Gluten-free diet

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Wheat

A gluten-free diet is a diet that excludes gluten, a protein composite found in wheat and related grains, including barley and rye. Gluten causes health problems in sufferers of celiac disease (CD) and some cases of wheat allergy. Some people[who?] believe that there are health benefits to gluten-free eating for the general population, but there is no published experimental evidence to support such claims. For those diagnosed with celiac disease, eating gluten-free is following an undisputed medical directive.[1] Non-celiac gluten sensitivity or gluten intolerance may not exist.[2]

Rationale behind adoption of the diet[edit]

Coeliac disease[edit]

Coeliac disease is an autoimmune disease that attacks the small intestine due to the presence of gluten, for which a gluten-free diet is the only medically-accepted treatment.[3] The disease affects an estimated 1% of adults worldwide[4] and appears to be on the increase,[5] but because of the rare occurrence of symptoms, it is believed only 5-10 percent of cases are diagnosed.[6] The amount of tolerable gluten varies among people with coeliac disease. Although there is no evidence to suggest a single definitive threshold, a daily gluten intake of less than 10 mg is unlikely to cause significant histological abnormalities.[7]

Non-celiac gluten sensitivity[edit]

Although gluten sensitivity in non-celiac individuals has been shown not to exist[8] in clinical tests, it has been asserted that some people may be sensitive to gluten but do not have celiac disease and may feel better on a diet with less gluten.[9] Self-reported nonceliac gluten sensitivity (NCGS) is becoming more common than those with diagnosed celiac disease. NCGS is not fully understood because it does not have a set of specific symptoms and the research on it is very limited. [10] In either case, for those without celiac disease or gluten sensitivity, the diet may be unnecessary.[11]

As a fad diet[edit]

Gluten-free fad diets are popular and endorsed by celebrities such as Miley Cyrus.[9] The book Wheat Belly which refers to wheat as a “chronic poison” became a New York Times bestseller within a month of publication in 2011.[12] People buy gluten-free food "because they think it will help them lose weight, because they seem to feel better or because they mistakenly believe they are sensitive to gluten."[13] However the gluten-free diet is not recommended as a means to eat healthier, lose weight,[14] or diagnose one's own symptoms.[15]

Evidence of the diet's efficacy as an autism treatment is poor.[16] Studies, including one by the University of Rochester, found that the popular autism diet does not demonstrate behavioral improvement and fails to show any genuine benefit to children diagnosed with autism who do not also have a known digestive condition which benefits from a gluten-free diet.[17]

Eating gluten-free[edit]

Quinoa is a pseudocereal that is gluten-free.

The diet includes naturally gluten-free food, such as meat, fish, nuts, legumes, fruit, vegetables, rice, corn, potatoes, quinoa, buckwheat, sorghum, and products made from these, such as breads and gluten-free beer. Gluten-free bread may be less fluffy, so additives are used to compensate, such as corn starch, eggs, xanthum gum, guar gum, and hydroxypropyl methylcellulose.

Processing of some glutenous ingredients removes the gluten, such as maltodextrin,[18] and some distilled beverages.[19]

Some vineyards use flour paste to caulk the oak barrels, but tests have not detected the presence of gluten in the wine.[20][21] Gluten may be used as a clarifying agent in wine, some of which might remain in the product.[22]

The diet excludes foods containing gluten, such as wheat, rye, barley, and foods that may include them, or shared transportation or processing facilities with them.[23]

Some foods may contain gluten, so they would need specific labeling, such as gluten-free ice-cream, ketchup, chicken bouillon, corn cereal, ice cream toppings, malt flavoring, oats,[24] and chocolate.[25] And some non-foodstuffs may contain gluten as an excipient or binding agent, such as medications and vitamin supplements, especially those in tablet form.[26][27] People with gluten intolerance may require special compounding of their medication.[23]

Risks[edit]

