Gluten Freedom: Enjoying a Gluten-Free Lifestyle

 

Is a Gluten-Free Diet and Lifestyle for YOU?

 

Here's a hilarious segment from the Jimmy Kimmel Live TV show asking pedestrains if they know what gluten is. Do you think they know?  To find out, click HERE.

 

As a vegan whose diet is filled with an abundance of fresh fruits and vegetables and a variety of whole grains, I am dedicated to eating foods that promote radiant health and avoiding foods that have the potential to harm the body. Eating a diet free of meat and animal products helps keep my cholesterol and blood pressure in check, and the vegan staples in my diet have ample nutrients, antioxidants, and fiber to keep all systems of my body running smoothly. However, in recent years, I've begun to consider cutting more than just animal products from my diet. My attention has turned to wheat and the gluten it contains. I became curious about the benefits of following a gluten-free diet.

Once considered a fringe way of eating for a small segment of the population with celiac disease, gluten-free diets have become a pervasive, mainstream food trend − perhaps the most significant one of the past decade. Whereas eating a diet devoid of gluten used to be synonymous with sacrifice − in which adherents had to give up the pleasures of bread, pasta, cupcakes, and the like − the emphasis of going gluten free is now on the "free." Those who eschew gluten have an increasing array of options for enjoying alternative grain products and baked goods, and, even more significantly, researchers are finding that gluten-avoiders are liberated from a host of health problems associated with the consumption of modern wheat.

So, what exactly is gluten? What is celiac disease? Are there benefits or risks to a gluten-free diet for non-celiac sufferers? In this article, I'll answer questions about all of the gluten-free basics. In addition, for those who are already following or are familiar with a gluten-free diet, I'll share the latest, eye-opening research on the topic. Finally, I'll present some delicious gluten-free recipes that newbies and seasoned dieters alike will enjoy!

The Skinny on Gluten

Gluten is a protein that is present in all forms of wheat (bulgur, durum, semolina, spelt, farro, and more) as well as in barley and rye. The term gluten comes from the Latin word for "glue," so it's unsurprising that the main function of gluten as far as baking is concerned is that it gives dough elasticity, helping it to rise and imparting a chewy texture. Gluten is different from the proteins found in other grains (such as rice) and in meat in that it is difficult for humans to digest completely.

The advent of industrialized farming and milling has increased the gluten content in modern wheat. On the whole, the wheat that we eat today is a distant relative of the wheat that nourished society for thousands of years. The development of "high-yield" wheat starting in the 1950s and '60s and radically changed in 1985, introduced hybridized wheat varieties containing gluten proteins never seen before. In addition, the advent of industrialized steel milling lead to the widespread production of nutritionally inert white flour. Along the way, geneticists also figured out how to increase glutens in wheat to yield better baking properties, such as fluffier results. Consequently, commercially produced wheat flour is not only nutritionally inferior, bleached, and chemically treated, but it is also supercharged with gluten.

Gluten is not limited to wheat products, however. These days, gluten is used as an ingredient in an array of commercially prepared foods including deli meats, soy sauce, soup mixes, salad dressings, and even certain brands of chocolate. In addition, gluten can be found in cosmetics, hair products, toothpaste, vitamins, and other kinds of personal products in the health and beauty aisle.

Understanding Celiac Disease

It may seem like there could be nothing more innocuous than our daily bread, an ancient dietary staple that has provided sustenance to so many over the centuries. But for the millions who suffer from celiac disease, even a bite of bread can be damaging and, consumed over time, life threatening. In celiac patients, the body misperceives the gluten protein as an invader, touching off an autoimmune response that can damage the small intestine, impair the absorption of nutrients, and lead to gastrointestinal distress, among other symptoms.

When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi, the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats.

