Like celiac disease, gluten intolerance is a condition in which ingesting gluten, the main protein in wheat, rye, and barley, causes an adverse reaction in the body. The body’s innate immune system recognizes gluten as an enemy and immediately works to eliminate it from the body. However, ingesting gluten does not cause intestinal villi damage or other permanent organ damage in gluten intolerance the way it does in celiac disease.
Although gluten sensitivity is not a food allergy, nor does it cause an autoimmune response (as seen in celiac disease), it can cause similar symptoms including abdominal pain and bloating, diarrhea, and fatigue. Joint pain and reflux can also occur. Although no specific tests are used to diagnose gluten intolerance, some experts recommend testing for both wheat allergy and celiac disease if gluten sensitivity is suspected. If tests for these conditions are negative, the person with symptoms should try eliminating gluten-containing foods from the diet and then, under the supervision of a doctor or a registered dietitian, reintroduce them to see if and how that affects symptoms.
Dietary Treatment for Gluten Sensitivity
There is no cure for celiac disease or gluten intolerance; avoiding gluten for life is recommended to reduce or resolve symptoms and some of the health and nutritional problems associated with celiac disease and gluten intolerance. Starting a gluten-free diet is not advised before a firm diagnosis is made, however, because doing so can decrease the accuracy of the test results.
Those diagnosed with celiac disease or gluten intolerance should consult with a registered dietitian to learn how to avoid gluten while consuming adequate calories and nutrients to meet individual needs. You can find a registered dietitian in your area by contacting the American Dietetic Association.
Gluten is found in wheat, rye, barley, and the variety of foods and beverages made with them, including many kinds of breads, baked goods, cereals, pastas, bouillon cubes, soups, sauces (soy sauce and gravy), seasonings, salad dressings, snack foods (such as potato or tortilla chips), prepared meats (deli meats, hot dogs, hamburger patties, and imitation seafood), imitation fish, egg substitutes, French fries, vegetables in sauce, yogurt drinks, frozen yogurt, flavored coffees and teas, and some candies (such as licorice and chocolate bars). Some dietary supplements and medications can also contain gluten, as does the glue found on envelops and stamps.
Oat, corn, and rice products do not contain gluten themselves, but often become contaminated when made in factories that also manufacture wheat products. Reading food labels (ingredient lists in particular) is critical for those with celiac disease. Although wheat is a “major food allergen” listed on ingredients lists on food packages, you’ll need to be savvy to identify other sources of gluten.
Although some studies have shown that consuming pure oats (about 50 grams a day, or the amount in ½ cup rolled oats) can be safe and help those with celiac disease comply with a gluten-free diet, there is controversy over whether oats can contribute to gastrointestinal and other symptoms. Many experts believe that oats often produce symptoms because of contamination with wheat during processing. So look for brands that guarantee their oats are gluten-free.
The FDA recently proposed a definition of the term “gluten-free” that manufacturers can use voluntarily on food packages. According to the FDA’s proposed definition, a product labeled “gluten-free” does not contain
• An ingredient that is a “prohibited grain”. This includes any species of wheat (such as durum wheat, spelt wheat, and Kamut), rye, barley, or their crossbred hybrids.
• An ingredient (such as wheat flour) derived from a “prohibited grain” that has not been processed to remove gluten.
• An ingredient (such as wheat starch) that is derived from a “prohibited grain” that has been processed to remove gluten, if the use of that ingredient results in the presence of >=20 micrograms of gluten per food.
• >=20 micrograms of gluten per gram of food.
If a food product says “no gluten”, “without gluten”, “free of gluten” and doesn’t meet the previously specified conditions, the FDA will consider that item misbranded.
The Gluten Intolerance Group developed a voluntary, independent food processing inspection program called the Gluten Free Certification Organization in August 2005 to test and monitor ingredients in, and the processing of, gluten-free products. It allows qualified foods to put a “gluten-free” certification mark on their package. To qualify, a food must contain < 10 ppm gluten (or 3 milligrams). People with celiac disease can malabsorb nutrients such as iron, calcium, folate, carbohydrates, fat, and fat-soluble vitamins (A, D, E, and K) so they may require nutrient supplementation. This should be discussed with physician or registered dietitian.
An inflammatory response refers to a reaction by the body characterized by the release of cells and chemicals to repair damage caused by disease or injury.
Villi are tiny fingerlike protrusions that line the small intestine and help nutrients from good get absorbed into the bloodstream.
Malnutrition is a condition that develops when the body doesn’t receive enough vitamins, minerals, and other nutrients required to meet its needs and maintain healthy tissues and organ function.
Osteoporosis is a condition in which bones become porous because they’ve lost too much protein and minerals such as calcium. This leads to reduced bone mass and bone strength and increases the risk of fracture.
An autoimmune condition is one n which the body wages an immune response against one of its own tissues, cells, or molecules.
Down’s syndrome is the most common cause of mental retardation and malformation in a newborn. It is caused by the presence of an extra chromosome (structures in the nucleus of every cell in the body that contain the genetic information necessary for growth and normal body functions)
Turner syndrome is a chromosomal disorder that affects females. In this condition, one of the two x chromosomes is damaged or nonexistent. This leads to impaired growth (with lack of a growth spurt in puberty), small stature, and frequent infertility.
Reduced gut motility is slower movement of food through the small intestine. This can contribute to constipation and other gastrointestinal problems.
Failure to thrive is a cluster of symptoms characterized by delayed growth or development in infants and children up to age 2.
Dermatitis herpetiformis is a rare, chronic, autoimmune skin disorder associated with celiac disease that’s characterized by itchy, blistering ski; it most often affects skin on the knees, back, elbows, and buttocks.