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Going Gluten Free

August 19, 2011 Written by JP       [Font too small?]

“Gluten free” products are becoming a regular fixture in health food stores and super markets throughout the world. But, why are so many manufacturers going out of their way to omit this inexpensive, grain-based protein? The current scientific literature offers several compelling reasons: 1) gluten intolerance is increasingly associated with the development and progression of autoimmune conditions such as type 1 diabetes and multiple sclerosis; 2) gluten consumption is capable of causing gastrointestinal discomfort, pain and tiredness even in those not diagnosed with celiac disease; 3) avoiding refined and whole grains containing gluten can improve seemingly unrelated health conditions such as gastroesophageal reflux (GERD).

The good news about going gluten free is that it’s easier than ever before. An example can be found on this site’s recipe section. Every single recipe, including the cakes, cereals and muffins are devoid of gluten.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Clinical and Immunological Features of Celiac Disease in Patients With … (link)

Study 2 - Clinical and Metabolic Effects of Gluten Free Diet in Children With … (link)

Study 3 - Prevalence of Celiac Disease in Multiple Sclerosis (link)

Study 4 - Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac … (link)

Study 5 - Gastroesophageal Reflux Symptoms in Patients With Celiac Disease (link)

Children With Celiac Disease May Be At Greater Risk for Mental Health Issues

Source: BMC Pediatrics 2011, 11:46 (link)

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19 Comments & Updates to “Going Gluten Free”

  1. Rachael @ Holistically Haute Says:

    My household recently transitioned to a gluten and dairy free kitchen in an effort to be healthier, eliminate toxins, and reduce acidity in our diets. None of us have Celiac (although a family member does) or gluten intolerances that we know of, and it is a bit of an adjustment in terms of the taste and textures of the breads and pastas…but overall it has been a pretty easy adjustment. You’re right…there has never been a better time to go gluten-free since gluten-free products are available even at some large chain grocery stores, and the prices are starting to come down. We are going to stick with it because we have noticed positive changes in our digestive health, energy levels, and have experienced some weight loss.

  2. JP Says:

    Rachael,

    Thank you for sharing your family’s experience with us. I could have added that it’s easier than ever to go dairy-free as well. For instance, I almost exclusively drink unsweetened almond milk instead of cow’s milk.

    In our household, I’m eating a gluten free diet and my wife is not. Although, she tends to eat far less gluten than most because she’s on a low carbohydrate diet.

    I’ve found that a GF diet is not only easy to adhere to (with the aid of some planning and several core recipes) but it can also be truly delicious. In all honesty, I don’t miss eating the foods I’m now omitting from my diet. It just feels much better knowing that I can eat tasty food that isn’t hurting me in one way or another.

    Be well!

    JP

  3. Mark Says:

    I for one am going in the opposite direction. My diet is rich if fresh vegetables, fruits and lean meats and low on the starchy carbs. Gluten intolerance, thankfully, has never been a problem.

    I am going to flirt with the vegetarian lifestyle this October for Vegetarian month. In an effort to keep up my protein intake -my exercise regime is weightlifting – I have begun to incorporate the use of vital gluten in my diet. A 1/4 cup is packed with 26 grams of protein

  4. JP Says:

    Mark,

    I hope the experiment turns out very well for you. I’d love it if you’d report back and share any impressions you have about your vegetarian trial. Please consider doing so. Any input from you would be most welcome.

    Be well!

    JP

  5. JP Says:

    Mark,

    I’m just curious. Why did you opt for wheat gluten as a supplemental protein source? Is there a cost, nutritional or other reason why you selected it over brown rice protein concentrate, hemp or pea protein powder?

    Be well!

    JP

  6. Chris Lindsay Says:

    Hi JP,

    You know me, I have to bring the skeptic perspective. ;)

    I wonder if you’d have a chance to listen to this episode of Skeptoid, or read the transcript, and give me your take? I’m a big fan of Brian Dunning and his podcast.

    http://skeptoid.com/episodes/4239

    But I’ve spoken with other evidence-based folks and they are of the opinion that there may be some nuance to the concerns about gluten. Although, the admit that robust, controlled studies have just not really been done at this point. The concerns seem to be coming from small unblinded studies.

