Living the "Gluten Free Diet"

When you walk through the aisles of your favorite drugstore or health food store, you'll find a wide variety of foods, including finding cereals, breads, crackers and desserts touting themselves as gluten-free.

However, what does this statement exactly mean? Free of precisely what? Gluten--scientifically, it's a protein that is very often confused with wheat. Basically, its comparable to freeing your diet of sugar, fat and starchy carbs, you might start to wonder whether you should even try eliminate it from your diet. Before you decide, know this: A true gluten-free diet (GFD) is extremely hard and difficult to follow, but it can provide tremendous help to people with certain health conditions, but is not recommended for most. Read on to see whether a gluten-free existence should be in your future and, if so, how to make the leap healthfully.

What is gluten and why avoid it?

Gluten refers to protein components, called peptides, in wheat, rye and barley. These peptides--gliadin (in wheat), secalin (in rye) and hordein (in barley)--are problematic for gluten-sensitive individuals and cause severe damage to the small intestine in those with celiac disease (CD), also known as gluten-sensitive enteropathy. More than just a marketing ploy, gluten-free foods can help people with CD and various other conditions feel better.

Cerliacal disease, often referred to as CD, is an immune disorder that is often misdiagnosed. About 1 in every 124 people in the United States are estimated to have CD, but the actual number is unclear since a true diagnosis requires a biopsy of intestinal tissue. When people with CD ingest gluten, their immune system responds as if gluten were an enemy to be destroyed. Repeated attacks can compromise the intestinal villi (fingerlike protrusions along the intestinal walls needed for proper nutrient absorption), leading to malnutrition from reduced nutrient absorption. Currently, the only treatment for CD is to eliminate gluten from the diet for life.

For CD to occur there must be three conditions, says Cynthia Kupper, RD, executive director of the Gluten Intolerance Group of North America: a genetic predisposition, exposure to the protein and something to set it off (such as stress or pregnancy).

Classic signs and symptoms of celiac disease include malnutrition, diarrhea, weight loss and abdominal pain. Someone with CD may not have these symptoms, however, says Kupper. They may instead experience fatigue, anemia, fertility issues or osteoporosis, even though they don't have the typical risk factors for osteoporosis. Surprisingly, half of patients with CD may have few or no obvious symptoms, and may go undiagnosed for years.

The intestinal biopsy to correctly diagnose CD is an expensive, specialized test. The first step to diagnosis is a blood test that looks for immunogludernina (IgA) antibodies, which are produced as an immune response to gluten ingestion, but it is not enough to make a definitive diagnosis. Physicians may also look for other antibodies.

Gluten allergy/intolerance/sensitivity

Some people believe they have problems with gluten even though they don't have full-blown CD. "I have met several people who think they are allergic to gluten because they have some symptoms, such as upset stomach, rash, heartburn and nausea after eating foods with gluten," explains Diana Elliott, RD, a clinical dietitian at Utc Medical Center and my personal dietician whom I interviewed. "However, if these symptoms are sporadic, or also occur after eating other often-problematic foods, such as dairy or peanuts, other food allergies may be manifesting themselves."

Food intolerance is a broader category that fits most people who have "problems" with certain foods. People with food intolerances may suffer reactions after consuming items such as aspartame, MSG and sulfites. Food sensitivity is not really a clinical term, but rather a catchall phrase to describe people who have a negative reaction after eating certain foods.

Elliott emphasizes the importance of having blood tests and/or biopsies of intestinal tissue to determine whether a person actually has CD. lf it is ruled out, other foods (or other problems) may be causing the problems the person thinks are related to gluten.

If you suspect that you may have CD or a gluten insensitivity or anything broad category of this, see your physician before eliminating gluten completely for any extended period of time. Why? Gluten causes intestinal damage, but this damage can be healed with a gluten-free diet. Without the gluten there is no intestinal damage or no reason for the antibodies to be present since they have nothing to fight. I encourage people who think they might be gluten intolerant to follow a strict gluten-free diet for no more than one week. If you feel better, go back to your regular diet and see your doctor. Start with your general practitioner, who can review your symptoms and order a blood test to check for levels of IgA antibodies.

Other miscellaneous medical conditions

Some people avoid gluten for other reasons. Undoubtedly some people with certain forms of autism, surprisingly and very unknown fact, improve on a diet free of gluten and casein (the protein in milk). Some multiple sclerosis sufferers are also experimenting with a gluten-free diet. "While it's mainly anecdotal, some do seem to benefit with a gluten-free diet. But it is mainly really mixed, and there is not a lot of research-based evidence," says Kupper.

Should the average joe actually go gluten-free?

There really isn't any valid reason for a non-gluten-sensitive person to adopt this diet, especially since it's so restrictive. There wouldn't be a motivator to avoid all gluten-containing foods if one doesn't have the uncomfortability that a celiac has if they inevitably eat something with even a slight amount gluten in it."

Making your gluten-free diet a healthy one

Like most diets, the healthfulness of gluten-free eating depends upon which foods a person chooses. "Theoretically, a person might have a more challenging time getting many of the Bs, such as [B.sub.1], [B.sub.2], [B.sub.3] and folate, particularly since our bread products are enriched with those nutrients," adds Lisagor.

