Gluten Free Diet

(Wheat-, Spelt-, Rye-, Triticale-, Oat-, Barley, Kamut-Free)

Background

Gluten is a water-insoluble protein fraction present in some cereal grains. One of gluten’s component proteins, gliadin, is the cause of some individual’s intolerance or sensitivity reactions to grains such as wheat, spelt, rye, triticale, oats, barley and kamut. The cause of this intolerance or sensitivity is still theoretical.

One possible explanation is that the deficiency of an intestinal enzyme results in the incomplete breakdown of gluten (gliadin) protein, forming toxic peptides (smaller molecules than the original protein) that accumulate in the gastrointestinal tract and eventually damage intestinal villi—where nutrient absorption normally occurs. Another theory implicates abnormal gluten (gliadin) protein-binding sites or receptors on the surface of intestinal cells, resulting in the abnormal binding of these proteins to the cells, then causing the cells’ destruction. Other explanations involve immunological defects or viral infections that result in the inactivation of gastrointestinal cells.

Whatever the mechanism of the intestinal cell damage following gluten (gliadin) intolerance, the resulting condition is a primary chronic intestinal malabsorption that typically and most severely involves the part of the small intestine that comes directly off the stomach (i.e. the duodenum etc.). This pathological process can be acute, subacute or insidious (occurring gradually over time). The intolerance usually presents in the first three years of life (usually when solid foods are first introduced) and may reappear again at any time. However, it may appear for the first time at any age and is never “outgrown”, requiring lifetime and total (continuous) avoidance of gluten (gliadin) in order to control the condition. Even a small amount of ingested gluten may induce a reaction that can be delayed for 1-2 months.

Many of these patients are also lactose intolerant with milk ingestion producing symptoms similar to those from gluten (gliadin). Early intolerance to cow’s milk lactose may increase sensitivity to gluten (gliadin) later in life. It has therefore been suggested that gluten (gliadin) intolerance can be a sequel to lactose intolerance.

Classically, these patients suffer with chronic diarrhea or constipation, vomiting (sometimes), bloating and cramping. Stools are usually loose, foul smelling, frothy, gray, greasy and floating. Adults often present with increased appetite, weight loss, weakness and fatigue, though some patients have few, if any, symptoms.

If untreated, this chronic malabsorption can contribute to hypertension, heart irregularities, bone derangements, amenorrhea, infertility, spontaneous abortion, diabetes, dermatitis herpetiformis, neurological disorders, intestinal ulceration and cancer.

Dietary treatment involves the avoidance of all dietary gluten (gliadin)—see dietary lists below. It is also a good idea to also avoid all dairy products since lactose intolerance is frequently concurrent with this condition. Note: this dietary treatment does not take into account other food allergies that may be unique to the individual concerned. See your clinician for further information regarding nutrition and your individual medical condition.

Be a strict label reader! Watch out for ingredients like cereal, starch, flour, thickeners, emulsifiers, gluten, stabilizers, hydrolyzed vegetable proteins, etc. Wheat starch is acceptable because the gluten (gliadin) fraction has been removed.

ALLOWED FOODS (Fresh is preferable to frozen which is preferable to canned)

  • Corn, hominy
  • Rice (brown, white, wild)
  • Tapioca
  • Potato, cassava, yam, arrowroot
  • Specialty breads made from rice or tapioca (PCC has a selection)
  • Hot cereals made from cornmeal, rice or hominy
  • Cold cereals made from rice, corn or amaranth
  • Gluten- (gliadin-) free bread made from rice, corn or potato; special gluten-free noodles made by the Henkel Corp.; some oriental rice or bean-based noodles
  • All meat, fish, poultry
  • Eggs
  • Vegetables—fresh, frozen, canned
  • Dried peas and beans, lentils, some commercially prepared vegetables
  • Fruits—fresh, dried, frozen, or canned; some commercial pie fillings
  • Corn flour, cornmeal, potato starch flour, rice bran, plain rice flours

FOODS TO AVOID

  • All wheat, spelt, rye, triticale, oats, barley and kamut, which includes most breads and pastas
  • Cereals containing bran, graham, wheat germ, malt, bulgur, millet or teff
  • Some commercial chocolate-flavored beverages, some non-dairy creamers, cheese-like products made from oat gum
  • Prepared meats (hot dogs, luncheon meats, chili con carne, Swiss steak, meat loaf, most pre-basted turkey
  • White sauces, creamed soups or vegetables—any sauces containing grain thickeners
  • Commercially processed beans
  • Thickened or prepared fruits, some pie fillings
  • Cakes, cookies, most baked goods
  • Infant and junior dinners containing flour thickeners
  • Caramel coloring and MSG may also not be well-tolerated

Resources

  1. Hunter, Beatrice Trum. Gluten Intolerance. 1987. Keats Publishing.
  2. Marz, Russell B. Medical Nutrition From Marz, 2nd edition. 1999. Omni-Press.
  3. Websites to use as resources: