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Gluten is wheat gum, the insoluble component of grains (such as wheat, barley, and rye). It is a mixture of gliadin, glutenin, and other proteins. Gluten causes allergic reactions in certain people. While a gluten-free diet is the primary therapeutic treatment for celiac disease, this diet may also help a host of other conditions, including dermatitis herpetiformis, psoriasis, rheumatoid arthritis, HIV enteropathy, and schizophrenia.
Celiac disease (also called gluten enteropathy) is a disorder of the small intestine characterized by sensitivity to gluten. In people with celiac disease, consumption of gluten causes inflammation in and damage to the lining of the small intestine, resulting in diarrhea, malabsorption, fat in the stool, and nutritional and vitamin deficiencies.
A gluten-free diet (GFD) is the primary treatment for celiac disease. Strict avoidance of wheat, barley, and rye (the three most abundant sources of gluten) usually improves gastrointestinal symptoms within a few weeks, although in some cases improvement may take many months. Some people with celiac disease must remove all gluten-containing foods from their diets in order to relieve symptoms. Following a GFD has been shown to reduce the incidence of cancer, low bone mineral density, and infertility in persons with celiac disease.
People with dermatitis herpetiformis (DH) may benefit from following a GFD. The cause of DH is mainly allergic reaction. Gluten-sensitivity enteropathy is found in 75% to 90% of people with DH.. Unlike celiac disease, however, gastrointestinal symptoms are mild or absent. Strict adherence to a lifelong GFD can eliminate symptoms of DH and the intestinal abnormalities, as well as reduce or eliminate the need for medication in most people. However, an average of 8 to 12 months of dietary restriction may be necessary before symptoms resolve. Not all people with DH improve on a GFD. Preliminary studies indicate sensitivity to other dietary proteins may be involved.
Anecdotal evidence suggests that people with psoriasis may improve on a hypoallergenic diet. Three trials have reported that eliminating gluten (as found in wheat, rye, and barley) improved psoriasis for some people. A doctor can help people with psoriasis determine whether gluten or other foods are contributing to their skin condition.
Preliminary evidence suggests that a GFD may help improve symptoms of rheumatoid arthritis. In one trial, 14 weeks of a gluten-free (no wheat, rye or barley), pure vegetarian diet, gradually changed to a lactovegetarian diet (permitting dairy), led to significant improvement in rheumatoid arthritis as evidenced by associated symptoms as well as by objective laboratory measures of disease.
HIV enteropathy, a complication of AIDS that characterized by weight loss and chronic diarrhea, may respond to a GFD. In a preliminary trial, men with HIV enteropathy experienced a reduction in the number of episodes of diarrhea as well as significant weight gain while following a GFD.
For many years, researchers have been speculating that certain dietary proteins, including gluten, may contribute to the symptoms of schizophrenia. People with schizophrenia are more likely to have immune-system reactions to gluten than the general population, according to some studies. While clinical research findings have been inconsistent, some, but not all, people with schizophrenia may benefit from a gluten-free (and dairy-free) diet.
Individuals who are sensitive to gluten may have the following symptoms:
To avoid gluten ask about ingredients at restaurants and others’ homes, and read food labels. The following list is not complete. Consult with a healthcare professional before making any significant changes to your diet.
Be careful of the following foods (which may contain small amounts of wheat flour):
Be careful of the following personal and over-the-counter items (which may contain small amounts of gluten):
* These foods are allowed by the Canadian and European Celiac Associations, but not by the U.S. Celia Sprue Association due to a concern of possible contamination with other gluten-containing grains during milling and transportation.
While wheat is one of the major gluten-containing grains, it is important to remember that “wheat-free” does not mean “gluten-free.” Make sure to carefully read food labels to determine if an item features gluten-containing items.
Prepare a note card with the foods that you need to avoid and bring this with you when food shopping or dining in restaurants. Communicate your special needs to the waiter or manager so that they can guide you to dishes that do not contain gluten.
Gluten allergies can often start in childhood as a result of early feeding of grains; consider breast-feeding your child for the first six months.
Be careful when buying grains from bulk bins. Make sure that the grains are adequately separated from the gluten-containing grains in order to avoid cross-contamination.
Celiac Sprue Association/USA, Inc.
P.O. Box 31700
Omaha, NE 68131
http://www.csaceliacs.org
Gluten Intolerance Group of North America
15110 10th Avenue SW, Suite A
Seattle, WA 98166
http://www.gluten.net
The Gluten-Free Gourmet: Living Well Without Wheat by Bette Hagman, New York: Henry Holt and Co., 2000.
More from the Gluten-Free Gourmet: Delicious Dining Without Wheat by Bette Hagman, New York: Henry Holt and Co., 2000.
Gluten-Free: More than 100 Delicious Recipes Your Family Will Love by Michael Cox, New York: Simon & Schuster, 2000.
The Sensitive Gourmet: Imaginative Cooking Without Dairy, Wheat or Gluten by Antoinette Savill, London: Thorsons, 1998.
Celiac Disease and Gluten-Free Diet Support Page
http://www.celiac.com
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The information presented in Foodnotes is for informational purposes only and was created by a team of U.S. registered dietitians and food experts. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements, making dietary changes, or before making any changes in prescribed medications. Information expires July 2004.