Public Health in the National News – The relationship between gluten and health is currently receiving quite a bit of attention. Gluten is a major storage protein component in wheat, rye, and barley. Celiac disease (CD) is an autoimmune disease triggered by ingestion of gluten. It is estimated that 1% of the population in the United States is affected by CD. In this disease, the immune system reacts to gluten by attacking the lining of the small intestine (villi) in genetically susceptible individuals, leading to an inability to absorb certain nutrients and consequently to some nutrient deficiencies. Digestive symptoms of the disease include abdominal pain, indigestion, gas, diarrhea, weight loss, and tiredness. In some cases, there are nondigestive symptoms such as skin rash, tingling or numbness in the hands or feet, depression, and mood changes. A recent study revealed that the number of individuals with CD has increased in the United States. This increase has been attributed to better diagnostic methods or to environmental factors. However, the exact reason for the increase is unknown. Blood tests and intestinal biopsies are necessary to confirm the diagnosis of CD, as symptoms may vary from one person to another. In addition, some individuals may be intolerant or sensitive to gluten and have milder symptoms, but not have CD (ie, the small intestinal villi are not attacked).
A gluten-free diet is the primary treatment for CD and gluten intolerance. People with CD and gluten sensitivity should avoid wheat, rye, barley, and their derivatives. Foods that contain gluten include bread, muffins, cakes, pies, cookies, pancakes, couscous, and pasta. Wheat, rye, and barley derivatives include hydrolyzed vegetable proteins and soy sauce (wheat); artificial seafood present in sushi (wheat); soups and broth (wheat); meatballs (wheat); beer (barley); and Rice Krispies and corn flakes, which contain malt made of barley. Cross contamination with gluten-containing products can also be a problem. Examples of possible sources of contaminants include oil from frying breaded products, and shared toasters, strainers for pasta, and grills used for pancakes.
Gluten-free substitution foods include breads, cakes, pies, and muffins made of potato and rice flour. However, these food products are low in fiber, calcium, vitamin D, and iron. Therefore, gluten-free vitamin and mineral supplements are usually necessary for people with CD and gluten sensitivity. High fiber, gluten-free, whole grain products are also available. These products include brown rice, wild rice, quinoa, corn, popcorn, and gluten-free oats. Gluten-free foods that are high in fiber include fruits and vegetables, legumes, soybeans, uncoated nuts, and seeds. Calcium-rich gluten-free foods include fortified milk substitutes such as rice milk, almond milk, and soy milk. Iron-rich foods include unprocessed meat, poultry, and fish; whole grains; fortified gluten-free cereal; fortified rice; legumes; and green leafy vegetables. For optimal health, there are naturally gluten-free foods including fruits, vegetables, poultry, fish, and plain meat. Also, check the food label for the ingredients and for gluten-free products, and when in doubt, contact the food manufacturer.
Restaurants with gluten-free menus:
This article was written by Ghada Soliman, MD, PhD, RD, LMNT, an associate professor in the UNMC COPH Department of Health Promotion, Social and Behavioral Health.