Three reasons why people avoid eating gluten.
According to Webster’s dictionary, gluten is a tenacious elastic protein substance, especially wheat flour that gives cohesiveness to the dough. When people with celiac disease eat gluten, it causes an immune response that attacks the small intestine. Villi in the small intestine get damaged and nutrients are poorly absorbed, leading to nutrient deficiencies, and increased risk for anemia, osteoporosis, infertility, and cancer.
Celiac disease is a hereditary disease. People who have a first-degree relative with celiac disease are more likely to develop the disorder (celiac.org).
Symptoms of celiac disease may include:
- Abdominal pain and bloating
- Diarrhea, constipation, or both
- Gas
- Lactose intolerance
- Nausea and vomiting
- Weight changes
- Bone or joint pain
- Depression and anxiety
The treatment for celiac disease is a lifelong elimination of gluten from the diet.
Celiac Disease vs. Non-Celiac Gluten Sensitivity
Sometimes a person may test negative for celiac disease but experience digestive issues after consuming gluten. This is known as Non-Celiac Gluten Sensitivity or Non-Celiac Wheat Sensitivity.
Is Gluten the Culprit?
The name for Non-Celiac Gluten Sensitivity or Non-Celiac Wheat Sensitivity is undetermined because research has not confirmed that gluten is triggering the immune reaction. Amylase-trypsin inhibitors, and not gluten, may be one culprit.
Amylase-trypsin inhibitors are found in six cereal grains: wheat, barley, rye, maize, millet and rice. Wheat, barley and rye are grains that contain gluten. Maize, millet and rice are grains that are naturally gluten free.
Amylase-trypsin inhibitors (ATIs) make up about 2-4% of the total wheat grain proteins and have been shown to cause adverse reactions in vitro and in animal studies. ATIs may play a role in Non-Celiac Gluten or Wheat Sensitivity disease but more research is needed.
Fructans, and not gluten, are another possible cause of digestive issues in people with Non-Celiac Gluten or Wheat Sensitivity. Fructans are sugars that belong to a group of carbohydrates called FODMAPs. The FODMAPs diet was developed at Monash University to help people with Irritable Bowel Syndrome (IBS) reduce their digestive symptoms. People with IBS suffer similar symptoms as those with Non-Celiac Gluten or Wheat Sensitivity: gas, cramping, bloating, and diarrhea. The letters in the word FODMAP summarize which foods are fermentable carbohydrates that may cause digestive distress:
Fermentable. The process through which gut bacteria ferment undigested carbohydrates to produce gas.
Oligosaccharides. Fructans and GOS – found in foods such as wheat, rye, onions, garlic, and legumes.
Disaccharides. Lactose – found in dairy products like milk, soft cheeses, and yogurt.
Monosaccharides. Fructose – found in honey, apples, high-fructose corn syrup.
And
Polyols. Sorbitol and Mannitol – found in some fruits and vegetables and used as artificial sweeteners.
Many Food Groups Contain The FODMAP Oligosaccharide Called Fructans
Fruits: Ripe bananas, watermelon, plums, grapefruit, persimmons
Vegetables: Onion, garlic, shallots, leeks, Brussels sprouts, beets, cabbage, asparagus, artichokes
Grains: Wheat, barley, rye, spelt, kamut
Nuts and Seeds: Cashews, pistachios, almonds
Legumes: Dried chickpeas, dried beans, dried lentils, soybeans (canned have a lower fructan level)
Others: Instant coffee, chamomile tea, inulin, chicory
The low-FODMAP diet intervention is currently the most evidenced-based diet intervention for IBS, according to the American Gastroenterological Association. It consists of three phases:
- Restriction of FODMAP-containing foods for no more than 4 to 6 weeks
- Reintroduction of FODMAP-containing foods
- Personalization based on the results from reintroduction
Be aware of the overlap with the fructan-containing foods and the gluten-containing foods. Up to 70% of fructans are eliminated when wheat is eliminated from a typical American diet. More research is needed to determine the role of fructans in Non-Celiac Gluten or Wheat Sensitivity.
At this point, eliminating gluten from the diet is the primary treatment for Non-Celiac Gluten or Wheat Sensitivity, according to The National Celiac Association.
Next, let’s look at the foods that contain gluten.
Foods That Contain Gluten
Grains: Wheat, rye, barley, triticale, malt, Brewer’s Yeast, wheat starch
Common Foods That Contain Gluten: Pasta, noodles, bread, pastries, crackers, baked goods, cereal, granola, pancakes, waffles, breading and coating mixes, croutons, sauces and gravies, flour tortillas, beer, malt beverages
Foods That May Contain Gluten: Energy bars, granola bars, French fries, potato chips, bologna and processed lunch meats, candy, candy bars, soup, multi-grain tortilla chips, salad dressings, marinades, starch, dextrin, brown-rice syrup, seitan, vegetarian burgers, imitation seafood, soy sauce, self-basting poultry, pre-seasoned meats, cheesecake filling, eggs served at restaurants (pancake batter may be added)
Other Items To Verify: Lipstick, lip gloss, lip balm, oral care and dental products, communion wafers, herbal or nutritional supplements, drugs and over-the-counter medications, vitamins and supplements, oats
Avoiding gluten is the treatment for celiac disease and the most widely-accepted treatment for Non-Celiac Gluten or Wheat Sensitivity. The FODMAPs diet can be used to help IBS sufferers and people with gluten sensitivity reduce their symptoms.
Unfortunately, the lists of foods that contain gluten and FODMAPs are extensive. Following a gluten free or low FODMAP diet is not easy. It takes effort because so many processed foods contain wheat and components of wheat. The restrictive nature of these diets can lead to nutrient deficiencies and a dietary intake of fiber that is below recommended levels. The fiber from cereal grains, for example, play a role in keeping your gut healthy and reducing your risk for developing chronic diseases like heart disease, cancer, and diabetes.
Get A Medical Exam and Assessment
See a doctor if you are experiencing digestive symptoms. A medical provider can use blood tests and biopsies of the small intestine to diagnose celiac disease. An allergist can use a skin prick test, a blood test, and an oral food challenge to diagnose food allergies. A gastroenterologist can diagnose and treat issues with the gastrointestinal tract such as Irritable Bowel Syndrome.
If you test positive for celiac disease, the treatment is to eliminate gluten from your diet. Follow up with your doctor for management of symptoms, normalization of lab values, and monitoring for prevention of complications. Ask for a referral to a registered dietitian for nutrition guidance as you eliminate gluten, reduce FODMAPs, or make other changes to your eating plan.