Gluten – What You Need To Know

By Shelby Stein, RDN, LRD – Community Dietitian

Gluten refers to the proteins that are found in some grains. Glutenin and gliadin are the main proteins that make up gluten. Think about bread or bread dough – glutenin provides elasticity, gives the dough the ability to stretch, and makes for a strong dough; gliadin gives the dough the ability to rise. Gluten acts like a glue that holds foods together and gives them their shape. Gluten is found primarily in four grains – wheat, rye, barley, and triticale (a cross between rye and wheat) – but is also sometimes found in oats (although they naturally contain zero gluten) due to cross-contact when they are grown and/or processed near wheat, rye, barley, or triticale. Wheat is commonly found in bread, pasta, baked goods, cereals, sauces, soups, and many processed foods. Rye is found in rye bread and beer. Barley is often in soups, “malt” products, and beer. Triticale is generally found in breads, cereals, and pasta. 

For three health conditions, a gluten-free diet is the primary treatment. Celiac disease, is an autoimmune condition in which ingestion of gluten triggers the immune system to attack and create inflammation in the small intestine. Over time, this causes damage to the small intestine (which is where most nutrient absorption takes place) and results in poor absorption of vitamins and minerals. This can then lead to severe nutrient deficiencies and other health problems. Celiac disease is hereditary and affects 1 in every 100 people worldwide. Celiac disease can develop at any age. Some common signs and symptoms of celiac disease include abdominal pain and bloating, chronic diarrhea, weight loss, chronic tiredness, and bone and joint pain. To test for celiac disease, a blood test and/or genetic test is done. If those results indicate a high likelihood of celiac disease, than an endoscopy (a scope with a camera will go through the mouth down to the intestinal tract) will be performed and a biopsy of the small intestine will be done. A visit with your doctor is always the first step in testing for and diagnosing celiac disease. A strict diet that avoids all gluten is the treatment for celiac disease. Dermatitis herpetiformis is a form of celiac disease that causes the immune system to attack the skin, rather than the small intestine, which leads to an itchy, bumpy rash. A gluten-free diet is the treatment for dermatitis herpetiformis. Lastly, gluten sensitivity is a condition in which the body does not well tolerate gluten. It does not cause an immune system response though. It is similar to lactose-intolerance. Most people with gluten sensitivity avoid gluten because eating gluten results in unpleasant digestive symptom, just as consuming lactose does to people who are lactose-intolerant. If you have any digestive symptoms or other health conditions, discuss those with your doctor to see if testing for celiac disease or gluten sensitivity is appropriate. 

Unless you have one of the conditions described above, there is no need to avoid gluten or foods that contain gluten – they are healthy and contain many nutrients. Wheat, rye, barley, and oats are all whole grains. Whole grains have been associated with improved health, specifically reduced risk of heart disease, stroke, some types of cancer, and diabetes along with promoting healthy bacterial balance in the digestive system. These whole grains are rich in fiber, B vitamins, protein, iron, zinc, and manganese, which are all important nutrients to consume for overall health. 

Gluten-free has become somewhat of a fad diet. This has resulted in an increased availability of gluten-free products in grocery stores, which has been great for individuals who have a medical need to stick to a gluten-free diet.  However, this has also resulted in a misconception that if something is gluten-free, that means it is a healthy choice. This is just not the case! A gluten-free cookie is still a cookie, a gluten-free cracker is still a cracker, and so on. The difference is what the food is made out of and the nutrients that it contains. Gluten-free products are made using gluten-free grains like rice, gluten-free oats, buckwheat, corn and quinoa. A gluten-free diet is not generally recommended to aide in weight loss. Gluten-free foods are not healthier than foods that contain gluten. In fact, often times gluten-free versions of food items often contain more calories, fat, and sugar and less fiber, vitamins, and minerals. This is because to make a gluten-free product that tastes good, think about bread for example, sugar, fat, and other ingredients are used to help make up for the texture and flavor that are lacking without the properties of gluten described above. 

Some individuals may think a gluten-free diet helps them lose weight and feel better, but sometimes, this is due to making healthier food choices overall. Often, when someone is avoiding gluten, they increase their intake of fruit, veggies, nuts, seeds, beans, and lean proteins because these foods do not contain gluten. In addition, many processed foods contain gluten, so by cutting out these foods it allows room for healthier options. For example, instead of a pop tart for breakfast (which contains gluten) one might have fruit, yogurt, and some almonds. 

The bottom line: gluten can be part of a healthy, balanced diet. You do not need to avoid gluten unless you have a medical condition which requires a gluten-free diet. The best route for all is to follow a healthy eating pattern – if you need to avoid gluten do so and avoid the gluten-containing grains and foods, otherwise enjoy the whole-grains that contain gluten! A healthy eating pattern is one that is rich in vegetables, fruits, lean proteins (lean meat/poultry and beans), healthy fats (nuts, seeds, and small amounts of liquid oils), and whole grains (ones that contain gluten like wheat, rye, and barley and naturally gluten-free whole grains like wild rice, brown rice, gluten-free oats, corn, and quinoa). 

If you’d like to set up an appointment with a registered dietitian for support in your nutrition and health goals or if you have additional questions on gluten or gluten-free diets, please give the diabetes program a call at 701-627-7931.