Gluten-Free Diet Basics
There are a great many reasons people choose to go gluten-free, and they are doing so in record numbers. If you’re at the point of deciding to cut gluten out—either on a trial basis or as a permanent life change—here are some things you’ll need to know.
Reasons to go gluten-free
Many people go gluten-free to help with chronic pain conditions like fibromyalgia and multiple sclerosis. Others avoid gluten to help treat ADHD and autism. And there’s a large and growing contingent that believes bypassing gluten makes for a healthier diet—there is some truth to this, as gluten is fairly indigestible for all of us.
Everyone diagnosed with celiac disease is prescribed a gluten-free diet. It is estimated that one in 133 Americans has celiac disease, though most are unaware they have it. Only 200,000 to 220,000 people have been diagnosed in the US, and it takes the average celiac patient 11 years to be accurately diagnosed.
In celiac disease, gluten causes inflammation and damage to the small intestine. If left untreated, it can result in malnutrition. The inflammation it causes can present over 250 symptoms: common ones include mild bloating and severe diarrhea. Some people with celiac have no symptoms at all—this is referred to as “silent celiac.” Other conditions associated with celiac disease include dermatitis herpetiformis (a skin condition causing extreme itching and blistering) and diabetes. At present, there is no cure for celiac disease. A diet free of gluten is the only known treatment.
And it should be noted that not all those that have such symptoms will have celiac. It is also possible for one to be gluten intolerant or gluten sensitive without the genetic markers.
If you feel you have gluten intolerance, don’t change your eating habits before you get tested as the testing is likely to be inaccurate once you begin a gluten-free diet.
What is gluten?
Gluten is a protein found in wheat, barley, and rye. Field contamination taints oats in most cases, unless they are specifically labeled gluten-free. Though the diet sounds simple to follow (avoid gluten!), it can become confusing.
Hidden sources of gluten
Gluten shows up in a lot of unexpected places. Items labeled “lite” or “light” are suspect. It also can be in savory foods like bouillon and broth, tomato sauce, soup, beans, cured meats, beef jerky, chips, cold cuts, or instant mashed potatoes. Condiments like ketchup, mustard, soy sauce, maple syrup, jam, and non-dairy creamers will sometimes be carriers.
Also look out for dairy products like ice cream, yogurt, and light sour cream. Nuts that have been treated in some manner can also have gluten. Lookout for nuts served on airplanes, glazed nuts, shelled nuts, and seeds. Gluten is also in a number of sweets, like licorice. Lastly gluten can show up in miscellaneous items like cocktail mixes, gum, some candied/dried fruit, canned fruit, fresh meat labeled “injected with a solution,” vitamins, over-the-counter medications, prescribed drugs, and toothpaste. That’s an exhausting list!
If you are sensitive to topically applied gluten products, take note that many personal care products—like deodorant, shampoo, lotion, and makeup—contain gluten.
Here’s a quick glimpse at some of the ingredients that may call for contacting the manufacturer: malt flavoring, modified food starch, cellulose, vegetable gum, vegetable starch, vegetable broth, taco seasoning, baking powder, caramel and caramel color, stabilizers, fillers, binders, natural flavors, rice malt, smoked flavoring, gelatinized starch, pre-gelatinized starch, and textured vegetable protein (TVP).
Have I been “glutened”?
Many people with gluten intolerance may claim that a gluten-free product caused a reaction. They often refer to this as having been “glutened.”
Another thing to consider is the possibility of cross-reactivity, as some food and grains may confuse the immune system into reacting as if they were gluten. Some of these include buckwheat, sorghum, millet, amaranth, quinoa, rice, corn, oats, potato, tapioca, cow’s milk, casein, American cheese, chocolate, sesame, hemp, yeast, and coffee. A recent study shows that not all quinoa is gluten-free. Some brands may cause an immune response in those with celiac disease.
All beer contains gluten unless it is labeled gluten-free. Brewer’s yeast, which is used in brewing, usually contains some amount of barley and grain. To err on the side of caution, it is advised to avoid gluten-removed beer, as the removal process is often undisclosed.
Distilled alcohol is gluten-free. Manufacturers desire pure products so they distill this type of alcohol several times, removing gluten and filtering out all sediment. This includes wine from barrels that have been sealed with wheat paste.
