Medical Conditions Which Need a Gluten-Free Diet & The Symptoms of Gluten Intolerance

You must have heard a lot about Gluten and Gluten-free diets, which are becoming popular day by day. Gluten owes its popularity to the increasing awareness of people regarding gluten intolerance. This in turn has given rise to increase in the production and sales of gluten-free food items. The industry of gluten-free food has grossed more than $15 billion in the year 2016.(1)

Thanks to the availability of gluten-free food products; a diet that used to be difficult to follow for people suffering from gluten intolerance has become easier. We will be easing your curiosity about gluten, foods that contain it and medical conditions which need a gluten-free diet & the symptoms of gluten intolerance.

What Exactly is Gluten?(5)

Gluten is a group of prolamins, which are storage proteins found in some cereal grains like rye, barley and wheat.(2) There are various types of prolamins that come under the gluten umbrella; however, based on the grains they are found, they can be classified further. For example; the prolamins present in wheat are gliadins and glutenins; and the prolamins present in barley are hordeins; and in rye are secalins.(3)

The Properties & Uses of Gluten

There are many culinary benefits of gluten and it gives the foods its characteristic chewy and soft texture present in many of the grain-based; gluten-containing food items.(4,5) Gluten proteins, upon heating, develop an elastic network, which can expand and hold gas, that gives the optimal rising or leavening and helps in retaining moisture in pasta, breads etc.(6) Thanks to these special properties of gluten, it is often used as additive in foods to increase moisture retention and enhance the texture in different types of processed foods.(5)

People who are suffering from celiac disease are gluten intolerant and have to completely remove gluten from their diet to avoid harmful reactions. However, gluten is not a health hazard for majority of the worldwide population.

What Are The Foods That Have Gluten In Them?

Gluten can be found in different types of processed and whole foods such as:

Processed Grain-Based Foods:(7) Breadcrumbs, bread, crackers, seitan, pasta, some veggie burgers, pastries, cookies; and wheat-containing soba noodles.

Grains:(7,8) Wheat bran; whole wheat, rye, barley spelt, triticale, kamut, faro, couscous, semolina, farina, bulgur, durum, einkorn, cracked wheat, wheat germ, mir and matzo.

Other Beverages & Foods:(8) Malt vinegar, certain salad dressings; barley malt, flour thickening used in gravies/ sauces, soy sauce, some broths and bouillon, flavored chips, some spice blends, beer and certain types of wine.

It’s not always clear if a certain food has gluten in it or not, as gluten is popularly used as a stabilizer or thickener in food production.

Even if the food item is actually gluten-free, it can be contaminated with gluten when it is produced. Various commercial food operations share equipment for preparation with foods that have gluten in them and this result in gluten contamination.

If you are on a rigid gluten-free diet and do not know whether a food item contains gluten or not, then you need to check the packaging for a gluten-free label or you have to get in touch with the manufacturer before buying it.

The Meaning of Gluten-Free Label

Gluten-Free Label helps you selecting your food better if you are on a gluten free diet and thus makes your life easier. For someone who cannot tolerate gluten, it can be quite difficult to find foods that do not contain gluten in them or which have not been inadvertently contaminated with gluten during processing. Due to this reason, various health authorities are implementing the gluten-free food labeling in the food products that contain them.

Gluten-Free Label helps making the elimination of gluten containing foods easier; however, it does not always mean that that particular food item is completely and absolutely free of gluten.

In the US States, Canada and the European Union, a food product that has gluten, which takes up lesser than 20 parts per million of the food item is allowed to have a gluten-free label.(9,10)

This gluten limit was given, as there was evidence that showed that many of the people suffering from gluten intolerance are unlikely to have any harmful reactions from such low amount of gluten. However, there are other countries which have chosen to set the gluten limit to as low as 3 ppm.(11)

Do Oats Contain Gluten?