Unless great care is taken, a gluten-free diet can lack the vitamins, minerals, and fiber which are found in wheat, barley, rye, kamut, and other gluten-containing whole grains.[6] Although this can be mitigated through the consumption of brown rice and quinoa,[28] many practitioners of the diet do not consume the recommended number of grain servings per day.[29][30] 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.[31]

Regulation and labels[edit]

Regulation of the label gluten-free varies by country. Most countries derive key provisions of their gluten free labeling regulations from the Codex Alimentarius international standards for food labeling has a standard relating to the labeling of products as gluten-free. It only applies to foods that would normally contain gluten.[32] Gluten free is defined as 20 ppm or less. It categorizes gluten free food as:

  • Food that is gluten free by composition
  • Food that has become gluten free through special processing.
  • Reduced gluten content, food which includes food products with between 20 and 100 ppm of gluten. Reduced gluten content is left up to individual nations to more specifically define.

The Codex Standard suggests the enzyme-linked Immunoassay (ELISA) R5 Mendez method for indicating the presence of gluten, but allows for other relevant methods, such as DNA. The Codex Standard specifies that the gluten free claim must appear in the immediate proximity of the name of the product, to ensure visibility.

There is no general agreement on the analytical method used to measure gluten in ingredients and food products.[33] The ELISA method was designed to detect w-gliadins, but it suffered from the setback that it lacked sensitivity for barley prolamins.[34] 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, gliadins rather than all-wheat proteins.[35]

Australia[edit]

The Australian government recommends[36] that:

  • food labeled gluten free include no detectable gluten, oats or their products, cereals containing gluten that have been malted or their products
  • food labeled low gluten claims such that the level of 20 mg gluten per 100 g of the food

Brazil[edit]

All food products must be clearly labelled whether they contain gluten or they are gluten-free.[37]

Canada[edit]

Health Canada considers that foods containing levels of gluten not exceeding 20 ppm as a result of contamination, meet the health and safety intent of section B.24.018 of the Food and Drug Regulations when a gluten-free claim is made. Any intentionally added gluten, even at low levels must be declared on the packaging and a gluten-free claim would be considered false and misleading.[38] Labels for all food products sold in Canada must clearly identify the presence of gluten if it is present at a level greater than 10 ppm.[39]

European Union[edit]

The EU[40] delineates the categories as:

  • gluten free: 20 ppm or less of gluten
  • very low gluten foodstuffs: 20-100ppm gluten.

In the United Kingdom, only cereals must be labelled; labelling of other products is voluntary.[41]

United States[edit]

Until 2013 anyone could use the gluten free claim with no repercussion. In 2008, Wellshire Farms chicken nuggets labeled gluten-free were purchased and samples were sent to a food allergy laboratory[42] where they were found to contain gluten. After this was reported in the Chicago Tribune, the products continued to be sold. The manufacturer has since replaced the batter used in its chicken nuggets.[43] The U.S. first addressed gluten free labeling in the 2004 Food Allergen Labeling and Consumer Protection Act (FALCPA). The FDA issued their Final Rule on August 5, 2013. Where a food voluntarily chooses to use a gluten free claim, the food bearing the claim in its labeling may not contain:

  • an ingredient that is a gluten-containing grain
  • an ingredient that is derived from a gluten-containing grain that has not been processed to remove gluten
  • an ingredient that is derived from a gluten-containing grain, that has been processed to remove gluten but results in the presence of 20 ppm or more gluten in the food. Any food product claiming to be gluten free and also bearing the term "wheat" in its ingredient list or in a separate "Contains wheat" statement, must also include the language "*the wheat has been processed to allow this food to meet the FDA requirements for gluten free foods," in close proximity to the ingredient statement.
  • Any food product that inherently does not contain gluten may use a gluten free label where any unavoidable presence of gluten in the food bearing the claim in its labeling is below 20 ppm gluten.