    Is it possible that it’s just a small, minority of people that need to be concerned with gluten, such as those born with a genetic predisposition to celiac disease?

  7. JP Says:

    Hi, Chris. Your skeptical perspective is always welcome here. :)

    I’m all for more well designed studies on the effects of gluten. Truly, I’d welcome them and happily report on whatever findings result from them.

    I think that celiac disease is only a small part of the problem. Some people appear to react negatively to gluten even though they test negative for CD. Study #4 provides an example.

    Also, it’s important to note that gluten is but one component of wheat and other popular grains. It’s quite possible that some people respond poorly to other substances naturally occurring in processed or whole grain based foods. This is why I’ll often recommend an “elimination diet” to those that suspect food intolerances or sensitivities. Such diets can be challenging to adhere to but are unlikely to be harmful if well planned out. Food allergy testing can also be employed as an additional source of information – but, I wouldn’t count on it as a stand alone diagnostic tool.

    Finally, I think it’s worthwhile to remember that modern forms of wheat are relatively new to the human diet. Just because we can grow and manipulate a crop to increase yield and sustain life doesn’t necessarily mean our bodies will accept it without incident.

    Be well!

    JP

  8. Pete Says:

    Those are some great recipes, thanks! As a celiac disease sufferer I need all the gluten-free ideas I can get.

  9. JP Says:

    Updated 07/20/15:

    http://www.nature.com/ajg/journal/vaop/ncurrent/full/ajg2015192a.html

    Am J Gastroenterol. 2015 Jul 7. doi: 10.1038/ajg.2015.192.

    Prevalence of Abnormal Liver Function Tests in Celiac Disease and the Effect of a Gluten-Free Diet in the US Population.

    OBJECTIVES: Guidelines recommend routine screening of liver function tests (LFTs) in patients diagnosed with celiac disease (CD). However, little is known about the prevalence of liver disorders in CD outside of Europe. Our aims were to estimate the prevalence of LFT abnormalities in CD and to evaluate the effect of a gluten-free diet (GFD) on LFTs.

    METHODS: Adult patients with biopsy-proven CD were identified from a prospectively maintained database and matched with healthy controls. LFT levels for women and men were defined as abnormal based on the Third National Health and Nutrition Examination Survey (NHANES III) criteria. Data on demographics, coexisting liver diseases, and laboratory work-ups including aspartate transaminase (AST) and alanine transaminase (ALT) values at the time of diagnosis and on a GFD were recorded. Subsequently, data from this cohort were compared with data from 7,789 individuals participating in the National Health and Nutrition Examination Survey, 2009-2010. Univariate logistic regression, Wilcoxon signed-ranks, Student’s t-test, χ2, and Fischer’s exact test were used for statistical analysis.

    RESULTS: In 463 CD patients with ALT or AST levels at the time of CD diagnosis, 40.6% had elevated LFTs compared with 24.2% of treated CD patients (P<0.001) and 16.6% of matched controls (P<0.001). Similarly, 36.7% of CD patients on the NHANES database had abnormal ALT values compared with 19.3% of non-celiac patients (P=0.03). Approximately, 78.6% of CD patients with elevated LFTs at diagnosis normalized LFTs on a GFD after a mean duration of 1.5±1.5 years.

    CONCLUSIONS: Forty percent of individuals will have elevated LFTs at CD diagnosis; however, the majority will normalize with standard CD therapy. LFTs should be checked in all patients with CD and coexisting liver disorder should be considered in patients whose LFTs have not improved within a year on a GFD.

    Be well!

    JP

  10. JP Says:

    Updated 07/20/15:

    Here’s a column that I wrote for Azumio.com … Lots of new information about gluten sensitivity here:

    https://api.azumio.com/blog/nutrition/are-you-gluten-sensitive

    Be well!

