GLUTEN FREE EATING
Gluten is a broad name for types of protein (‘prolamins’) that are found in grains. The main types of prolamins are glutenin and gliadin. It is very stretchy and elastic and is used as a binding agent to hold foods together. Gliadin contains peptide bonds with a high number of the amino acids proline and glutamine, which can be resistant to digestion in some people and cause gastrointestinal symptoms such as bloating, diarrhoea or constipation, and abdominal pain. If you experience any of these symptoms because of eating gluten-containing foods, the best remedy is to remove gluten from the diet. This article is a comprehensive guide of all things gluten free eating.
FOODS WITH GLUTEN
Gluten is found in:
- Varieties and derivatives of wheat such as:
- KAMUT® khorasan
- wheat einkorn
- And in various forms including:
- malted barley flour
- malted milk or milkshakes
- malt extract
- malt syrup
- malt flavoring
- malt vinegar
- Brewer’s Yeast
- Wheat Starch (that has not been processed to remove the presence of gluten to below 20ppm and adhere to the FDA Labeling Law)
Gluten can be found in a variety of other foods, not just wheat-based foods. The next list is a comprehensive guide to these lesser-known sources of gluten.
What foods contain gluten?
- Beef jerky – certain flavors of beef jerky – such as teriyaki – contain soy sauce. Meat substitutes – Seitan is made of wheat gluten.
- Broth/stock – some powdered or packaged broths can contain gluten, such as yeast extract derived from barley. Some may contain hydrolyzed wheat protein. GFCO does not certify products as gluten-free if they contain hydrolyzed wheat protein.
- Cheese – some hard cheeses could be soaked in beer.
- Chocolate – some additives, including emulsifiers and flavouring agents in certain chocolates or fillings, could contain gluten. Some specialty chocolates contain barley malt powder.
- Cocktail mixers – some mixers that you add to alcohol, such as certain Bloody Mary mixers, contain wheat or barley derivatives as an ingredient.
- Cooking spray – certain brands of cooking spray contain wheat flour, but most do not.
- Corn flakes and crisp rice cereal – some popular brands are made with malt from barley.
- Energy bars/granola bars – many are made with oats and are often not labelled or certified gluten-free. To avoid potential cross-contact with oats that may contain gluten, stick to bars with oats that are labelled or certified gluten-free.
- French fries – say no to “crunchy,” “seasoned,” or “battered” fries or fries with gravy or sauces on them if you cannot verify that they use entirely gluten-free ingredients. French fries from fast food restaurants are most likely fried in the same oil as gluten-containing foods. Frozen seasoned fries from the grocery store could also contain wheat flour.
- Frozen vegetables – while plain vegetables – fresh or frozen are naturally gluten-free, any with sauces, seasonings, add-ons or special shapes (like broccoli stars) could contain wheat gluten.
- Hard lemonades and wine coolers – some wine coolers – or beverages marketed as wine coolers – could also use a malt base. Some beverages that might appear to be hard cider made from apples could be a malt-based, apple flavored drink.
- Ice pops and dessert bars – while fruit ice pops made with only fruit juice, water, and sweetener should be gluten-free, other frozen treats on a stick could contain gluten. For example, fudge bars could be made with malted barley extract. Ice cream bars and frozen yogurt bars could contain added ingredients, wheat starch that isn’t certified gluten-free, or flavorings containing gluten such as malt.
- Imitation crab products – some may use wheat starch to bind and unless labeled or certified, wheat starch cannot be assumed to be gluten-free.
- Liquorice – red and black liquorice typically contain wheat flour as a binder.
- Marinades and barbeque sauces – may contain malt vinegar, soy sauce, or flour.
- Meatless (veggie or vegan) pepperoni – some brands use wheat gluten as a binder.
- Meatless or vegan deli meats, hot dogs and burgers – pre-sliced and packaged, these are often made with wheat gluten.
- Mustard – wheat flour could be added as a thickener or bulking agent in some specialty mustards.
- Nuts – plain, packaged nuts don’t typically contain gluten, but avoid nuts from bulk bins due to possible cross-contact. Seasoned nuts may contain gluten.
- Other “imitation meats,” could contain gluten due to the use of vital wheat gluten or yeast extract, which may not be gluten-free. If products with yeast extract are not labeled or certified gluten-free, they should be avoided.
- Pickles – some brands are made using malt vinegar (derived from barley).
- Processed and flavored potato or corn chips – some chip brands use wheat starch or whole wheat in their “reconstituted” chips (versus sliced potatoes or corn-only). Also watch out for flavorings derived from wheat or barley.
