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Gluten

Gluten is a protein found in all forms of wheat (including durum, semolina, and spelt), rye, oats, barley and related grain hybrids such as triticale and kamut.

What is gluten?

Gluten comes from the Latin word for ‘glue’ and is an elastic protein found in grains including wheat, rye, oats, triticale, durum, spelt, kamut and barley. Gluten provides bread dough with its elasticity by trapping gases released during the fermentation process - this helps the dough to rise. During the cooking process, gluten becomes firm – this helps to ensure the bread maintains its proper shape and gives bread its honeycomb-like structure.

Some people have a condition known as coeliac disease; these people are unable to digest the gluten protein and must therefore remove gluten from their diet.

Should I avoid gluten?

In those individuals with diagnosed coeliac disease, gluten damages the lining of the small bowel and must therefore be strictly avoided. Other people may have a sensitivity to either wheat or gluten which causes symptoms of stomach discomfort. They may feel more comfortable with a diet which is lower in gluten, however complete exclusion is often not necessary.

In general, gluten is a safe and natural component of many foods and should not be removed from the diet. If you feel that you have a problem with gluten, it is best to contact your doctor or a dietitian who will guide you through investigations of your concern. Self-diagnosis of a food intolerance is strongly warned against as any diet which avoids certain foods may result in vitamin and mineral deficiencies and further health complications.

Coeliac disease

Coeliac disease (pronounced seel-ee-ak) is an auto-immune disease, which occurs when the body is intolerant to gluten, a protein found in a number of grains. Exposure to gluten in a sensitive person causes damage to the lining of the small intestine (see diagram below). This damage can result in decreased absorption of nutrients and a wide variety of symptoms such as diarrhoea, weight loss, anaemia and bloating. Even though symptoms may not always be obvious, damage to the gut wall still occurs which can have detrimental effects on health. The exact cause of coeliac disease is not yet known, but it appears genetic and environmental factors play important roles.

Coeliac disease is a permanent medical condition, and  the only treatment for coeliac disease is total avoidance of gluten-containing foods. Long-term problems associated with failure to adhere to a strict gluten-free diet include increased risk of bowel lymphoma (a type of cancer), osteoporosis, infertility and chronic ill health. The risk of these is no greater than normal when a gluten-free diet is followed.

Removing gluten from the diet is not easy. Grains are used in the preparation of many foods. It is often hard to tell by an ingredient's name what may be in it, so it is easy to eat gluten without even knowing it. However, staying on a strict gluten-free diet can dramatically improve the patient's condition. Since it is necessary to remain on the gluten-free diet throughout life, it will be helpful to review it with a registered dietitian.

Special considerations

1. The person who prepares the patient's food must fully understand the gluten-free diet. Read food labels carefully and do not use anything that contains the following grains: wheat, rye, barley and oats. Buckwheat, millet, amaranth and quinoa are deemed to be gluten-free as long as they are free from wheat contamination; some buckwheat flours have wheat flour in them. The following do not contain gluten and can be eaten in any amount: corn, potato, rice, soybeans, tapioca, arrowroot, and carob.
   
2. Grains are used in the processing of many ingredients, so it will be necessary to seek out hidden gluten. The following terms found in food labels may mean that there is gluten in the product.
   • Hydrolyzed Vegetable Protein (HVP), unless made from soy or corn
   • Flour or Cereal products, unless made with pure rice flour, corn flour, potato flour, or soy flour
   • Vegetable Protein unless made from soy or maize
   • Malt or Malt Flavouring unless derived from maize
   • Modified Starch or Modified Food Starch unless arrowroot, corn, potato, tapioca, waxy maize, or maize is used
   • Vegetable Gum unless vegetable gums are carob bean gum, locust bean gum, cellulose gum, guar gum, gum arabic, gum aracia, gum tragacanth, xanthan gum, or vegetable starch
   • Soy Sauce or Soy Sauce Solids unless you know they do not contain wheat
   • Distilled White Vinegar is made from grains and may contain gluten. Many commercially prepared condiments are prepared with distilled white vinegar and may contain very small amounts of gluten.
3. Any of the following words on food labels usually means that a grain containing gluten has been used:
   • stabiliser
   • starch
   • flavouring
   • emulsifier
   • hydrolysed
   • plant protein
4. There are now several companies that produce gluten-free products, and several support groups to provide delicious recipes and help patients adapt to the gluten-free diet.

Food groups and gluten