“Gluten” has become a bit of a buzz word over the last few years, and it often has an element of negativity attached to it with some people thinking that gluten should be avoided.
A gluten-free diet is sometimes seen as a “fad” or a way to lose weight which can give it a bad reputation – but for people with coeliac disease or a severe gluten intolerance a gluten-free diet is a necessary and non-negotiable requirement. The word “diet” can also be a bit misleading!
My approach with clients generally is to not cut out a specific food group, unless someone is allergic or intolerant of course. I prefer a focus on wholesome, nutritious foods and a lot of the time these are naturally gluten-free anyway.
Definition of gluten
Mosby’s Dictionary of Medicine, Nursing and Health Professions defines gluten as follows:
“The insoluble protein constituent of wheat and other grains like rye and barley. It is obtained from flour by washing out the starch and is used as an adhesive agent, giving to dough its tough, elastic character.”
Gluten is a mixture of hundreds of distinct proteins within the same family, although it is primarily made up of these two classes of proteins:
- gliadin, which gives bread the ability to rise during baking
- glutenin, which is responsible for dough’s elasticity
Gluten sensitivity, gluten intolerance and coeliac disease
The terms “gluten sensitivity” (or “non coeliac gluten sensitivity”) and “gluten intolerance” are often used interchangeably. Neither of these terms are well defined within the medical community but gluten sensitivity is generally considered to be a milder form of gluten intolerance.
For the purpose of this blog I will use the term “gluten intolerance”. For someone suffering from a gluten intolerance, symptoms after ingesting gluten can range from mild to severe and often include short-term bloating and stomach pain. Gluten intolerance however doesn’t usually cause any long-term harm to the body. It’s worth noting that scientifically it remains unclear how gluten sensitivity works, and a diagnosis is usually made by eliminating other conditions and possibilities.
Coeliac disease on the other hand is a well-defined autoimmune disease and symptoms experienced can range from abdominal distension, vomitting, diarrhoea, migraines and muscle wasting to extreme lethargy. In coeliac disease the the body’s immune system attacks itself after the consumption of gluten, which causes damage to the lining of the small intestine. In the long term this means that the body cannot properly absorb nutrients from food, which explains nutritional deficiencies in some and symptoms like lethargy, brain fog and even depression.
Individuals who develop coeliac disease are born with a genetic predisposition, but the age of onset can vary from infancy to old age – it often lies dormant until it is triggered later in life.
A blood test cannot confirm a diagnosis of coeliac disease, but it can reveal the presence of antibodies which would suggest some kind of autoimmune reaction to gluten. A doctor might also recommend an endoscopy to check the small intestine for damage – damage to the lining of the small intestine would confirm a diagnosis of coeliac disease while a lack of damage would suggest gluten intolerance or wheat allergy.
The only known effective treatment to prevent damage to the digestive system is a gluten-free diet.
Foods with gluten
Gluten is not just in bread and pasta. There is a whole list of gluten-containing foods, and for people with coeliac disease or a gluten intolerance specifically it’s foods with “hidden gluten” that they need to be careful of.
Gluten is one of the 14 allergens that must be displayed clearly on prepackaged foods (allergens are often in bold on the list of ingredients) in the UK. Food business operators in the retail and catering sector are also required to provide allergen information. You can find out more info about allergen guidance for food businesses on the Food Standards Agency website.
Sometimes people also think that only wheat products contain gluten which is incorrect – whilst it is true that all wheat products do indeed contain gluten, gluten is also present in other foods and not all gluten comes from wheat only.
The grains wheat, barley and rye contain the protein gluten and cannot be eaten on a gluten-free diet, although it’s interesting to note that wheat has a much higher content of gluten than rye and barley.
Foods that commonly contain gluten from wheat, barley or rye include:
- bread & pastries
- breakfast cereals
- pasta
- battered foods, or foods fried in breadcrumbs
- seasonings and spice mixes
- beer
Wheat is one of the main staples of a traditional Western diet and there are many forms of it which are also off-limits including the below examples:
- Wheat flour, wheat starch, wheat bran, wheat germ, wheat protein, cracked wheat
- Bulgur
- Couscous
- Durum
- Einkorn
- Emmer
- Farro
- Freekeh
- Kamut
- Malt
- Semolina
- Spelt
- Plus: barley and rye, and derivatives thereof
It’s worth highlighting that although buckwheat contains the term “wheat” it is – confusingly! – wheat free as it is a seed rather than a grain, and can therefore be consumed on a gluten-free diet.
