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 Gluten is wheat gum, the insoluble component of grains (such as wheat, barley, and rye). It is a mixture of gliadin, glutenin, and other proteins. Gluten causes allergy-like reactions in certain people. While a gluten-free diet is the primary therapeutic treatment for coeliac disease, this diet may also help a host of other conditions, including dermatitis herpetiformis, psoriasis, rheumatoid arthritis, HIV enteropathy, and schizophrenia. Why do people follow this diet?Coeliac disease (also called gluten enteropathy) is a disorder of the small intestine characterised by sensitivity to gluten. In people with coeliac disease, eating gluten causes inflammation in and damage to the lining of the small intestine, resulting in diarrhoea, malabsorption, fat in the stool, and nutritional and vitamin deficiencies. A gluten-free diet is the primary treatment for coeliac disease. Strict avoidance of wheat, barley, and rye (the three most abundant sources of gluten) usually improves gastrointestinal symptoms within a few weeks, although in some cases improvement may take many months. Some people with coeliac disease must remove all gluten-containing foods from their diets in order to relieve symptoms. Following a gluten-free diet has been shown to reduce the incidence of cancer, low bone mineral density, and infertility in persons with coeliac disease. People with dermatitis herpetiformis may benefit from following a gluten-free diet. The cause of dermatitis herpetiformis is mainly an allergic-type reaction. Gluten-sensitivity enteropathy is found in 75 to 90% of people with dermatitis herpetiformis. Unlike coeliac disease, however, gastrointestinal symptoms are mild or absent. Strict adherence to a lifelong gluten-free diet can eliminate dermatitis herpetiformis symptoms and intestinal abnormalities, as well as reduce or eliminate the need for medication in most people. However, an average of 8 to 12 months of dietary restriction may be necessary before symptoms resolve. Not all people with dermatitis herpetiformis improve on a gluten-free diet. Preliminary studies indicate sensitivity to other dietary proteins may be involved. Anecdotal evidence suggests that people with psoriasis may improve on a hypoallergenic diet. Three trials have reported that eliminating gluten (as found in wheat, rye, and barley) improved psoriasis for some people. A doctor can help people with psoriasis determine whether gluten or other foods are contributing to their skin condition. Preliminary evidence suggests that a gluten-free diet may help improve symptoms of rheumatoid arthritis. In one trial, 14 weeks of a gluten-free (no wheat, rye or barley), pure vegetarian diet, gradually changed to a lactovegetarian diet (permitting dairy), led to significant improvement in rheumatoid arthritis as evidenced by associated symptoms as well as by objective laboratory measures of disease. HIV enteropathy, a complication of AIDS that is characterised by weight loss and chronic diarrhoea, may respond to a gluten-free diet. In a preliminary trial, men with HIV enteropathy experienced a reduction in the number of episodes of diarrhoea as well as significant weight gain while following a gluten-free diet. For many years, researchers have been speculating that certain dietary proteins, including gluten, may contribute to the symptoms of schizophrenia. People with schizophrenia are more likely to have immune-system reactions to gluten than the general population, according to some studies. While clinical research findings have been inconsistent, some, but not all, people with schizophrenia may benefit from a gluten-free (and dairy-free) diet. What are the symptoms?Individuals who are sensitive to gluten may have the following symptoms:
What do I need to avoid?To avoid gluten ask about ingredients at restaurants and others’ homes, and read food labels. Avoid questionable products until the manufacturer guarantees they are gluten-free. Recheck products regularly as ingredients may change. Beginning January 1, 2006, food labels in the US must accurately declare in a special “allergy statement” if wheat protein, even in small amounts, is present in an ingredient used in that food. However, this regulation does not pertain to other gluten-containing grains, so labels must still be checked carefully for those sources. At home, care should be taken to keep gluten-containing itemsfoods used by other members of the household from contaminating cooking appliances, food-preparation surfaces, utensils, shared condiment jars, and so forth. The following list is not complete. Consult with a healthcare professional before making any significant changes to your diet. Grains and grain products to avoid (check ingredients of breads, breading, cereals, coating mixes, crackers, croutons, fried snacks, muffins, pasta, pastries, stuffing, etc.and so on)
* While oats contain a substance similar to gluten, modern research has found that eating moderate amounts of oats does not appear to cause problems for people with coeliac disease or dermatitis herpetiformis. However, oats may be contaminated with gluten from other grains during processing; therefore only useing only oat products tested and guaranteed to be free of gluten is recommended. Other food products and ingredients that may contain gluten (check labels or manufacturer for ingredients from the list above)
Be careful of the following personal and over-the-counter items (which may contain small amounts of gluten):
 Best bets
While wheat is one of the major gluten-containing grains, it is important to remember that “wheat-free” does not mean “gluten-free.” Make sure to carefully read food labels to determine if an item features gluten-containing items. Prepare a note card with the foods that you need to avoid and bring this with you when food shopping or dining in restaurants. Communicate your special needs to the waiter or manager so that they can guide you to dishes that do not contain gluten. Gluten allergies can often start in childhood as a result of early feeding of grains; consider breast-feeding your child for the first six months. Be careful when buying grains from bulk bins. Make sure that the grains are adequately separated from the gluten-containing grains in order to avoid cross-contamination. Are there any groups or books associated with this diet?Celiac Sprue Association/USA, Inc. Gluten Intolerance Group of North America The Gluten-Free Gourmet: Living Well Without Wheat by Bette Hagman, New York: Henry Holt and Co., 2000. More from the Gluten-Free Gourmet: Delicious Dining Without Wheat by Bette Hagman, New York: Henry Holt and Co., 2000. Celiac Disease and Gluten-Free Diet Support Page Canadian Celiac Association Celiac Disease Foundation Celiac Disease: A Hidden Epidemic by Peter H. Green and Rory Jones, New York: HarperCollins Publishers, 2006. Gluten-Free Diet: A Comprehensive Resource Guide by Shelley
Case, Regina, Sk CA: Case Nutrition Consulting, 2003. Gluten-Free 101: Easy, Basic Dishes Without Wheat by Carol Fenster, Centennial, CO: Savory Palate, 2003. Wheat-Free, Gluten-Free Cookbook series by Connie Sarros. New York: McGraw-Hill, 2003-4. The Gluten-Free Mall. Gluten Free Foods for Celiac Disease and Special Diets. http://www.glutenfreemall.com/ Gluten-Free Diet Guide for Families by The Children’s Digestive Health & Nutrition Foundation and The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, 2005. Available at http://www.naspghan.org/assets/diseaseInfo/pdf/GlutenFreeDietGuide-E.pdf Gluten in Pharmaceutical Products by Sister Jeanne Patricia Crowe and Nancy Patin Falini. Am J Health-Syst Pharm 2001;58:396-401. Available at http://www.medscape.com/viewarticle/406948 BibliographyBaker PG, Read AE. Reversible infertility in male coeliac patients. Br Med J 1975;2:316–7. Bazex A, Gaillet L, Bazex J. Gluten-free diet and psoriasis. 