    JP

  11. JP Says:

    Updated 1/18/16:

    http://www.cghjournal.org/article/S1542-3565%2815%2901715-2/abstract

    Clin Gastroenterol Hepatol. 2015 Dec 31.

    Efficacy of a Gluten-free Diet in Subjects With Irritable Bowel Syndrome-Diarrhea Unaware of Their HLA-DQ2/8 Genotype.

    BACKGROUND & AIMS: A gluten-containing diet alters bowel barrier function in patients with irritable bowel syndrome-diarrhea (IBS-D), particularly those who are positive for human leukocyte antigen (HLA) allele DQ2/8. We studied the effects of a gluten-free diet (GFD) in patients with IBS-D who have not previously considered the effects of gluten in their diet and were unaware of their HLA-DQ2/8 genotype.

    METHODS: We performed a prospective study of 41 patients with IBS-D (20 HLA-DQ2/8-positive and 21 HLA-DQ2/8-negative) at the Royal Hallamshire Hospital in Sheffield, United Kingdom, from September 2012 through July 2015. All subjects were placed on a 6 week GFD following evaluation by a dietician. Subjects completed validated questionnaires at baseline and week 6 of the GFD. The primary endpoint was mean change in IBS symptom severity score (IBS-SSS); a 50 point reduction was considered to indicate a clinical response. Secondary endpoints were changes in hospital anxiety and depression score, fatigue impact score, and short form 36 results. Clinical responders who chose to continue a GFD after the study period were evaluated on average 18 months later to assess diet durability, symptom scores, and anthropometric and biochemical status.

    RESULTS: A 6 week GFD reduced IBS-SSS by ≥50 points in 29 patients overall (71%). The mean total IBS-SSS decreased from 286 before the diet to 131 points after 6 weeks on the diet (P<.001)-the reduction was similar in each HLA-DQ group. However, HLA-DQ2/8-negative subjects had a greater reduction in abdominal distension (P=.04). Both groups had marked mean improvements in hospital anxiety and depression scores, fatigue impact score, and short form 36 results, although HLA-DQ2/8-positive subjects had a greater reduction in depression score and increase in vitality score than HLA-DQ2/8-negative subjects (P=.02 and P=.03, respectively). Twenty-one of the 29 subjects with a clinical response (72%) planned to continue the GFD long term; 18 months after the study they were still on a GFD, with maintained symptom reductions, and demonstrated similar anthropometric and biochemical features compared to baseline.

    CONCLUSION: A dietitian-led GFD provided sustained benefit to patients with IBS-D. The symptoms that improved differed in magnitude according to HLA-DQ status.

    Be well!

    JP

  12. JP Says:

    Updated 07/17/16:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936999/

    Springerplus. 2016 Jul 7;5(1):994.

    Potential beneficial effects of a gluten-free diet in newly diagnosed children with type 1 diabetes: a pilot study.

    AIM: Gluten-free diet has shown promising effects in preventing type 1 diabetes (T1D) in animals as well as beneficial effects on the immune system. Gluten-free diet at diabetes onset may alter the natural course and outcome of autoimmune diseases such as T1D.

    METHODS: In a 12-month study, 15 children newly diagnosed with T1D were instructed to follow a gluten-free diet. Questionnaires were used to evaluate adherence to the gluten-free diet. Partial remission (PR) was defined by insulin dose-adjusted A1c (IDAA1c) ≤9 or stimulated C-peptide (SCP) >300 pmol/L measured 90 min after a liquid mixed meal at the inclusion, six and 12 months after onset. The intervention group was compared with two previous cohorts. Linear mixed models were used to estimate differences between cohorts.

