A gluten-free diet is a diet that is completely free of
gluten, which is a generic term for storage proteins
found in grains. In celiac disease (also referred to as
celiac sprue), persons develop an inflammatory
immune system response to gluten that results in damage
to the small intestine, which inhibits absorption of
nutrients. Some persons also develop dermatitis herpetiformis,
an itchy and blistering skin condition.
Because of gluten intolerance, affected persons must
completely avoid foods that contain gluten.
The gluten-free diet is the prescribed medical
treatment for gluten intolerance diseases, including
celiac disease and dermatitis herpetiformis. Celiac disease
is a genetically inherited, chronic digestive disease
that results in damage to parts of the small intestine
that are responsible for absorption of nutrients. Celiac
disease affects almost three million people in the
United States, about one percent of the population.
Celiac disease is found among North American and
European populations, where wheat is a staple food,
but is found infrequently among descendants of China
and Japan and persons with an African-Caribbean
background, where wheat is not as widely consumed.
In addition, dermatitis herpetiformis is an important
disorder or complication of gluten-sensitive enteropathy,
which is manifested in the form of a skin rash.
Approximately 10% of persons with celiac disease
have dermatitis herpetiformis, but about 85% of persons
with dermatitis herpetiformis also have celiac
disease.
When a person with celiac disease consumes gluten,
the villi of the small intestine, where absorption of
key nutrients takes place, become damaged, resulting
in nutrients passing through the digestive system without
being absorbed. The person exhibits gastrointestinal
distress and eventually malnutrition. In infancy,
celiac disease manifests itself as failure to thrive, diarrhea,
abdominal distention, developmental delay, and
in some infants, as severe malnutrition.
After infancy, the symptoms of celiac disease are
less dramatic. Older children may be short or exhibit
dental enamel defects. Women comprise about 75% of
newly diagnosed adult cases of celiac disease. Symptoms
of celiac disease include diarrhea, constipation
alternating with diarrhea, intestinal gas, fatty, greasy,
foul-smelling stools, bloating, nausea, vomiting, skin
irritation, weight loss, anemia, neurological effects
(including seizures, and possibly migraine headaches),
fatigue, concentration and memory problems. In some
cases, there may be intestinal damage without significant
gastrointestinal symptoms. Celiac disease is diagnosed
by blood tests for certain antibodies and small
intestine biopsy. A positive small intestine biopsy,
followed by an improvement in health after following
a gluten-free diet, is confirmation of celiac disease. A
gluten-free diet should not be started before diagnosis
is confirmed.
Some individuals may exhibit gluten intolerance,
with gastrointestinal symptoms similar to those seen
with celiac disease, but without its resulting intestinal
damage. Gluten intolerance is diagnosed by following a gluten-free diet, followed by reintroduction of gluten-
containing foods, to evaluate health improvement
associated with elimination or reduction of gluten
from the diet. Some individuals with gluten intolerance
maybe be able to tolerate a low-gluten diet under
the supervision of a physician or dietitian.
A gluten-free diet may also be helpful for persons
with multiple sclerosis and other autoimmune disorders,
as well as for persons with autism spectrum disorders,
Attention Deficit Hyperactivity Disorder
(ADHD), and some behavioral problems.
The foods of concern for individuals with, or susceptible
to, celiac disease are the cereal grains that
contain the storage proteins prolamin and glutelin
(commonly referred to as glutens in wheat), including
all varieties of wheat (e.g., durum, spelt, kamut), barley
(where the storage proteins are called hordiens),
rye (where the storage proteins are called secalins), and
their cross-bred hybrids (such as triticale).
Grains and starches that are allowed in a glutenfree
diet include: rice, corn, soy, potato, sweet potato,
tapioca, beans, garfava, sorghum, quinoa, millet,
arrowroot, amaranth, tef, nut flours, and buckwheat.
However, some commercial buckwheat products are
mixtures of wheat and buckwheat flours and should be
avoided. Other foods that are allowed (only a partial
list) include fresh, canned, and frozen fruit or fruit
juices, fresh vegetables, canned and frozen vegetables
without gluten-containing additives, milk, aged
cheese, all unprocessed meats, poultry, fish, eggs,
dried beans, nuts, and seeds. A dietitian should be
consulted to develop and monitor a gluten-free diet.
Gluten-free foods can be found in health food
stores, through mail order sources, and in some supermarkets.
Cookbooks are available to help in food
preparation. Many food manufacturers maintain lists
of gluten-free products. The Gluten-Free Certification
Organization (GFCO) of the Gluten Intolerance Group, in cooperation with the Food Services, Inc., a
subsidiary of the Orthodox Union, a kosher certification
agency, has developed a gluten-free certification
program. This program benefits consumers by giving
them confidence that a product is gluten-free through
a process whereby products have been tested and the
manufacturing site inspected.
The program also saves
the consumer time that would have been spent calling
the manufacturer for the gluten-free status of the
product. Certification is a yearly process based on
ingredient review, on-site inspection and product testing.
The Celiac Sprue Association (CSA) also has the
CSA Recognition Seal Program that certifies glutenfree
products. Requirements for obtaining the CSA
Seal for products include:
-Ingredient review and verification by testing to assure
products are free of wheat, barley, rye and oats
-Provision of written facility procedures and on-site
facility audits to assure that procedures are in place
to control any cross or outside contamination in
processing and packaging
Foods may contain gluten, although gluten will
not be indicated on the ingredient list, because it was
not included in the formulation of the product. For
example, a conveyer belt may be dusted with a glutencontaining
material to prevent foods from sticking
and may contaminate the finished food product.