Symptoms and Diagnosis

Celiac disease can have severe and life-threatening consequences. If you suspect that you have celiac, it is important to receive proper testing and diagnosis. Originally thought to be a rare childhood syndrome, celiac disease is now known to be a common genetic disorder, and one not limited to childhood. It runs in families and may either present during infancy or childhood, or be triggered by events in adulthood including surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

Symptoms of celiac disease vary from person to person. They can vary depending on a person's age and degree of damage to the small intestine. Many adults have the disease for a decade or more before they are diagnosed. The longer a person goes undiagnosed and untreated, the greater the chance of developing long-term complications. These include malnutrition − which can lead to anemia, osteoporosis, and miscarriage, among other problems − liver diseases, and cancers of the intestine. Those who go through life with undiagnosed celiac have a fourfold risk of death (Mayo Clinic).

Symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms may include:

• abdominal bloating and pain
• chronic diarrhea
• vomiting
• constipation
• pale, foul-smelling, or fatty stool
• unexplained weight loss or weight gain

 

Gastrointestinal distress is especially common in children with celiac, as is irritability. Malabsorption of nutrients during the years when nutrition is critical to a child's normal growth and development can result in other problems such as delayed growth, short stature, and delayed puberty.

About one quarter of individuals with celiac have no gastrointestinal symptoms at all. Instead, they may have one or more of the following:

• unexplained iron-deficiency anemia
• fatigue
• bone or joint pain
• migraine headaches
• arthritis
• bone loss or osteoporosis
• depression or anxiety
• tingling numbness in the hands and feet
• seizures
• missed menstrual periods
• infertility or recurrent miscarriage
• canker sores inside the mouth
• an itchy skin rash called dermatitis herpetiformis

 

Prevalence

Celiac disease affects people in all parts of the world. Celiac disease is four times more common now than 60 years ago, and affects about one in 100 people (Mayo Clinic). The Celiac Disease Foundation estimates that 2.5 million Americans are undiagnosed and at risk for long-term health complications (Celiac.org). Worldwide, between 0.6 and 1 percent of the population is affected with the disease (New York Times).

Scientists do not fully understand what has been causing the four-fold increase in prevalence since the 1950s. It may be a result of many factors. Some posit that the increased consumption of wheat in modern diets, the introduction of high-gluten wheat varietals, and the addition of gluten to processed foods are the culprits. Other evidence points to the "hygiene hypothesis," in which sanitized modern environments leave us less exposed to a large variety of microbes that can help protect us from autoimmune and allergic diseases. Studies have shown that children with celiac have fewer beneficial bacteria (bifidobacteria and lactobacilli strains) in their guts than healthy controls. Breast feeding may also be implicated; researchers have found that breast feeding can boost bifidobacteria counts and help protect children from developing celiac (Velasquez-Manoff).

Genetics also factors into the mix. Among people who have a first-degree relative − a parent, sibling, or child − diagnosed with celiac disease, as many as 1 in 22 people may have the disease. Those who carry the gene for celiac do not always develop the disease, however. More than 95% of carriers tolerate gluten without any problems. Typically, those who develop the disease do so because of some kind of immunological trigger (Velasquez-Manoff).

Screening & Diagnosis

If you suspect that you may have celiac disease, the best place to start is a simple blood test that screens for celiac disease antibodies. People with celiac disease who consume gluten have higher than normal levels of tissue transglutaminase (tTG) antibodies in their blood. In about 98% of patients with celiac disease who eat gluten, the test will be positive (Celiac.org). It is important to note that celiac sufferers who have been avoiding gluten will get a false negative on this test, since the presence of gluten is necessary to generate the antibodies. While in the past it was recommended to remain on a gluten-inclusive diet for four to six weeks prior to testing, new and more sensitive blood tests may be accurate within only three days of gluten consumption (Lincoff).