- Restaurant eggs – some restaurants add pancake batter to their scrambled egg and omelet mixtures to increase fluffiness and sweetness. Even though eggs are naturally gluten-free, these dishes are not.
- Rice pilaf – could be made with orzo (a small wheat pasta) or contain wheat flour.
- Salad dressings – may contain malt vinegar, soy sauce, or flour. Could also contain modified food starch that’s used to emulsify, thicken, or as an anti-caking agent.
- Sausage – could contain rusk, a twice-baked, gluten-containing bread that is used as a cereal filler in some types of sausage like British “banger” sausages. Some specialty or plant-based (meat-free) sausages could contain wheat gluten.
- Seasoned rice – seasonings could be combined with gluten-containing ingredients like soy sauce solids (powder), wheat flour, or wheat starch.
- Sliced deli meats – they may contain added ingredients that could contain gluten as thickeners, such as wheat-derived dextrin or modified food starch. While these two additives are not always derived from gluten-containing grains, some are. Even if deli meats are gluten-free, watch out for cross-contact when deli workers use the same slicing machines for all products. One way to avoid cross-contact is with pre-packaged lunch meats that are labeled or certified gluten-free.
- Some milkshakes – if a milkshake is made with malt – a malted milkshake – it contains an ingredient derived from barley.
- Soup thickened with “roux” – roux is a mixture of fat, usually butter, and flour.
- Soy sauce and teriyaki sauce – made with fermented crushed wheat and soy in a salty brine with mold cultures.
- Specialty ketchup – some brands may use additional ingredients like malt vinegar or miso
- Specialty or flavoured coffee and teas – coffee alternatives could be made with roasted barley. Also watch out for roasted barley tea, including brand names that don’t mention barley.
- Taco seasonings – certain brands contain wheat.
- Vinegar – fermented vinegars made from gluten-containing grains need to be avoided.
- Yeast spreads – e.g. Vegemite or Marmite made from yeasts derived from wheat, barley, oats, and rye.
There are three gluten-related conditions: coeliac disease, wheat allergy and non-coeliac gluten sensitivity.
Signs of Coeliac Disease
Coeliac disease is the most severe gluten-related disorder. In this disease, the gliadin part of gluten contains toxic peptide bonds which trigger an autoimmune response in the body i.e. the body starts to attack itself. Coeliac disease is a genetic disorder linked to the genes HLA-DQA1 and HLA-DQB1. If you don’t have the genes, you cannot have coeliac disease.
Coeliac disease can cause common gastrointestinal symptoms such as diarrhoea, constipation, bloating and stomach pain. It can also cause more serious symptoms such as inflammation and damage to the lining of the stomach and small intestine which can affect the body’s ability to absorb nutrients from food. It can also cause increased gut permeability (leaky gut) which means toxins and bacteria can leak through the intestinal wall into the blood stream. However, many coeliacs have no gastrointestinal symptoms at all, but instead suffer from severe nutrient deficiencies, fatigue, low mood and other inflammatory conditions within the body. Coeliac can be diagnosed by a blood test, genetic test and/or a small intestine biopsy to look for damage to the intestinal wall. If you have a coeliac diagnosis, it is very important to completely remove gluten from the diet to prevent these harmful gut symptoms.
A wheat allergy is also an IgE antibody immune response to the toxic peptide bonds in gliadin. In this case there is a histamine response, and the symptoms are similar to any allergy – itching, swelling, sneezing, redness or a skin rash. Anaphylaxis can occur in a severe allergy. Again, the only treatment option is a strict gluten free diet.
Non coeliac gluten sensitivity
Non-coeliac gluten sensitivity is an IgG, IgG4 and complement response to the protein in wheat. In people with this sensitivity, gluten triggers common gastrointestinal symptoms such as bloating, gas, constipation, diarrhoea, heartburn, indigestion etc. A sensitivity may not cause any gastrointestinal symptoms at all. Instead, gluten may trigger fatigue, joint inflammation, headaches, skin conditions, hormone imbalances etc. and may contribute to multi system disorders such as chronic fatigue syndrome and fibromyalgia. Sensitivities can be very tricky to pinpoint. Gluten can trigger symptoms 2 days after consumption and the symptoms may last for weeks. The best way to test for this sensitivity is excluding gluten from the diet for at least 4 weeks to see if the symptoms persist. If gluten is found to be the culprit, it is recommended to remove gluten from the diet on an ongoing basis.