    RESULTS: After 6 months, more children on a gluten-free diet tended to have SCP values above 300 pmol/L compared to the European cohort (p = 0.08). The adherence to a gluten-free diet decreased during the 12-month study period. After 1 year there was no difference in SCP levels or percentage in remission according to SCP (p > 0.1). Three times as many children were still in PR based on IDAA1c (p < 0.05). Twelve months after onset HbA1c were 21 % lower and IDAA1c >1 unit lower in the cohort on a gluten-free diet compared to the two previous cohorts (p < 0.001).

    CONCLUSION: Gluten-free diet is feasible in highly motivated families and is associated with a significantly better outcome as assessed by HbA1c and IDAA1c. This finding needs confirmation in a randomized trial including screening for quality of life.

    Be well!

    JP

  13. JP Says:

    Updated 09/16/!6:

    https://www.cambridge.org/core/journals/public-health-nutrition/article/gluten-contamination-in-gluten-free-bakery-products-a-risk-for-coeliac-disease-patients/8315A5B961393978CFFF02A61A5A1633

    Public Health Nutr. 2016 Sep 15:1-4.

    Gluten contamination in gluten-free bakery products: a risk for coeliac disease patients.

    OBJECTIVE: The present study aimed to assess the safety of gluten-free bakery products for consumption by coeliac patients. Design/setting In the current exploratory cross-sectional quantitative study, a total of 130 samples were collected from twenty-five bakeries in Brasilia (Brazil). For the quantification of gluten, an ELISA was used. The threshold of 20 ppm gluten was considered as the safe upper limit for gluten-free food, as proposed in the Codex Alimentarius.

    RESULTS: The results revealed a total of 21·5 % of contamination among the bakery products sampled. Sixty-four per cent of the bakeries sold at least one contaminated product in our sample.

    CONCLUSIONS:
    These findings represent a risk for coeliac patients since the ingestion of gluten traces may be sufficient to adversely impact on their health.

    Be well!

    JP

  14. JP Says:

    Updated 09/25/16:

    http://www.advances.umed.wroc.pl/pdf/2016/25/4/751.pdf

    Adv Clin Exp Med. 2016 Jul-Aug;25(4):751-4.

    Celiac Disease and Epilepsy: The Effect of Gluten-Free Diet on Seizure Control.

    BACKGROUND: Determining the true prevalence of celiac disease (CD) is difficult because of many atypical symptoms. Although CD primarily affects the gastrointestinal tract, patients may be asymptomatic or have extra intestinal symptoms.

    OBJECTIVES: In this study, we assessed the prevalence of CD in patients with epilepsy and the effect of a gluten-free diet on seizure control in these patients.

    MATERIAL AND METHODS: Patients with epilepsy in Imam Reza and Farabi Hospitals, Kermanshah, Iran, were studied. At first, the patients were screened by means of measuring the immunoglobulin A antiendomysial (IgA) antibodies. In the patients testing positive for IgA antibodies, 2-3 endoscopic small bowel biopsies were taken from the distal duodenum to confirm CD changes. People with CD received a gluten-free diet for 5 months and their seizure activity was recorded.

    RESULTS: During the study period, we studied 113 patients with epilepsy. Seven patients (6%) were diagnosed with CD. After 5 months of instituting a gluten-free diet, in 6 patients seizures were completely under control and antiepileptic drugs were discontinued. In one case, anticonvulsant drugs were reduced by half and seizures were controlled.

    CONCLUSIONS: Our results showed that about 6% of epileptic patients were positive for CD. Institution of a glutenfree diet is useful for seizure control in these patients.

    Be well!

    JP

  15. JP Says:

    Updated 10/06/16:

    http://link.springer.com/article/10.1007%2Fs00384-016-2663-x

    Int J Colorectal Dis. 2016 Sep 30.

    Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome.

    PURPOSE: Irritable bowel syndrome (IBS) is common but therapies are unsatisfactory. Food is often suspected as cause by patients, but diagnostic procedures, apart from allergy testing, are limited. Based on the hypothesis of non-celiac wheat sensitivity (WS) in a subgroup of IBS patients, we tested the long-term response to a gluten-free diet (GFD) and investigated HLA-DQ2 or -DQ8 expression as a diagnostic marker for WS in diarrhea-dominant (IBS-D) and mixed-type IBS (IBS-M).