 Endoscopic Biopsy

While blood testing is a good first step, the only way to confirm a celiac disease diagnosis for certain is by having an endoscopic biopsy (Celiac.org). Endoscopy is a procedure in which a gastroenterologist inserts a scope in through the mouth, down the esophagus and stomach, and into the small intestine. The doctor then takes tissue samples from the lining of the small intestine, which are studied under a microscope to look for damage and inflammation due to celiac disease. In order for the biopsy to be accurate, the patient must have been consuming gluten for one to three months prior to the procedure.

For individuals with dermatitis herpetiformis, which is characterized by itchy bumps or blisters in response to eating gluten, a skin biopsy is sufficient for diagnosis of celiac disease. This biopsy involves collecting a small piece of skin near the rash and testing it for antibodies.

Living Gluten-Free: What and What Not to Eat

The only known treatment for celiac disease is the complete avoidance of gluten. This means that celiac patients must avoid the following (Mayo Clinic):

All food and drinks containing:

• Wheat
• Barley (malt, malt flavoring and malt vinegar are usually made from barley)
• Rye
• Triticale (a cross between wheat and rye)

 

Read labels carefully. Sometimes wheat products are packaged under other names such as durum flour, graham flour, semolina, bulgur, and farina. Other grains that contain gluten include kamut and spelt. Certain grains, such as oats, can be contaminated with wheat during growing and processing stages of production. For this reason, oats should be avoided unless they are labeled as gluten-free.   

In addition, the following foods should be avoided unless they're specifically labeled as gluten-free, since they are often made with wheat or contain gluten additives:

• Beer
• Breads
• Cakes and pies
• Cereals
• Cookies and crackers
• Croutons
• Gravies
• Imitation meat or seafood
• Matzo
• Pastas
• Processed luncheon meats
• Salad dressings
• Sauces, including soy sauce
• Seasoned rice mixes
• Seasoned snack foods, such as potato and tortilla chips
• Self-basting poultry
• Soups and soup bases
• Vegetables in sauce

 

Also, be on the lookout for hidden ingredients that contain gluten including malt flavoring, modified food starch, and other food additives. Many medications and vitamins use gluten as a binding agent, so read labels carefully before consuming. Additionally, any cosmetics that come in contact with the mouth (such as lipstick) and contain gluten can be harmful.

That certainly sounds like a lot to avoid! But the good news is that a cornucopia of healthy and delicious foods are naturally gluten-free. These include:

• Fruits and vegetables
• Beans, seeds, and nuts in their natural, unprocessed form
• Fresh eggs
• Fresh meats, fish and poultry (not breaded or batter-coated)
• Most dairy products

 

Also, just because you're jettisoning wheat doesn't mean that you have to entirely leave grains and starches behind. The following are naturally gluten free:

• Amaranth
• Arrowroot
• Buckwheat
• Corn and cornmeal
• Flax
• Gluten-free flours (rice, soy, corn, potato, bean, coconut)
• Hominy (corn)
• Millet
• Quinoa
• Rice
• Sorghum
• Soy
• Tapioca
• Teff

 

Risks and Benefits of a Gluten-Free Diet for Non-Celiac Patients

For celiac patients, avoiding gluten is an absolute necessity. But what about for everyone else? It is estimated that 18 million Americans have what is known as "non-celiac gluten sensitivity" (National Foundation for Celiac Awareness). This means that they experience symptoms similar to those with celiac disease yet lack the same antibodies and intestinal damage as seen in celiac disease. They experience symptom relief when adhering to a strict gluten-free diet.

But are there other benefits to avoiding wheat aside from symptom relief? It appears so. A recent study compared the health profiles of non-celiac wheat/gluten avoiders to celiac disease patients and the general public. The findings indicated that those who avoided wheat/gluten − both celiac and non-celiac − had similar cardiovascular benefits. They had lower body mass index (BMI) and a lower rate of high blood pressure compared to the general population (Tavakkoli, A. et al., 2013).

