Gluten-Free Diets — Help for Gluten Intolerance

Gluten-Free Diets — Help for Gluten Intolerance

Hot Topics are short, concise practice and science-based answers to current questions RDs and DTRs may receive. Hot Topics are not an ADA position or stance on a topic and does not reflect Association consensus on the issue. Rather, they provide expert opinion to an emerging area of food, nutrition and health. Hot Topics are meant to assist RDs and DTRs to answer questions from patients/clients and the media.


Title of Topic: Gluten-Free Diets — Help for Gluten Intolerance
Date of Release: April 2008
Claim of Topic: Gluten-Free diets are beneficial and medically necessary for celiac disease, dermatitis herpetiformis, and gluten intolerance.

Discussion of Topic:
Gluten is a generic term for proteins (prolamins) found in wheat, barley, rye and oat. Gluten is responsible for the elasticity in dough and structure in bread. Each grain has a specific gluten protein (gliadin in wheat, hordein in barley, secalin in rye, and avenin in oats) which contain amino acid sequences that can be harmful to people with celiac disease (CD), dermatitis herpetiformis (HD) and gluten intolerance.

Gastrointestinal symptoms (diarrhea, gas, bloating, vomiting, constipation and malabsorption) are common complaints of individuals with gluten sensitivity. Following a gluten-free (GF) diet alleviates most symptoms. GF diets are medically prescribed for CD, DH and gluten intolerance. A GF diet may be beneficial, but restrictive, for wheat allergic individuals. If you suspect gluten intolerance, you should see a physician before starting a gluten-free diet.

A GF diet is free of any form of wheat (durum, graham, kamut, semolina, and spelt), rye, barley and triticale. Rice, corn, soy, potato, tapioca, beans, garfava, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, Montina and nut flours are allowed. Care must also be taken to identify ingredients that are derived from the prohibited grains such as malt, malt flavoring or malt vinegar (source is barley), wheat starch, modified food starch, and bran. Although oats contain the gluten protein, avenin, research shows that pure oats in moderation (1 cup, cooked) are safe for most people with CD, however, most oats and oat products sold can be cross-contaminated with gluten-containing grains.

Adherence to a GF diet can be challenging, however, the availability of GF products in the marketplace increases each year. Some grocery store chains have a dedicated GF bakery that produces breads, cookies, cakes, and pies. Numerous food brands now have GF lines such as flours, soups, pizza, lasagna, macaroni and cheese, crackers, and pretzels. Many restaurants have GF menus available on request. Anyone with CD, HD or gluten intolerance should consult a registered dietitian to help with menu planning and to avoid possible nutrient deficiencies which can include fiber, iron, zinc, magnesium, calcium, vitamin D, vitamin A, vitamin E, folate, vitamin B6, and vitamin B12.

A registered dietitian can also assist with label reading, which is a key for success with GF diets. Gluten-containing grains and their derivates should be considered when reading ingredient labels. The Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004 mandated that foods containing allergens, such as wheat, be clearly labeled. This is helpful for anyone with wheat allergy, CD, HD and gluten intolerance. Because rye, barley and triticale must also be considered for gluten intolerance, FALCPA directed the Food and Drug Administration (FDA) to issue regulations that define and permit the use of “gluten free” in food labeling. The final rule is pending.

Bottom Line:
Research supports the use of GF diets for individuals with celiac disease, dermatitis herpetiformis and gluten intolerance. GF diets are free of any form of wheat (durum, graham, kamut, semolina, and spelt), rye, barley and triticale. Rice, corn, soy, potato, tapioca, beans, garfava, sorghum, quinoa, millet, buckwheat, arrowroot, amaranth, teff, Montina and nut flours are recommended. Many grocery stores now carry GF-labeled foods and many restaurants have dedicated GF menus.

Opportunities for the RD/DTR:
Registered dietitians are essential for successful compliance of a nutritionally-sound GF diet. Dietitians also have a role in working with gluten intolerant and wheat allergic clients in label reading and understanding which products are good choices. Dietitians must be actively aware of and engaged in educational and research updates on celiac disease and gluten intolerance, since the incidence in the general population is increasing.

Resources/References:

  1. Advances in Celiac Disease and Gluten-Free Diet. Niewinski, M. JADA. April 2008. 661-672.
  2. Food Allergen Labeling and Consumer Protection Act.
    www.cfsan.fda.gov/~dms/alrgqa.html. Accessed 4/9/2008.
  3. The Gluten-Free Diet. Gluten Intolerance Group.
    www.gluten.net/diet.html. Accessed 4/9/2008.
  4. Celiac Disease. National Digestive Diseases Information Clearinghouse. May 2007. 1-12.
  5. Formulating for Health Claims. Food Product Design
    www.foodproductdesign.com/articles/466/7bh3011343857724.html. Accessed May 2008.

Written by Christina Ferroli, Ph.D., R.D. of Public Health/Community Nutrition dietetic practice group