See also[edit]

References[edit]

  1. ^ Kenneth Chang (February 4, 2013). "Gluten-Free, Whether You Need It or Not" ("Well" blog by expert journalist). The New York Times. Retrieved February 5, 2013. "The definition is less a diagnosis than a description — someone who does not have celiac, but whose health improves on a gluten-free diet and worsens again if gluten is eaten. It could even be more than one illness." 
  2. ^ Gibson, Peter; Biesiekierski JR1; Peters SL; Newnham ED; Rosella O; Muir JG (Aug 2013). "No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates". Gastroenterology 145 (2): 320–8.e1–3. doi:10.1053/j.gastro.2013.04.051. PMID 23648697. 
  3. ^ De Palma, Giada; Inmaculada Nadal, Maria Carmen Collado and Yolanda Sanz (2009). "Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects". British Journal of Nutrition 102: 1154–1160. doi:10.1017/S0007114509371767. Retrieved 25 July 2013. 
  4. ^ Green PH, Cellier C (2007). "Celiac disease". N. Engl. J. Med. 357 (17): 1731–43. doi:10.1056/NEJMra071600. PMID 17960014. 
  5. ^ Anderson B (2011). "Coeliac disease: new tests, new genes and rising prevalence". Medicine Today 12 (6): 69–71. 
  6. ^ a b Jaret, Peter. "The Truth About Gluten". WebMD. WebMD. Retrieved 30 March 2014. 
  7. ^ Akobeng AK, Thomas AG (June 2008). "Systematic review: tolerable amount of gluten for people with coeliac disease". Aliment. Pharmacol. Ther. 27 (11): 1044–52. doi:10.1111/j.1365-2036.2008.03669.x. PMID 18315587. 
  8. ^ Biesiekierski, Jessica; Biesiekierski, Simone; Peters, Evan; Newnham, Ourania Rosella; Muir, Jane; Gibson, Peter (Aug 2013). "No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates". Gastroenterology 145 (2): 320–8.e1–3. doi:10.1053/j.gastro.2013.04.051. PMID 23648697. 
  9. ^ a b Gluten-Free, Whether You Need It or Not. New York Times.
  10. ^ Lunden, Knut (October 2012). "Non-celiac Gluten Sensitivity". Gastrointestinal Endoscopy Clinics of North America 22 (4): 723 Extra |pages= or |at= (help). doi:10.1016/j.giec.2012.07.006. 
  11. ^ Sarah Auffret (2012-10-18). "Gluten-free fad not backed by science". Western Farm Press. Retrieved 2013-12-06. 
  12. ^ David Quick (September 11, 2012). "'Wheat Belly' continues its run on NYT Best Seller list, but is demonizing wheat and gluten justified?". The Post and Courier. Retrieved December 16, 2012. 
  13. ^ "Gluten-free diet fad: Are celiac disease rates actually rising?". CBS News. 2012-07-31. Retrieved 2013-12-06. 
  14. ^ Glenn A. Gaesser, Siddhartha S. Angadi (September 2012). "Gluten-Free Diet: Imprudent Dietary Advice for the General Population?". Journal of the Academy of Nutrition and Dietetics 112 (9): 1330–1333. doi:10.1016/j.jand.2012.06.009. PMID 22939437. 
  15. ^ Lewis, Shannon. "Three Reasons to Go Gluten Free and Three Reasons Not to". Related Forms & Information. Province Health & Services. Retrieved 30 March 2014. 
  16. ^ Millward C, Ferriter M, Calver S, Connell-Jones G (2008). Ferriter, Michael, ed. "Gluten- and casein-free diets for autistic spectrum disorder.". Cochrane Database Syst Rev (2): CD003498. doi:10.1002/14651858.CD003498.pub3. PMID 18425890. 
  17. ^ "Popular Autism Diet Does Not Demonstrate Behavioral Improvement". 
  18. ^ Ingredients "Gluten Free Living". Retrieved August 31, 2009. 
  19. ^ Adams, Scott. "Which alcoholic beverages are safe?". Retrieved 21 August 2014. 