For others, gluten-free diets may be attractive as a weight-loss regimen even though they have no problems tolerating gluten. Many celebrities, personalities and athletes, including Gwyneth Paltrow, Kim Kardashian, Elizabeth Hasselbeck, Drew Brees, Chelsea Clinton, and Miley Cyrus have jumped on this bandwagon. Some of this is hype in the sense that merely avoiding wheat is no guarantee of weight loss or a healthier diet. Gluten-free alternatives to pasta, bread, cakes, cookies and other processed indulgences are no less caloric (or sugar and carbohydrate packed) than their gluten-containing counterparts. Junk food is still junk food, no matter what!

At the same time, those who adhere to a nutritionally dense diet of fruits, vegetables, legumes, nuts, lean meats and dairy, and reasonable portions of gluten-free whole grains like quinoa and brown rice will undoubtedly find weight loss benefits. In addition, the high gluten content of modern wheat may have digestive consequences for even non-celiac sufferers that can impact weight. As discussed earlier, gluten is a difficult protein for all humans to digest. It can damage tight junctions in the lining of the intestine, leading to what is known as leaky gut syndrome and inflammation, which can trigger bloating, fatigue, and weight gain (Fasano 2011). Also, many gluten-containing foods have a high glycemic load and raise your blood sugar, causing a spike in insulin. Over time, eating foods high on the glycemic index and overloading your cells with insulin can lead to insulin resistance, which makes fat loss difficult. All of this may account for the lower body mass index and more favorable cardiovascular profiles seen in those who avoid gluten.

Gluten has also been garnering attention lately as being linked to a host of health problems including autism (Whiteley et al., 1999), ADHD (Niederhofer & Pittschieler, 2006), chronic headaches (Perlmutter, 2013), and much more. In his book Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugars -- Your Brain's Silent Killers, neurologist David Perlmutter, MD, argues that recent changes to wheat crops have transformed a once-safe food into something quite dangerous for human consumption. The potential of gluten (and, for that matter, any high-glycemic carbohydrate) to increase inflammation in the body, says Perlmutter, may account for the rise in inflammation-based degenerative diseases like Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis (Reichelt & Jensen, 2004). Perlmutter's claims are backed up by peer reviewed studies, and, while more research is needed, the findings suggest that streamlining gluten intake may have positive health outcomes for just about everyone.

Risks

A gluten-free diet is not without risks, even for celiac patients. A study in the British Journal of Nutrition found that gluten-free diets could hamper the growth of beneficial gut bacteria, due to reduced levels of POLYSACCHARIDES. In the study, populations of healthy bacteria (Bifidobacterium, B. longum and Lactobacillus) decreased, while populations of potentially unhealthy bacteria increased after subjects followed a gluten-free diet for one month. This may create intestinal conditions that favor the overgrowth of opportunistic pathogens and weaken defenses against infection and chronic inflammation (Sanz, 2010). Gluten-free dieters should take care to supplement their diets with probiotics and polysaccharides (potato, rice, and corn are good alternatives to polysaccharides found in wheat).

Nutritional deficiencies are also of some concern for gluten-free followers. Gluten-free products may provide less nutrients and B vitamins like folic acid than their wheat-based counterparts (Strawbridge, 2013). This is because breads and cereals made from wheat are often fortified with B vitamins, while those made with white rice, tapioca, and other gluten-free flours are generally not. This can be a problem for anyone, but it’s especially worrisome for women who are pregnant or may become pregnant, as folic acid is vital to prevent birth defects. Taking a gluten-free multivitamin supplement is a good idea for anyone following a gluten-free diet.

Also, since whole wheat is a major source of dietary fiber, those who eschew gluten should take care to maintain adequate fiber intake from other grains, such as brown rice or quinoa, or from fruits, vegetables, and beans.