While the growing number of gluten-free products make the diet more varied and easier to follow, they won't provide certainly by no means are all the nutrients your body needs. The convenience of gluten-free products are wonderful but they often substitute rice flour, potato starch, tapioca and cornstarch for wheat/rye/barley, which are absolutely necessary for your body to process. Therefore most gluten-free bread products are made from highly refined carbohydrates, which means they are low in B vitamins and fiber.

Use the following principles as your diet's backbone to make it a healthful one.

* go nuts Include lots of nuts to increase your intake of fiber, protein and vitamin E, an antioxidant. Also choose nut-based flours for baking.

* bean me up Add more beans for increased fiber and protein.

* bow down to brown. Brown is the color to go. Choose brown rather than white rice for more fiber.

* venture out Try grains like quinoa, buckwheat, amaranth and teff (an Ethiopian whole grain).

* get colorful Eat a wide variety of fruits and vegetables.

* use substitutions Com, potato, rice, soybean, tapioca, arrowroot, amaranth, quinoa, millet and buckwheat are easy substitutes for wheat. Items like tapioca, often found in gluten-free flours or baking mixes, can be substituted in some recipes. Rice, com and potatoes are easy sources of starch, and can serve as a main dish or side dish instead of pasta or bread. Consult a gluten-free cookbook for specific uses.

Whether you absolutely need to follow a gluten-free diet or decide to try it for personal reasons, heed the advice of Lisagor: "Aim for having that good, old balanced diet."

Here are some color coded guide to having a healthful gluten free diet. Green means go, yellow means exercise, and red means absolutely, under all circumstances, avoid.

Even if you think a product is okay, always scan the label. Avoid products that contain wheat, wheat starch, wheat germ, wheat gluten, wheat bran, triticale, spelt, semolina, rye, kamut, farro, durum, couscous, bulgur, barley, einkom or emmer. As you look at the list below, keep in mind that the label is always the bottom line.

GREEN: Corn, vegetables, fruits, potatoes and legumes

YELLOW: Dried fruits

bakery section:

GREEN: Corn tortillas, breads containing amaranth, arrowroot, buckwheat, com bran, corn flour, cornmeal, cornstarch, flax, legume flours, rice flours, soy flour and teff

RED: Croutons, bread containing the above-mentioned "avoid" ingredients or any breads not labeled gluten-free

beverage aisle:

GREEN: Most coffee/tea (except some coffee substitutes), soft drinks, wine, distilled/hard liquor (rum, gin, whiskey, vodka)--the distillation process keeps gluten from the final product

RED: Coffee substitutes that contain barley; beer, ale and lager, though some gluten-free beers are available in specialty stores.

cereal aisle:

GREEN: Amaranth flakes, cream of buckwheat, puffed com, puffed millet, puffed rice, soy flakes, grits

YELLOW: Oatmeal--oats can be cross-contaminated with wheat/barley. Pure oats are okay and a great source of fiber, but risk of contamination is high.

RED: Cereals containing malt extract, barley malt extract or malt flavoring

condiments:

GREEN: Vinegars (except malt vinegar), plain pickles, relish, olives, ketchup, mustard

YELLOW: Baking powder, and salad dressing

RED: Malt vinegar, marinades and soy sauces--most soy sauces contain a wheat source; also, gravy/thickened sauces--many contain flour or other problematic thickening starches.

refrigerated section:

GREEN: Milk, cheese, plain yogurt (no toppings), eggs, tofu

YELLOW: Sour cream, cheese spreads, flavored yogurts, egg substitutes

RED: Flavored milk drinks containing wheat starch or barley malt, yogurts with toppings like granola, malted-milk products

deli section:

GREEN: Fresh meats/fish/poultry

YELLOW: Processed deli-type meats, which may contain wheat starch or wheat fillers

RED: Breaded meat/chicken/fish (breading generally contains wheat flour), imitation crab, canned fish in vegetable broth

frozen food aisle:

YELLOW: Fruits and vegetables with hydrolyzed plant protein or hydrolyzed vegetable protein (HPP/HVP), found in many sauces, frozen dishes and soups. Check ice cream labels too--some contain ingredients to avoid.

RED: Veggie burgers/sausage patties/other vegetarian meat alternatives--these usually contain wheat gluten (sometimes in the form of texturized vegetable protein)--pizza

snack aisle:

GREEN: Popcorn and nuts

YELLOW: Flavored potato and com chips, which often contain wheat starch or wheat flour. Rice crackers, rice, com cakes, snacks, puddings, most candy RED: Licorice

grains:

GREEN: Rice, pasta made from beans, soy, corn, quinoa and rice

RED: Pasta and couscous (made from semolina) plus any of the avoid items listed at left

miscellaneous/ center aisles:

GREEN: Dry whole beans

YELLOW: Beans in any kind of sauce--such as baked beans--as the sauce may be thickened with some kind of wheat, fruit pie fillings, canned or dry soups with ingredients to avoid or HPP and HVP.

RED: Boxed stuffing, dinner mixes--most contain some kind of wheat unless you buy a specific gluten-free version.