    METHODS: The response to a GFD served as reference test for WS and HLA-DQ2/8 expression was determined as index test. Patients were classified as responders if they reported complete or considerable relief of IBS symptoms on at least 75 % of weeks over a 4-month period of gluten-free diet. Established questionnaires (IBS-Quality of Life (IBS-QoL), IBS Symptom Severity Scale (IBS-SSS), European Quality of Life-5 Dimensions (EQ-5D)) were used for secondary outcome measures.

    RESULTS: Thirty-five patients finished the study. Of these, 12 (34 %) were responders and classified as having WS (95 % CI 21-51 %). HLA-DQ2/8 expression had a specificity of 52 % (95 % CI 33-71 %) and sensitivity of 25 % (95 % CI 8-54 %) for WS. Responders showed improvement in quality of life and symptom scores. At 1-year follow-up, all responders and 55 % of non-responders were still on GFD and reported symptom relief.

    CONCLUSION: Using strict criteria as recommended for IBS studies, about one third of patients with IBS-D or IBS-M are wheat sensitive, with a similar proportion in both IBS types. Expression of HLA-DQ2/8 is not useful as diagnostic marker for WS. Long-term adherence to a GFD is high and can sustain symptomatic improvement.

    Be well!

    JP

  16. JP Says:

    Updated 12/26/16:

    http://www.sciencedirect.com/science/article/pii/S0308814616320003

    Food Chem. 2017 Apr 15;221:1954-1961.

    Gluten-free pasta incorporating chia (Salvia hispanica L.) as thickening agent: An approach to naturally improve the nutritional profile and the in vitro carbohydrate digestibility.

    A gluten-free pasta was prepared adding chia at rice flour for testing the thickening and nutritional properties of this specie. Chemical analysis showed chia is a source of protein (19.52% and 15.81%, seeds and mucilage respectively), insoluble/soluble dietary fiber ratio (4.3 and 1.79 seeds and mucilage respectively), fat and ash content. The total phenolic acids content ranged from 734.5μg/g to 923.9μg/g for seeds and mucilage respectively. Chia was a good thickening agent and, improved the nutritional profile of enriched samples compared to CGF. After cooking TPAs increased in all samples, ranging from 5.3% in DW to 52.8% in CM5. The addition of chia seeds also increased the slowly digestible starch fraction of rice flour, commonly known to have a high glycemic index. Results suggest that chia should be added as thickening agent in the formulation of GF pasta for conferring healthier characteristics.

    Be well!

    JP

  17. JP Says:

    Updated 01/19/17:

    http://www.sciencedirect.com/science/article/pii/S0531556516305010

    Experimental Gerontology, Available online 18 January 2017

    Abstract Exercise is known to have numerous beneficial effects. Recent studies indicate that exercise improves mitochondrial energetics not only in skeletal muscle but also in other tissues. While exercise elicits positive effects on memory, neurogenesis, and synaptic plasticity, the effects of exercise on brain mitochondrial energetics remain relatively unknown. Herein, we studied the effects of exercise training in old and young mice on brain mitochondrial energetics, in comparison to known effects on peripheral tissues that utilize fatty acid oxidation. Exercise improved the capacity for muscle and liver to oxidize palmitate in old mice, but not young mice. In the brain, exercise increased rates of respiration and reactive oxygen species (ROS) production in the old group only while utilizing complex I substrates, effects that were not seen in the young group. Coupled complex I to III enzymatic activity was significantly increased in old trained versus untrained mice with no effect on coupled II to III enzymatic activity. Mitochondrial protein content and markers of mitochondrial biogenesis (PGC-1α and TFAM) were not affected by exercise training in the brain, in contrast to the skeletal muscle of old mice. Brain levels of the autophagy marker LC3-II and protein levels of other signaling proteins that regulate metabolism or transport (BDNF, HSP60, phosphorylated mTOR, FNDC5, SIRT3) were not significantly altered. Old exercised mice showed a significant increase in DRP1 protein levels in the brain without changes in phosphorylation, while MFN2 and OPA1 protein levels were unchanged. Our results suggest that exercise training in old mice can improve brain mitochondrial function through effects on electron transport chain function and mitochondrial dynamics without increasing mitochondrial biogenesis.