  20. ^ "Barrel inserts". StaVin Barrel Inserts Inc. Retrieved 17 August 2014. 
  21. ^ Celiac.com, referencing a study from The Gluten-Free Dietician, retrieved September 29, 2013
  22. ^ Simonato, Tolin, and Pasini, March 4, 2011 "Immunochemical and Mass Spectrometry Detection of Residual Proteins in Gluten Fined Red Wine," Journal of Agricultural and Food Chemistry
  23. ^ a b Spersud, Erik and Jennifer (January 3, 2008). Everything You Want To Know About Recipes And Restaurants And Much More. USA: Authorhouse. p. 172. doi:10.1007/b62130. ISBN 978-1-4343-6034-2. 
  24. ^ "What Foods Have Gluten?". American Diabetes Association. Retrieved 13 August 2014. 
  25. ^ Is chocolate gluten-free, Gluten free dark chocolate
  26. ^ "Frequently Asked Questions". IPC Americas Inc. February 27, 2008. Archived from the original on April 11, 2008. Retrieved April 15, 2008. 
  27. ^ "Excipient Ingredients in Medications". Gluten Free Drugs. November 3, 2007. Retrieved April 15, 2008. 
  28. ^ Lee AR, Ng DL, Dave E, Ciaccio J, Green PHR (2009). "The effect of substituting alternative grains in the diet on the nutritional profile of the gluten-free diet". Journal of Human Nutrition and Dietetics 22 (4): 359–363. doi:10.1111/j.1365-277X.2009.00970.x. PMID 19519750. 
  29. ^ Cortigiani, L.; Nutini, P.; Caiulo, V. A.; Ughi, C.; Ceccarelli, M. (1989). "Selenium in celiac disease". Minerva pediatrica 41 (11): 539–542. PMID 2622422. 
  30. ^ Stazi, A. V.; Trinti, B. (2008). "Selenium deficiency in celiac disease: Risk of autoimmune thyroid diseases". Minerva medica 99 (6): 643–653. PMID 19034261. 
  31. ^ "Side Effects of the Gluten-Free Diet". about.com. 2009. 
  32. ^ "Codex Standard For "Gluten-Free Foods" CODEX STAN 118-1981" (PDF). Codex Alimentarius. February 22, 2006. 
  33. ^ Hischenhuber C, Crevel R, Jarry B, Makai M, Moneret-Vautrin DA, Romano A, Troncone R, Ward R (2006) Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease. Aliment Pharmacol Ther 23(5):5590575
  34. ^ Poms, R. E.; Klein, C. L.; Anklam, E. (2004). "Methods for allergen analysis in food: A review". Food Additives and Contaminants 21 (1): 1–31. doi:10.1080/02652030310001620423. PMID 14744677. 
  35. ^ Codex Alimentarius (2003) Draft revised standards for gluten-free foods, report of the 25th session of the Codex Committee on Nutrition and Foods for Special Dietary Uses, November 2003
  36. ^ "FINAL ASSESSMENT REPORT PROPOSAL P264 REVIEW OF GLUTEN CLAIMS WITH SPECIFIC REFERENCE TO OATS AND MALT". Australian Government. Retrieved 9 August 2014. 
  37. ^ "General labeling for Packaged Foods (free translation)". ANVISA. July 2014. 
  38. ^ "Health Canada's Position on Gluten-Free Claims". Health Canada. Retrieved 9 August 2014. 
  39. ^ Canadian Celiac Association
  40. ^ "Commission Regulation (EC) No 41/2009 of 20 January 2009 concerning the composition and labelling of foodstuffs suitable for people intolerant to gluten.". Retrieved 9 August 2014. 
  41. ^ "Guidance Notes on the Food Labelling (Amendment) (No. 2) Regulations 2004" (PDF). Food Standards Agency. November 2005. 
  42. ^ Roe, Sam. "Children at risk in food roulette". Chicagotribune.com. Retrieved September 20, 2009. 
  43. ^ Roe, Sam. "Whole Foods pulls 'gluten-free' products from shelves after Tribune story". Chicagotribune.com. Retrieved September 20, 2009.