We can run very comprehensive food allergy and sensitivity tests in the Physical Nutrition clinic to identify gluten reactions.
Zonulin is a protein that regulates tight junctions in the stomach lining. These tight junctions regulate what can be absorbed into the body from the stomach – absorbing the good nutrients and leaving any unbeneficial or potentially harmful molecules to be excreted. There is some research that suggests the gliadin in gluten increases the amount of zonulin in the stomach wall. More zonulin opens up the tight junctions of the stomach wall which means more molecules (and potentially toxic molecules) can be absorbed into the body and can cause the harmful symptoms of leaky gut.
Ancient grains are strains of wheat that have been bred, grown and cultivated the same way for thousands of years. Some of these grains e.g. spelt, einkorn, emmer and khorasan contain gluten and some do not e.g. quinoa. Ancient grains are generally grown organically. The wheat that we are used to buying every day in the supermarket has most likely been genetically modified. Wheat is a staple and the goal of genetic modification is to develop a larger, cheaper crop. Unfortunately, a GMO crop has a higher gluten content than ancient wheat varieties. Also, wheat is heavily sprayed with pesticides. Some of my gluten sensitive (not allergic or coeliac) clients find that if they consume supermarket bread it will make them ill. However, if they go out their way to buy non-GMO, organic, sourdough wholemeal bread, they have no problem with it at all.
GLUTEN FREE FOODS
Which grains are gluten free?
There are many grains that are gluten-free, such as:
These can all be found in your local supermarket or health food store and can be used in very similar ways to gluten-containing products. It is easy to find recipes containing almond or coconut flour instead of wheat flour or using amaranth or buckwheat instead of oats.
Do oats contain gluten?
The proteins in oats are similar to those found in wheat, barley, and rye, however they have a slightly different structure so most people can eat oats on a gluten free diet. However, a small number of people react the same way to oats as they do to gluten. Oats can also be cross contaminated with gluten during processing. If you have coeliac disease, it is best to remove oats from your diet, however those with a gluten sensitivity can test to see if oats produce any symptoms and therefore whether they are safe to eat or not.
How do you know if a food is gluten free?
Food Standards Australia & NZ (FSANZ) have strict rules about what is allowed to be printed on food products. It is important to read food labels to find out if a product contains gluten. If an ingredient list contains wheat, barley, rye, malt, yeast or oats, the food item is not gluten free. Food products will also have allergy information. Check to make sure wheat allergy is not mentioned.
If this is stated on a food label, the product has no detectable traces of gluten and is safe to eat.
‘Contains traces of gluten’
Some food products may be contaminated by gluten during processing. These foods should be safe for those with a non-coeliac gluten condition, however those with coeliac disease should avoid.
HOW TO GO GLUTEN FREE
Coeliac and cross contamination
When one family member is coeliac and others are not, it can be difficult to prepare meals at home to suit everybody. However, it is important to keep preparation of gluten-free foods completely separate to non-gluten free foods. This is because even using the same knives and chopping boards can expose someone with coeliac disease to gluten and cause symptoms. When handling gluten-free foods and preparing gluten-free meals, make sure to wash your hands thoroughly before touching food items, use separate containers for gluten free ingredients and wipe down any kitchen appliances before use. It is easiest to prepare gluten free meals first so there is no chance of any residual gluten products. It can also be useful to buy knives and chopping boards of the same colour so their are distinct from your other utensils, or labelling utensils “GF only” to ensure no mix-ups.
Eating out gluten free can sometimes be a challenge. It pays to call ahead and check that the restaurant has gluten free options. If you get caught somewhere with no gluten free options (or you don’t like the dishes on offer), don’t be afraid to ask the restaurant staff for what you want. If you have a particular dish in mind, ask them if they can make it gluten free. There are so many gluten-sensitive individuals so they are more than used to catering for this food exclusion. If you have been diagnosed with coeliac, make sure to mention this to the restaurant staff as the kitchen should be trained to take extra care when preparing your meal to prevent any cross-contamination.
Eating meals at family and friends’ places can be an even bigger challenge. Sometimes, family and friends may not understand why you are following a particular diet and your choices may be upsetting their view of a culturally appropriate meal. However, you shouldn’t have to feel that you need to eat a food that you know will make you feel unwell to please someone else. If you feel that you will not be able to trust the food on offer or a friend or family member refuses to comply with gluten free, it is always safer to take your own dishes with you.
GLUTEN FREE DIET PLAN
Check out my gluten free meal plan for some meal inspiration, and guidance on gluten free eating.