If you have been diagnosed with celiac disease, or any form of gluten intolerance, your prescription is a gluten-free diet. To clarify (in case your doctor did not) this means you may not cheat. It means a lifelong commitment to avoiding gluten. Cheating on the gluten-free diet, even once a month, is known to increase mortality rates by up to 600 percent.
One would think that eating French fries would be safe: not so. Frozen French fries often contain gluten. Some restaurants even add flour to their scrambled eggs!
Though more and more restaurants are becoming aware of the gluten-free diet, it can be troublesome to explain yourself over and over again to restaurant staff. You will find restaurant cards for the gluten-free diet online, such as those available from Triumph Dining (triumphdining.com). Just hand one over to the wait staff, and you’re done. They are available in different languages and food cultures.
Avoiding cross-contamination and gluten-free labeling
While some may tolerate food manufactured in a facility that also makes gluten products, others may not. Minute portions of gluten can trigger an autoimmune reaction in those with celiac.
In February the FDA sent their final ruling about gluten-free labeling to the White House for approval. Their ruling was that products labeled gluten-free should not contain more than 20 ppm gluten. Because the White House’s Office of Information and Regulatory Affairs (OIRA) is already three months behind on 84 of their 143 pending rules, continue to read labels carefully or contact manufacturers with question until this rule has been approved.
Even with the new rule coming, gluten-intolerant individuals still need to be mindful of foods not regulated by the FDA. The USDA regulates our meat and poultry, so be cautious of products such as sausage, bacon, ham, and cold cuts, as they may not be subjected to these new rules.
Gluten-free certification and food testing
Many manufacturers make our jobs easier by having their products certified gluten-free. You will notice a few different logos for certification. Gluten-Free Certification Organization’s (GFCO) label reads “Certified Gluten-Free” with “GF” inside a circle. They certify products under 10 ppm. The Celiac Sprue Association (CSA) certifies products under five ppm. They require products to also be oat-free, as many with celiac are intolerant to oats, even oats that are gluten-free. One of the newest certification programs is the National Foundation for Celiac Awareness (NFCA) along with Quality Assurance International (the organization behind the green USDA-Certified labels). Their label reads “This Product is Certified Gluten Free,” and inside a black circle reads “Gluten-Free” with a white check mark. They certify products that contain 10 ppm gluten or less.
And finally, the newest kid on the block is the International Certification Services Inc. (ICS). They certify products for US distribution at under 10ppm and their emblem is u-shaped with ICS in the center surrounded by Certified Gluten-Free.
Will I lose or gain weight?
It’s difficult to say: some with celiac are underweight due to lack of nutrition, while others are overweight or normal weight. Years ago, before the surge of processed gluten-free products, the most readily available foods were meat, fruit, vegetables, dairy, nuts, and seeds. Avoiding bread and pasta did cause weight loss in most, and was certainly a healthier alternative. However, now many are reaching for high-starch and high-sugar gluten-free baked goods and snacks which not only cause weight gain, but are unhealthy.
Gluten-free flour and healthier ingredients
You’ll find plenty of products that contain white rice flour, tapioca flour/starch, potato starch, and cornstarch, but there are better choices out there: look for products with whole grains, high fiber, and high protein. Use nutritious flours such as teff, millet, sorghum, oat, non-GMO cornmeal, and corn flour. Or try bean flours like garbanzo, fava, and garfava. When consuming rice flour, choose brown rice over white rice. Add some flaxseed meal or chia seeds to baked goods. (Chia seeds are considered a superfood.) Soy flour is also high in fiber and protein: it is very controversial, however, as it may increase estrogen levels in both males and females.
We are seeing more gluten-free products with healthier ingredients now, and fiber is part of that equation. Psyllium husk powder is a golden fine grain—two teaspoons have 4.5 grams of fiber. Flaxseed meal contains four grams per two tablespoons. Another healthy high-fiber alternative is inulin, a fine white powder used for lowering cholesterol, for weight loss, and creating healthy bacteria in the digestive tract.
Now you are armed with information that some take years to learn. I hope this will make your journey a safer one.
Carla Spacher is a gluten-free consultant, professional recipe developer, and the founder of glutenfreerecipebox.com.