Gluten-free

gluten

A gluten-free diet is a diet that excludes foods containing gluten. Gluten is a protein complex found in wheat (including ancient varieties: kamut and spelt), barley, rye, and triticale (a wheat/rye hybrid). A gluten-free diet is the only medically accepted treatment for celiac disease (an autoimmune disorder of the small intestine that occurs in genetically predisposed people of all ages).

Being gluten intolerant can often mean a person may also be wheat intolerant as well as suffer from the related inflammatory skin condition dermatitis herpetiformis (chronic blistering). A smaller minority of people who suffer from wheat intolerance alone are tolerant to gluten. Despite unknown benefits for the general population, and evidence to suggest adverse effects, a significant demand has developed for gluten-free food in the United States.

A gluten-free diet might also exclude oats. Medical practitioners are divided on whether oats are acceptable to celiac disease sufferers or whether they become cross-contaminated in milling facilities by other grains. Oats may also be contaminated when grown in rotation with wheat when wheat seeds from the previous harvest sprout up the next season in the oat field and are harvested along with the oats. The exact level at which gluten is harmless for people with celiac disease is uncertain. A 2008 systematic review tentatively concluded that consumption of less than 10 mg of gluten per day for celiac disease patients is unlikely to cause histological abnormalities, although it noted that few reliable studies had been conducted.

Gluten-free foods include quinoa (a pseudograin), and several grains and starch sources are considered acceptable for a gluten-free diet such as 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, lupin, sorghum (jowar), taro, teff, chia seed, and yam. Sometimes various types of bean, soybean, and nut flours are used in gluten-free products to add protein and dietary fiber. Almond flour has a low glycemic index (it doesn’t cause a spike in blood sugar), and is a low-carbohydrate alternative to wheat flour. In spite of its name, buckwheat is not related to wheat. Pure buckwheat is considered acceptable for a gluten-free diet, however, many commercial buckwheat products are mixtures of wheat and buckwheat flours, and thus, not gluten-free. Gram flour, derived from chickpeas, also is gluten-free (this is not the same as Graham flour made from wheat).

Gluten may be used in some unexpected ways, for example it may be added as a stabilizing agent or thickener in products such as ice-cream and ketchup, over-the-counter or prescription medications and vitamins, and in cosmetics such as lipstick, lip balms, and lip gloss; even glues used on envelopes may contain gluten.

In the United States, the FDA considers foods containing less than or equal to 20 ppm to be gluten-free, but there is no regulation or law in the U.S. for labeling foods as ‘gluten-free.’ The finding of a current study indicates that some inherently gluten-free grains, seed, and flours not labeled gluten-free are contaminated with gluten. The consumption of these products can lead to inadvertent gluten intake. The use of highly sensitive assays is mandatory to certify gluten-free food products. The European Union, World Health Organization, and Codex Alimentarius require reliable measurement of the wheat prolamins (a plant protein), gliadins (a cereal protein) rather than all-wheat proteins. There still is no general agreement on the analytical method used to measure gluten in ingredients and food products.

Several celiac disease groups report that according to the American Dietetic Association’s ‘Manual of Clinical Dietetics,’ many types of alcoholic beverages are considered gluten-free, provided no colorings or other additives have been added as these ingredients may contain gluten. Although most forms of whiskey are distilled from a mash that includes grains that contain gluten, distillation removes any proteins present in the mash, including gluten. Although up to 49% of the mash for Bourbon and up to 20% of the mash for corn whiskey may be made up of wheat, or rye, all-corn Bourbons and corn whiskeys do exist, and are generally labeled as such. Spirits made without any grain such as brandy, wine, mead, cider, sherry, port, rum, tequila, and vermouth generally do not contain gluten, although some vineyards use a flour paste to caulk the oak barrels in which wine is aged, and other vineyards use gluten as a clarifying agent (though it is unclear whether gluten remains at the end of the clarification process).

Almost all beers are brewed with malted barley or wheat and will contain gluten. Sorghum and buckwheat-based gluten-free beers are available, but remain a niche market. Some low-gluten beers are also available, however, there is disagreement over the use of gluten products in brewed beverages: Some brewers argue that the proteins from such grains as barley or wheat are converted into amino acids during the brewing process and are therefore gluten-free; however, there is evidence that this claim is false.

Bread, which is a staple in most diets, typically is made from grains such as wheat, that contain gluten. Wheat gluten contributes to the elasticity of dough and is thus an important component of bread. Gluten-free bread is made with ground flours from a variety of materials such as almonds, rice (rice bread), sorghum (sorghum bread), corn (cornbread), or legumes such as beans (bean bread), but since these flours lack gluten it can be difficult for them to retain their shape as they rise and they may be less ‘fluffy.’ Additives such as xanthum gum, hydroxypropyl methylcellulose (HPMC), corn starch, or eggs are used to compensate for the lack of gluten.

Gluten-free diets have become popular. This may be because celiac disease was underdiagnosed and also that people are ‘unnecessarily turning to the diets as a food fad.’There also appears to be an increased incidence of celiac disease, with one study which looked for antibodies from 1950s American blood samples finding that celiac disease is about four times as common as it was. Many are adopting gluten-free diets to treat celiac disease-like symptoms in the absence of a positive test for celiac disease.

Many gluten-free products are not fortified or enriched by such nutrients as folate, iron, and fiber as traditional breads and cereals have been during the last century. Additionally, because gluten-free products are not always available, many Gluten-Sensitive Enteropathy (GSE) patients do not consume the recommended number of grain servings per day.

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