For people following gluten-free diets, oats can be a bit of a puzzling food for them. Oats are often processed and transported with equipment that is shared with wheat and this is the main problem with oats. This can cause lot of gluten contamination with oats, even if gluten or wheat are not mentioned on the label of the product.(12)

However, you can find oats that are labeled and certified as gluten-free, which are actually regular oats that are processed with equipment that do not contain any gluten contamination.

However, there is some debate with the experts claiming that gluten-free oats do not exist, even if they claim to be. Avenin is a protein present in oats and it structurally resembles the proteins present in gluten.

Previous research shows that, in rare and a very small percentage of patients who are suffering from gluten intolerance, can also suffer from similar reaction to avenin.(13) However, there is huge evidence that shows many patients suffering from gluten intolerance are able to tolerate gluten-free oats without any problem.(14)

Studies are needed to understand more about the affect the avenin in oats has on the immune system and the digestive system on individuals suffering with gluten intolerance. If you suspect that you may be intolerant to oats, consult your healthcare provider.

Medical Conditions Which Need a Gluten-Free Diet

Even though for many people gluten is safe, there are some medical conditions that mandate a gluten-free diet for treatment and these are:

Celiac Disease: This is an autoimmune condition where the patient’s immune system starts attacking their small intestine cells after gluten consumption.(15) The exact cause of celiac disease is not known; however, genetic component is thought to be a causative factor. Celiac Disease is one of the frequently-researched causes of intolerance to gluten and considered to affect around 1% of the population all over the world.(15) Treatment for celiac disease is under research; however, the most effectively utilized treatment for celiac disease is following a strict gluten-free diet.(15)

Non-Celiac Gluten Sensitivity: This is a medical condition where there is resolution of many of the negative symptoms upon eliminating gluten from the diet of patients who test negative for wheat allergy or celiac disease.(16) The current treatment plan for this condition is following a gluten-free diet.

Wheat Allergy: This is not actual gluten intolerance; however, is a closely linked condition. The fact is, wheat allergies are an actual intolerance to not just the gluten protein, but to the wheat itself. This means that a person suffering from wheat allergy can safely consume gluten from non-wheat sources, such as rye/barley; however, they need to avoid wheat absolutely.(17)

The sad thing is people suffering from wheat allergy tend to follow gluten-free diet, as these 2 ingredients are closely interlinked and are present in most of the same foods.

What are the Symptoms of Gluten Intolerance?(18,19)

The symptoms of gluten intolerance differ from person to person. There are some people who do not have symptoms at all due to which diseases, such as NCGS or celiac disease, can remain undiagnosed or be misdiagnosed. Some of the common symptoms of gluten intolerance consist of:

Skin Symptoms: Eczema, rash and inflammation of the skin.

Digestive Symptoms: Constipation, abdominal pain, bloating, diarrhea; and inflammation of digestive tissue.

Neurological Symptoms: Anxiety, confusion, numbness, fatigue, depression, difficulty speaking and loss of concentration.

Other Symptoms of Gluten Intolerance: Nutrient deficiencies, weight loss, osteoporosis, anemia, headaches and weak immune function.

There are some symptoms, which can seem like gluten intolerance; however, can turn out to be a reaction to something different altogether.

NOTE: If you are already following a rigid gluten-free diet, then tests/investigations done for gluten-related diseases, such as celiac disease, can give inaccurate results.(20)

So, you need to consult your doctor if you suspect you are suffering from gluten intolerance before trying or starting to follow a gluten free diet.

To Summarize…………

Day by day, Gluten-free diets are gaining popularity; however, people are still confused as to what gluten is and when it should be avoided completely.

Gluten is actually a group of proteins that is found naturally in cereal grains (rye barley, wheat). Gluten is not unhealthy; however, some people suffering from certain medical issues like wheat allergy and celiac disease need to completely eliminate it from their diet to avoid serious adverse reactions.

Some of the gluten intolerance symptoms are: skin inflammation, neurological and digestive issues.

If you think that you are intolerant to gluten, then please consult your medical practitioner immediately.

References:

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