Concluding Thoughts

Given the preponderance of emerging research on the benefits of gluten-free diets for both celiac and non-celiac individuals, it seems that going gluten free is much more than a fleeting trend: it is a lifestyle that is here to stay. The gluten-free movement has called our attention to the potential perils of modern wheat for all individuals and the need for awareness about gluten intolerance, which can be life threatening. Gluten-free diets need to be undertaken with care and with appropriate supplements to avoid any possible risks. But with so many delicious, naturally gluten-free food choices and an increasing array of alternative prepared foods, it's possible to enjoy a widely varied diet that is both tasty and nutritious without consuming a speck of wheat (below are some gluten-free recipes with many more on my website). Undoubtedly, we're entering a new era of "gluten freedom"!

 

Four Recipes

 

1) Easy, Delicious & Super-Healthy Pancakes (gluten free/vegan)

Serves 1 -2

Ingredients

• 1/4 cup garbanzo flour
• 1/4 cup arrowroot flour
• 1/4 cup sorghum flour
• 2 tbsp. flax meal
• 1/4 tsp. sea salt
• 1/2 tsp. baking powder
• 1/2 cup unsweetened almond milk

Mix together all of the ingredients so there are no lumps. Pour the batter onto a hot griddle or pan with butter or coconut oil (my favorite oil to use). Top with your favorite fruit or preserves. I often slice a banana to garnish the side of the pancakes. Everyone loves these pancakes and you'd never know that they are gluten-free.

TIP: Make sure that your baking powder is aluminum-free.

 

2) Happy-Hour Hummus (gluten free/vegan)

from MyRecipes.com

Ingredients

• 5 tablespoons water
• 1/4 cup fresh lemon juice
• 1/4 cup tahini (roasted sesame seed paste)
• 3 tablespoons olive oil
• 1/2 teaspoon salt
• 2 (15-ounce) cans chickpeas (garbanzo beans), rinsed and drained
• 1 garlic clove, crushed
• 1/2 teaspoon paprika (optional)
• Fresh chopped flat-leaf parsley (optional)
• 1 tablespoon pine nuts, toasted (optional)

Preparation

Place first 7 ingredients in a food processor; process until smooth, scraping sides as necessary. Spoon hummus into a bowl. Sprinkle with paprika, parsley, and pine nuts, if desired. Serve with chopped veggies and/or rice chips for dipping.

 

3) Zucchini with Quinoa Stuffing (gluten free)

from Real Simple

Ingredients

• 1/2 cup quinoa, rinsed
• 4 medium zucchini
• 1 15-ounce can cannellini beans, rinsed
• 1 cup grape or cherry tomatoes, quartered
• 1/2 cup almonds, chopped (about 2 ounces)
• 2 cloves garlic, chopped
• 3/4 cup grated Parmesan (3 ounces - I use a dairy-free source)
• 4 tablespoons olive oil

Preparation

Heat oven to 400° F. In a large saucepan, combine the quinoa and 1 cup water and bring to a boil. Reduce heat to medium-low, cover, and simmer until the quinoa is tender and the water is absorbed, 12 to 15 minutes.

Meanwhile, cut the zucchini in half lengthwise and scoop out the seeds. Arrange in a large baking dish, cut-side up.

Fluff the quinoa and fold in the beans, tomatoes, almonds, garlic, ½ cup of the Parmesan, and 3 tablespoons of the oil.

Spoon the mixture into the zucchini. Top with the remaining tablespoon of oil and ¼ cup Parmesan. Cover with foil and bake until the zucchini is tender, 25 to 30 minutes. Remove the foil and bake until golden, 8 to 10 minutes.

 

4) Chocolate Mousse (gluten free/vegan)

from Gluten Free Gigi

Ingredients

• ¾ cup coconut milk
• 1 cup allergen-free chocolate chips
• ¼ cup dairy free butter substitute (OR coconut oil)
• 2 Tablespoons agave nectar, pure maple syrup, or raw honey
• 1 teaspoon pure vanilla extract
• Pinch of salt

Preparation

Shake the can of coconut milk before opening. Combine coconut milk and chocolate chips in a saucepan over low heat. Stir as the chocolate melts. Remove from heat and set aside. Add butter substitute, sweetener, vanilla, and salt to your blender. Pour chocolate mixture in, place the lid on (be sure it's secure!), and blend to a smooth mixture. Pour into four 6-ounce ramekins. Chill mousse for 2 hours before serving.

