Gluten-Free Diet

  • Author:
    Betty Kovacs Harbolic, MS, RD

    Betty is a Registered Dietitian who earned her B.S. degree in Food and Nutrition from Marymount College of Fordham University and her M.S. degree in Clinical Nutrition from New York University. She is the Co-Director and Director of nutrition for the New York Obesity Research Center Weight Loss Program.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Digestion Q&A by Dr. Lee on Gluten Free Diets

Medical Author Dr. Dennis Lee

Viewer Question: Do you know if oat bran contains gluten? And is it OK to eat if I have celiac sprue?

Dietician's Response: A Gluten is the protein fraction of wheat, rye, and barley. Gluten contains several different types of protein, each with a different arrangement of amino acids. (Proteins are chains of amino acids hooked together.) It is believed that several of these proteins are responsible for the inflammation that causes celiac disease (also known as sprue or gluten-sensitive enteropathy).

Quick GuideGluten-Free Diet: Popular Gluten-Free Foods in Pictures

Gluten-Free Diet: Popular Gluten-Free Foods in Pictures

What is a gluten-free diet?

Anyone who has had to follow a gluten-free diet has seen a huge change in the availability of these foods. What was once only found in specialty stores and known by very few people has now become a very popular diet trend. Products and restaurants are proudly displaying their gluten-free status. Many now see this as the latest "diet fad." Gluten is the protein found in wheat, rye, barley, and triticale. A gluten-free diet excludes all of these, along with anything that could have come in contact with them. Does everyone need this or only people with specific diseases? This article with provide you with that answer and guide you on how to follow this diet, if in fact, you do need to.

Who needs to follow a gluten-free diet?

People have been following a gluten-free diet for many reasons, but not all are medically necessary. There are some conditions and diseases that do require that you follow a gluten-free diet.

Celiac disease

Probably the most well-known disease that requires a gluten-free diet is celiac disease. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy. The exact cause of celiac disease is not clear, but it known to have a genetic (inherited) component. Celiac disease affects approximately 1% of the population, but this may increase as there has been a rise in the incidence of celiac disease over the past decade.

Celiac disease is an autoimmune disease, where the immune system starts attacking normal tissue, particularly the inner lining tissue of the small intestine, in response to eating gluten. The specific reaction that leads to inflammation is to proteins called prolamins found in certain grains; gliadin found in wheat, secalin found in rye, horedin found in barley, and for some avenin found in oats. Although only some react to the prolamins in oats, everyone who has celiac and lives in North America is instructed to avoid oats. This is due to the cross contamination caused by the crop being rotated and milled with wheat.

A gluten-free diet is not optional for people with celiac disease. It is considered a necessary medical nutrition therapy. When you have celiac disease your body reacts to gluten as if it were toxic. This reaction occurs in the small intestine and ends up damaging the inner lining of the small intestine (mucosal surface). When the mucosal surface is damaged the small intestine is not able to absorb nutrients properly leaving people at risk for nutritional deficiencies including protein, fat, iron, calcium, and fat soluble vitamins (A, D, E, and K). It can also result in anemia, diarrhea, abdominal cramping, vomiting, failure to thrive, osteoporosis, and delayed growth. When gluten is removed from the diet there are clinical improvements to the small intestines. Getting diagnosed as early as possible and sticking with a gluten-free diet is key to avoid intestinal damage and long-term consequences of lymphoma.

Medically Reviewed by a Doctor on 4/8/2015

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