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Effects of additional dietary gluten on the small-intestinal mucosa of volunteers and of patients with dermatitis herpetiformis. Scand J Gastroenterol 1987;22:543–9. Fry L. Dermatitis herpetiformis. Baillieres Clin Gastroenterol 1995;9:371–93 [review]. Garioch JJ, Lewis HM, Sargent SA, et al. 25 years’ experience of a gluten-free diet in the treatment of dermatitis herpetiformis. Br J Dermatol 1994;131:541–5. Greenberger JN, Isselbacher KJ. Disorders of absorption. In Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine, 14th ed. New York: McGraw-Hill, 1998, Chapter 285. Hall K. Allergy of the nervous system: a review. Ann Allergy 1976;36:49–64 [review]. Hall RP. Dietary management of dermatitis herpetiformis. Arch Dermatol 1987; 123:1378a–1380a. Hardman CM, Garioch JJ, Leonard JN, et al. Absence of toxicity of oats in patients with dermatitis herpetiformis. N Engl J Med 1997; 337(26):1884–7. Hill ID, Dirks MH, Liptak GS, et al. 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Lancet 1991;338:899–902. Kosnai I, Karpati S, Savilahti E, et al. Gluten challenge in children with dermatitis herpetiformis: a clinical, morphological and immunohistological study. Gut 1986;27:1464–70. McFarlane XA, Bhalla AK, Robertson DAF. Effect of a gluten free diet on osteopenia in adults with newly diagnosed coeliac disease. Gut 1996;39:180–4. Michaelsson G, Gerden B. How common is gluten intolerance among patients with psoriasis? Acta Derm Venereol 1991;71:90. Michäelsson G, Gerdén B, Hagforsen E, et al. Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet. Br J Dermatol 2000;142:44–51. Mora S, Barera G, Ricotti A, et al. Reversal of low bone density with a gluten-free diet in children and adolescents with coeliac disease. Am J Clin Nutr 1998;67:477–81. National Digestive Diseases Information Clearinghouse. Coeliac Disease. NIH Publication No. 06–4269. National Institutes of Health, October 2005. Nellen H, Flores G, Wacher N. Treatment of human immunodeficiency virus enteropathy with a gluten-free diet. Arch Intern Med 2000;160:244 [letter]. Potkin SG, Weinberger D, Kleinman J, et al. Wheat gluten challenge in schizophrenic patients. Am J Psychiatry 1981;138:1208–11. Reichelt KL, Landmark J. Specific IgA antibody increases in schizophrenia. Biol Psychiatry 1995;37:410–3. Reunala T, Kosnai I, Karpati S, et al. Dermatitis herpetiformis: jejunal findings and skin response to gluten free diet. Arch Dis Child 1984; 59:517–22. Ross-Smith P, Jenner FA. Diet (gluten) and schizophrenia. J Hum Nutr 1980;34:107–12 [review]. Singh MM, Kay SR. Wheat gluten as a pathogenic factor in schizophrenia. Science 1976;191:401–2. Srinivassan U, Leonard N, Jones E, et al. Absence of oats toxicity in adult coeliac disease. BMJ 1996;313:1300–1. Storms LH, Clopton JM, Wright C. Effects of gluten on schizophrenics. Arch Gen Psychiatry 1982;39:323–7. Thompson T. Oats and the gluten-free diet. J Am Diet Assoc 2003;103:376-9. Thompson T. Wheat starch, gliadin, and the gluten-free diet. J Am Diet Assoc 2001;101:1456-9. van der Meer JB, Zeedijk N, Poen H, van der Putte SC. Rapid improvement of dermatitis herpetiformis after elemental diet. Arch Dermatol Res 1981;271:455–9. Vlissides DN, Venulet A, Jenner FA. A double-blind gluten-free/gluten-load controlled trial in a secure ward population. Br J Psychiatry 1986;148:447–52. Yancy KB, Lawley TJ. “Immunologically Mediated Skin Diseases.” Harrison’s Online. 1999. www.harrisonsonline.com/hill-bin/Chapters.cgi (accessed January 10, 2000). Zeedijk N, van der Meer JB, Poen H, van der Putte SC. Dermatitis herpetiformis: consequences of elemental diet. Acta Derm Venereol 1986;66:316–20. 
Copyright © 2006 Healthnotes, Inc. All rights reserved. www.healthnotes.com Learn more about Healthnotes, the company. Learn more about the authors of Healthnotes. The information presented in the Food Guide is for informational purposes only and was created by a team of US–registered dietitians and food experts. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements, making dietary changes, or before making any changes in prescribed medications. Information expires March 2007. |
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