    Be well!

    JP

  18. JP Says:

    Updated 01/25/17:

    https://www.ncbi.nlm.nih.gov/pubmed/28118560

    J AOAC Int. 2016 Dec 16.

    The Celiac Patient Antibody Response to Conventional and Gluten-Removed Beer.

    Enzymatic digestion, or hydrolysis, has beenproposed for treating gluten-containing foods andbeverages to make them safe for persons with celiacdisease (CD). There are no validated testing methodsthat allow the quantitation of all the hydrolyzed orfermented gluten peptides in foods and beverages thatmight be harmful to CD patients, making itdifficult to assess the safety of hydrolyzed products.This study examines an ELISA-based method todetermine whether serum antibody binding ofresidual peptides in a fermented barley-basedproduct is greater among active-CD patients thana normal control group, using commercial beersas a test case. Sera from 31 active-CD patients and29 nonceliac control subjects were used to assessthe binding of proteins from barley, rice, traditionalbeer, gluten-free beer, and enzymatically treated(gluten-removed) traditional beer. In the ELISA,none of the subjects’ sera bound to proteins in thegluten-free beer. Eleven active-CD patient serumsamples demonstrated immunoglobulin A (IgA) orimmunoglobulin G (IgG) binding to a barley extract,compared to only one nonceliac control subject. Ofthe seven active-CD patients who had an IgA bindingresponse to barley, four also responded to traditionalbeer, and two of these responded to the glutenremovedbeer. None of the nonceliac control subjects’sera bound to all three beer samples. Binding ofprotein fragments in hydrolyzed or fermented foodsand beverages by serum from active-CD patients,but not nonceliac control subjects, may indicate thepresence of residual peptides that are celiac-specific.

    Be well!

    JP

  19. JP Says:

    Updated 08/07/17:

    http://pubs.rsc.org/en/Content/ArticleLanding/2017/FO/C7FO00099E#!divAbstract

    Food Funct. 2017 Aug 3.

    Commercially available gluten-free pastas elevate postprandial glycemia in comparison to conventional wheat pasta in healthy adults: a double-blind randomized crossover trial.

    Given the popularity of gluten-free diets, research regarding the health implications of gluten-free (GF) products is necessary. This study compared the postprandial glycemic responses to three GF pastas commonly available in the U.S. market to that of wheat pasta in healthy adults. Thirteen healthy non-smoking men and women from a university campus population were enrolled in this randomized 4 × 4 block crossover study and completed all four treatments. Participants followed a standardized diet and activity protocol the day prior to testing, and one week separated testing periods. The test meal (a macaroni and cheese dish prepared with conventional wheat pasta or with GF pasta composed of either brown rice, rice and corn, or corn and quinoa flours) was consumed under observation, and blood was sampled in the fasted state and at one-half hour intervals for the first 2 hours following meal ingestion. A significant pasta × time interaction was observed for the incremental postprandial glycemia curves (p = 0.036, repeated measures ANOVA; effect size [partial eta squared], 0.943). Post-hoc analysis revealed a significant difference for the 30-minute postprandial blood glucose concentrations: the plasma glucose concentration was 57% higher for the GF rice and corn pasta compared to traditional wheat pasta (p = 0.011). Since postprandial glycemia was higher for GF pasta composed of rice and corn flours compared to wheat pasta, more research is needed to understand how the substitute ingredients for GF pastas impact health parameters and disease risk.

    Be well!

    JP

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