Things like hydrolysed vegetable proteins, modified food starch, natural or artificial flavours , seasonings and flavourings may also contain gluten, and even foods that do not naturally contain gluten could be cross-contaminated if produced on equipment also used to produce gluten-containing foods.
Foods from reputable companies and brands that are labelled as “gluten-free” are not just certified 100% gluten-free but also manufactured in a strictly gluten free environment.
Gluten & inflammation
I could easily write a separate long blog post on this subject, but just to cover this very briefly:
Gluten is sometimes referred to as “inflammatory” which is one of the reasons some people choose a gluten-free diet.
Whilst it causes inflammation for people with coeliac disease there is no compelling evidence that a gluten-free diet improves health or prevents disease in people without coeliac, although research is ongoing in this area.
Most health professionals say that “gluten is a completely harmless protein that occurs naturally in various foods and that the vast majority of people can digest and absorb without issue”.
Gluten-free products
The “free from” aisles in the supermarkets have been expanding over the last few years, and there is now a huge choice of gluten-free products. If you look at these though you will see that the majority of these are processed and not healthy – from gluten-free pasta and biscuits to bread, crumpets, pancakes, breakfast cereals, beers and so on.
Remember that as soon as you need to check the ingredients on a label you are looking at food that has been processed in some way (unlike buying fresh vegetables and fruit, whole grains, nuts, fish, meat etc), and the longer the list of ingredients the more processed it is. A lot of the foods in the gluten-free aisle have high contents of sugar, saturated fats and chemical preservatives.
Some foods are also naturally gluten-free but there can be a risk of cross-contamination in a factory along the way, as mentioned above – oats are a typical example. If you are coeliac or gluten intolerant it’s recommended to buy oats that specifically say “gluten-free”. Quinoa is another example – it is naturally gluten-free but some packets advise that it “may contain gluten” due to manufacturing or packaging processes.
Eating out
A lot of establishments (including some popular chains) have successfully achieved GF accreditation developed by Coeliac UK, which helps identify venues that follow strict procedures in food handling and ingredient use to ensure a safe gluten-free experience. Look out for Coeliac UK’s GF symbol on menus and in the windows of accredited venues.
Some cuisines are less gluten-heavy than others. Many Thai, Vietnamese and Indian restaurants for example offer a good choice of naturally gluten-free dishes. In most restaurants a grilled fish or meat dish with vegetables on the side is usually a safe and healthy choice too.
In some cafés it’s worth checking whether cakes marked as “gluten-free” are in fact suitable for coeliacs – the answer is often “no” due to them being made in an environment with a high cross contamination risk.
Anyone with coeliac disease or a gluten intolerance must also watch out for “hidden gluten”, and I would recommend to always mention this at the time of ordering when eating out. For example, eggs can be poached in malt vinegar, and malt is derived from the gluten-containing grain barley. Gluten might also end up in chicken broth, salad dressings, soy sauce and seasonings or marinades, and it’s always worth checking whether they use a separate fryer when it is stated that the chips are gluten-free for example.
My advice would be to always look at the menus online or call the restaurant before booking a table. A lot of places have specific gluten-free menus and cater for a variety of dietary needs. If there is no specific gluten-free menu but all the allergens are displayed clearly (or dishes are marked either “GF” or “GF optional”) then that is normally a good sign and a pretty safe option too!
Some restaurants and cafés are also completely gluten-free – I can recommend the following from personal experience with both the food offering and flavours being of the highest quality:
- Dough Lover, Brighton
- Remedy Kitchen, Manchester (their whole menu is completely free from gluten, dairy and refined sugar)
Pho is another personal favourite when it comes to gluten-free dining as the majority of their menu is naturally gluten-free.
As a conclusion – if you or your child are diagnosed with coeliac disease or gluten intolerance you can still eat lots of healthy foods. It takes a bit of time and practice to get used to checking ingredients and labels, but you will soon find your go-to brands and places to eat out. If you want some additional help with this or any recommendations please let me know.
Coeliac UK is a great source of information for anyone diagnosed with or interested in coeliac disease, and you can download a really useful “Gluten free checklist” from their website too.
Feel free to get in touch if you have any questions at all in regards to this post.
Thank you for reading and keep well x