 

REFERENCES

 

Web Resources

Celiac Disease Foundation — http://celiac.org/

Mayo Clinic

http://www.mayo.edu/research/discoverys-edge/celiac-disease-rise

http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/gluten-free-diet/art-20048530

National Digestive Diseases Information Clearinghouse

http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/

National Foundation for Celiac Awareness

http://www.celiaccentral.org

Articles

Grainstorm. "What is Wrong with Modern Wheat?" http://www.grainstorm.com/pages/modern-wheat

Lincoff, Nina. "New Blood Test Could Diagnose Celiac in 24 Hours." HealthlineNews. 17 Jan 2014. http://www.healthline.com/health-news/food-new-blood-test-for-celiac-disease-011714

Strawbridge, Holly. "Going Gluten Free Just Because? Here's What You Need to Know." Harvard Health Blog. 20 Feb. 2013.http://www.health.harvard.edu/blog/going-gluten-free-just-because-heres-what-you-need-to-know-201302205916

Velasquez-Manoff, Moises. "Who Has the Guts for Gluten?" New York Times. 23 Feb 2013.             http://www.nytimes.com/2013/02/24/opinion/sunday/what-really-causes-celiac-disease.html?_r=0

Scientific Studies

Annibale, B., Severi, C., Chistolini, A., Antonelli, G., Lahner, E., Marcheggiano, A., ... & Delle Fave, G. (2001). Efficacy of gluten-free diet alone on recovery from iron deficiency anemia in adult celiac patients. The American journal of gastroenterology, 96(1), 132-            137.

Fasano, A. (2011). Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiological reviews, 91(1), 151-175.

Niederhofer, H., & Pittschieler, K. (2006). A preliminary investigation of ADHD symptoms in persons with celiac disease. Journal of Attention Disorders, 10(2), 200-204.

Perlmutter, David MD & Aristo Vojdani, PhD. (2013). Association between headache and sensitivities to gluten and dairy. Integrative Medicine. 12(2), 18-23.

Puyfoulhoux, G., Rouanet, J. M., Besançon, P., Baroux, B., Baccou, J. C., & Caporiccio, B. (2001). Iron availability from iron-fortified spirulina by an in vitro digestion/Caco-2 cell culture model. Journal of agricultural and food chemistry, 49(3), 1625-1629.

Reichelt, K. L., & Jensen, D. (2004). IgA antibodies against gliadin and gluten in multiple sclerosis. Acta neurologica scandinavica, 110(4), 239-241.

Sanz, Y. (2010). Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans. Gut microbes, 1(3), 135-137.

Tavakkoli, A., Lewis, S. K., Tennyson, C. A., Lebwohl, B., & Green, P. H. (2013). Characteristics of Patients Who Avoid Wheat and/or Gluten in the Absence of Celiac Disease. Digestive diseases and sciences, 1-7.

Whiteley, P., Rodgers, J., Savery, D., & Shattock, P. (1999). A gluten-free diet as an intervention for autism and associated spectrum disorders: preliminary findings. Autism, 3(1), 45-65.

Books

Perlmutter, David MD and Kristin Loberg. Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugars -- Your Brain's Silent Killers. New York: Little, Brown and Company, 2013.

 

© Susan Smith Jones, MS, PhD, is a leading voice in America and worldwide in the fields of health and fitness, personal growth, optimal nutrition, natural remedies, longevity, balanced living, and human potential. As a much sought-after motivational speaker and wellness consultant, Susan shares her wealth of knowledge and expertise on how to live successfully and create your best life in body, mind, and spirit. Susan is the author of more than 2,000 magazine articles and over 25 books, including Wired for High-Level Wellness,  Living on the Lighter Side, and Healthy, Happy & Radiant...at Any Age.