diet.

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Is a Gluten-Free Diet Healthy?

Foods without gluten aren't necessarily more nutritious. In fact, a gluten-free diet can promote certain nutrient deficiencies. Most gluten-free products are not fortified with vitamins and minerals, so they are low in calcium, iron, zinc, magnesium and B vitamins.

Some gluten-free foods have more sugar and fat to mimic the texture and mouth-feel of foods with gluten. Also, the low fiber content of many gluten-free foods may cause constipation.

However, a gluten-free diet that is based on fruits, vegetables, lean proteins, nuts, seeds, legumes and whole grains that do not contain gluten, such as brown rice and quinoa, can be quite healthy.

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Could I Have Celiac Disease Without Knowing It?

Not everyone who has celiac disease has symptoms. So it's possible to have celiac disease and not know it. Sometimes the symptoms are thought to be a sign of another condition, such as irritable bowel syndrome.

About 1 in 133 people in the United States has diagnosed celiac disease. But according to current studies, that number might be much higher. Some people develop celiac disease later in life. A doctor can diagnose the condition by testing a piece of tissue from the intestines (biopsy)or doing a blood test that detects antibodies to the protein in gluten.

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How Is Celiac Disease Diagnosed?

Only a doctor can diagnose celiac disease for sure. But if you suspect you have a gluten sensitivity, try the elimination diet. For two to four weeks, eliminate all foods that contain gluten (including hidden sources such as stamps and envelopes that must be licked). Then, gradually bring gluten back into your diet and see how you feel. It's very difficult to completely eliminate all sources of gluten in the diet so this method isn't always effective.

If you decide to see your doctor for testing, don't limit gluten in your diet before any blood tests or biopsies. This could affect the reliability of the diagnosis.

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The Bottom Line

It's possible that a gluten-free diet could help people with celiac disease as well as those without the disease. However, keep in mind that eliminating all sources of gluten from your diet if you do not have a gluten intolerance can be stressful, time-consuming and costly. If you suspect that a gluten-free diet may help you, contact a registered dietitian to help you put together a food plan that has adequate fiber and nutrients.

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Resources

Celiac Disease – An Overlooked Disorder

Celiac Disease Foundation

National Foundation for Celiac Awareness

The Gluten Intolerance Group of North America

The Gluten-Free Diet by Shelley Case, R.D.

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Jody Paglia Tanzman holds degrees from both Boston University and Hunter College, where she completed the Didactic Program in Dietetics (DPD). She is currently a dietetic intern at Brigham and Women’s Hospital.

 

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