Gluten-free diet

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A gluten-free diet is a diet completely free of ingredients derived from gluten-containing cereals: wheat (including Kamut and spelt), barley, rye, oats and triticale. Though most, but not all, patients can tolerate pure oat products, there is a controversy about including them in a gluten-free diet: some medical practitioners say they may be permitted, but the Coeliac Society advises against them.

The gluten-free diet must be strictly followed by sufferers of coeliac disease^[1] and dermatitis herpetiformis.^[2] Some medical practitioners also believe the diet may be helpful for persons with multiple sclerosis and other autoimmune disorders,^{[citation needed]} as well as autism spectrum disorders,^[3][4] ADHD, and some behavioural problems^{[citation needed]}.

One well-controlled study examined the effect of a strict casein-free and gluten-free diet on children with autism. The experimental group were fed the diet for 12 months. During that period the children had significantly fewer autistic symptoms than the control children, who were not fed the diet.^[5]

Contents 1 Gluten-free food 1.1 Alcohol and the gluten-free diet 2 Gluten-free beer 3 Consumption of low gluten foods 4 Controversy over oats 5 See also 6 References 7 External links

Gluten-free food

Several grains and starch sources are considered acceptable for a gluten-free diet. The most frequently used are maize (corn), potatoes, rice, and tapioca (derived from cassava). Other grains and starch sources generally considered suitable for gluten-free diets include amaranth, arrowroot, millet, montina, lupine, quinoa, sorghum (jowar), sweet potato, taro, teff, and yam. Various types of bean, soybean, and nut flours are sometimes used in gluten-free products to add protein and dietary fiber. In spite of its name, buckwheat is not related to wheat; pure buckwheat is considered acceptable for a gluten-free diet, although many commercial buckwheat products are actually mixtures of wheat and buckwheat flours, and thus not acceptable.

Special care must be taken when checking ingredients lists as gluten may come in forms such as vegetable proteins and starch, modified food starch (when derived from wheat instead of maize), maltodextrin, malt flavoring, and glucose syrup. Many common ingredients contain wheat or barley derivatives.

Many foods will contain gluten, but not be indicated on the ingredients, because they are not in the formulation of the product, but in the preparation of it. One example of this is the dusting of the conveyor belts in the production facilities to prevent the foods from sticking during processing. The food itself might not contain gluten, but there is gluten in the ingested product.

The legal definition of the phrase "gluten-free" varies from country to country. Current research suggests that for persons with coeliac disease the maximum safe level of gluten in a finished product is probably less than 0.02% (200 parts per million) and possibly as little as 0.002% (20 parts per million). Since ordinary wheat flour contains approximately 12% gluten, even a tiny amount of wheat flour can cross-contaminate a gluten-free product. Therefore, considerable care must be taken to prevent cross-contamination in both commercial and home food preparation.

This diet rules out all ordinary breads, pastas, and many convenience foods. Many countries do not require labelling of gluten containing products, but in several countries (especially the European Union) new product labelling standards are enforcing the labelling of gluten-containing ingredients. Various gluten-free bakery and pasta products are available from specialty retailers.

Alcohol and the gluten-free diet

Almost all beers are brewed with barley (and sometimes wheat), and hence are unsafe for the gluten-avoider to drink. Sorghum and buckwheat based beers are available, but remain very much a specialty product. Most specialists now consider all distilled forms of alcohol safe to drink, provided no colourings or other additives have been added, as they might include gluten ingredients. Wine, sherry, port, cider, rum, tequila, bourbon and vermouth are all probably safe. Liqueurs and pre-mixed drinks should be examined carefully for gluten-derived ingredients. Some gluten free beers are available.

Gluten-free beer

Main article: Gluten free beer

Some brewers claim that beers brewed mainly from grains such as rice, sorghum, buckwheat and maize (which tend not to produce an autoimmune response in coeliacs), but including some barley or wheat, are safe for coeliacs, arguing that the proteins from such grains as barley are converted into amino acids. However, there is evidence that the claim is not true^[6], and note that those brewers who produce low gluten beers are required to test every batch for gluten, and are only able to record gluten levels in "parts per million" ('ppm') because gluten does survive the brewing process. Those involved in gluten free brewing, and others representing coeliacs or those with other conditions that require a gluten free diet, tend to be very clear that beer brewed using wheat or barley are not appropriate for those with coeliac disease or dermatitis herpetiformis,^{[7] [8] [9]} although the carefully controlled gluten levels of particular malt brews of England and Finland may be low enough to be consumed in relative safety (Against the Grain, 13ppm; Koff, 20ppm; Laitilan, 4ppm).^[10] However, there is a school of thought that all testing is unreliable for hordein,^[11] and doubtless brews that do not begin with glycoproteins that cause an autoimmune response are the safest for all those with a gluten intolerance.

However, while it is likely that most coeliacs will be able to drink beer at under 20 ppm (in moderation) without causing themselves any harm, it is likely that each person has a different level at which an autoimmune response will be activated and there is some debate over the gluten “level” acceptable to coeliacs.^[12]

In November 2006, Lakefront Brewery of Milwaukee,Wisconsin launched its "New Grist" gluten-free beer, brewed with sorghum and rice. It is one of its most successful lines. It is aimed at those with celiac disease, although its low-carb content also makes it popular with health-minded drinkers.^[13]

In December of 2006 Anheuser-Busch began selling Redbridge, a sorghum-based, gluten-free beer.^[14]

Consumption of low gluten foods

It is important, therefore, for consumers of all "low gluten" foods and beverages to tell their consultant, and to ensure that even if the obvious symptoms are absent, there are no other negative effects continuing that they are unaware of. Some large scale commercial brewers suggest that their beers may not be dangerous to coeliacs, but the evidence does not support this and there is a risk that coeliacs want to rationalize that they can continue to be exposed to “normal beverages”.^[15]

Notwithstanding this advice, the recent development of gluten free ales, lagers, and beers has been a very positive move forward to liberating those who suffer a variety of related conditions from possible social isolation, and there is an entire grass-roots movement of people working to produce flavorful gluten-free beer”.^[16] Improvements in gluten free breads and pastas may now make it possible to consume foods that are acceptable in flavour and texture without any wheat or gluten component.

In many ways beer seems to be the hardest gluten free product to "get right". However, gluten free beer is becoming increasingly available, and there are now a range of ales, beers, and lagers to choose from. The international resource for gluten free beer^[17] is www.glutenfreebeerfestival.com, whose Dr Steve Ford divides the market into two types: "no gluten" and "low gluten", writing that the resource promotes choice - to choose a beer if that is wanted, and to allow the coeliac to have a choice of brew that they may wish to consume.^[18]

Controversy over oats

The suitability of oats in the gluten-free diet is still somewhat controversial. Some research suggests that oats in themselves are gluten free, but that they are virtually always contaminated by other grains during distribution or processing. However, recent research^[19] indicated that a protein naturally found in oats (avenin) possessed peptide sequences closely resembling wheat gluten and caused mucosal inflammation in significant numbers of coeliac disease sufferers. Some examination results show that oats are very dangerous to certain celiacs, while not very harmfull to others. Given such conflicting results, excluding oats is the only risk free choice for coeliac disease sufferers.^[20]

See also

• Gluten-free, casein-free diet
• Gluten-free, casein-free diet for autism

References

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