Written by Sharon Gray, MPH, RD, CD-N
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Gluten free labeling is on many foods in the grocery store and following the gluten free diet is popular. It is estimated that over 30% of the North American population has embraced a gluten-free lifestyle. But is it necessary? For the majority of people, gluten is not a problem and gluten-free options are not healthier or worth the added cost. The gluten-free diet is a medical necessity for the 1-2% of the population with the autoimmune disorder, celiac disease. For these individuals, ingesting even small amounts of gluten can cause serious health problems. There is a growing body of evidence that people may have non-celiac gluten sensitivity. It is estimated that 0.5 – 13% of the population may have this condition.
Symptoms of celiac disease can include:
- Chronic fatigue and weakness
- Abdominal bloating and gas
- Lactose intolerance
- Bone/joint pain
- Unexplained anemia
- Nausea and vomiting
- Weight loss
Non-celiac gluten sensitivity is characterized by a wide variety of intestinal and other symptoms similar to celiac disease. For anyone with gastrointestinal problems, testing for celiac disease and other medical conditions is important before starting a gluten-free diet.
So, what actually is gluten?
Gluten is a protein compound found in wheat, rye, and barley. The gluten–free diet requires the elimination of all types of wheat including spelt, kamut, einkorn, emmer, farro, durum, and triticale as well as rye and barley. In addition to cereals, pastas, breads, and baked goods, gluten-containing ingredients can be found in other foods and beverages such as soups, sauces, gravies, salad dressings, burgers, meat substitutes, snack foods, candy and alcohol. Medications and nutritional supplements may also contain gluten.
Many people believe gluten-free products are healthy; however, that is not always true. Many gluten-free items are high in fat and sugar and low in key nutrients (e.g. – fiber, iron, B vitamins). A heavy reliance on these products can actually lead to weight gain and poor nutritional status. All the claims of going gluten-free for optimum health, weight loss, and increased energy are not always accurate. There may be other factors at play, such as preparing food from scratch or eliminating some other foods that lead people feeling better versus actual gluten elimination.
So, if you do need to follow a gluten-free diet, knowing how to read food labels is important. The most important areas to focus on are the ingredient list and any gluten-free claims, symbols, or certifications. When reading a label for gluten content, look for any of the following words: wheat, rye, barley, oats*, malt and/or Brewer’s yeast. Oats are of concern as they can have levels of gluten contamination. For products to be sold in the United States, one of four terms can be used: gluten free, no gluten, Free of gluten, or without gluten. These claims are found on the product label, usually on the front of the package, but can also be elsewhere on the label. Note that even if a label does not include a symbol or wording to indicate the package contents to be gluten free, the product could still be free of gluten. A popular phone app, the Gluten Free Scanner, scans bar codes for products and draws upon a large food database to tell if there may or may not be gluten in an item.
American and Canadian Celiac Associations have also developed gluten free certification programs. These programs have specific criteria that food manufacturers are required to meet to put the agency’s logo on their product labels. Some are shown here:
Gluten free certification program (GFCP) Beyond celiac (right)
Gluten free certification org (GFCO). gluten intolerance group (middle)
Recognition seal program Celiac Support association (left)
Eating Away from Home
Once the basics of the gluten-free diet have been mastered at home, eating safely away from home certainly is possible. Individuals with celiac disease need to be concerned about cross-contamination of foods, which can easily occur in restaurants. The key is careful planning and research. Check the internet to see if a restaurant’s website has a gluten-free menu or offers gluten-free options. Find Me Gluten Free is a popular phone app that can locate restaurants with gluten-free options. Wickedglutenfree.com also provides an extensive directory of restaurants with gluten-free options in the New England region.
Gluten-free resources are extensive, including specialty retailers, celiac organizations, apps, websites, books and cookbooks. Below are just a few:
Celiac Disease Foundation: www.celiac.org
Beyond Celiac: www.beyondceliac.org
Gluten Intolerance Group of North America: www.gluten.org
Shelley Case, RD website: www.shelleycase.com
Gluten Freedom: The Leading Expert offers the Essential Guide to a Healthy, Gluten-Free Lifestyle, Dr. Alessio Fasano, MD & Susie Flaherty, April 2014.
Gluten Free, The Definitive Resource Guide, Shelley Case, 2016.
Shop Well App: shopwell.com
Gluten Free Scanner App: scanglutenfree.com
Find me Gluten Free App
For most people, gluten is not a problem and the gluten-free diet is not necessary or a healthier option. Gluten-free products also typically cost more so the extra cost is not worth it for most people. For individuals with gluten intolerance or diagnosed celiac disease, following a gluten-free diet is a medical necessity. Speak with your doctor abut testing if you are concerned that your symptoms could be related to ingestion of gluten. If you must follow a gluten-free diet, there are many food options available and extensive resources to help you successfully navigate this diet.