Saturday, May 1, 2010

Gluten Intolerance?

Here is a question I recently received from

Jan A. asks: I have type 2 diabetes and just found out I have gluten intolerance.  I haven’t been able to figure out what I can eat.  I have been leaving grains out of my diet.  What should I do?

Answer:  I am so glad to answer this question, as gluten has become a hot issue lately! First, I would like to explain that gluten is not inherently a poison. Gluten is a protein found in wheat. Gluten is strong and stringy, and is responsible for bread's ability to rise without breaking apart and collapsing. You cannot make yeast-rising bread with flour that does not contain gluten.

Gluten contains two fractions, gliadin and glutenin, both of which evoke an autoimmune response in people with Celiac disease. Celiac is an autoimmune disease resulting in an inflammatory condition in the small intestine. The protein fractions of barley and rye (hordeins and secalins, respectively) are closely related to those in gluten, and will also initiate autoimmune activity (although oats are gluten free, they have been suspect in the past due to contamination during processing). People with Celiac disease must eliminate all sources of wheat, barley and rye - and their derivatives - completely from their diets or risk serious damage to their GI tract and a host of other issues.  There is no established threshold for immune response initiation, so complete elimination is paramount.

It is possible that a larger number of people than previously thought are sensitive to gluten. Type 1 diabetes (another autoimmune condition) has been linked to Celiac disease with increasing frequency. However, while there are specific antibody and biopsy tests to help diagnose Celiac disease, tests for gluten sensitivity are generally unreliable. The easiest thing to do is to try a gluten-elimination diet and see if whatever symptoms you are experiencing improve.

Avoiding gluten sounds simple but is actually quite tricky, as gluten is ubiquitous in the average American diet. Keep in mind that "wheat-free" does not mean "gluten-free" and there are many non-food products that must be avoided.

For example, sources of gluten include:
  • Bread, pasta and any products made from barley, rye, wheat and any of their derivatives, including  kamut, triticale, spelt, graham, semolina and durum.
  • Vinegars made from fermented wheat, rye or barley (malt vinegar)
  • Beer, made from fermented barley 
  • Soy sauce, made from fermented wheat or barley 
  • Gravies, sauces, jellies thickened with flour or starch
  • Emulsifiers in some toothpastes contain gluten
  • Modified food starch, found in many packaged foods and processed cheeses (and even Twizzlers!)
  • Hydrolyzed or Texturized vegetable protein, may use wheat, rye or barley proteins
  • Dextrin 
  • Malt syrup and malt flavoring (derived from barley; found in some soy and rice milk products)
  • Vegetable gum
  • Glue on envelopes 
  • Prescription and OTC medications may contain wheat starch as a filler
  • Lipstick may also contain wheat starch as a dispersing agent/filler
  • Natural and artificial flavorings - may contain gluten.
Here is an even more comprehensive list of gluten-containing foods and ingredients.

Ok, so at this point you are probably wondering: “is there anything I can eat?” The answer is yes! 

Naturally gluten-free foods include:
  • Fruits
  • Vegetables
  • Meat, poultry, seafood
  • Beans and legumes
  • Gluten-Free Grains  (corn, quinoa, rice, oats, millet, amaranth, teff, buckwheat, soybeans, arrowroot)
  • Dairy (milk, yogurt and most cheeses)
  • Oils and fats 
  • Alcohol, except beer
Quinoa is a favorite of mine – it cooks in half the time it takes to make brown rice and is the highest grain source of protein. A gluten-free diet requires you to ‘think outside the box,’ especially in terms of breakfast foods. Why not have a scrambled egg with some quinoa and a piece of fruit?  For lunch, you can create delicious and hearty salads with lettuce, veggies and beans. Top it off with a dressing of olive oil and lemon juice (instead of vinegar). When dining out, be sure to ask your server about dishes with sauces, breading and cream soups (may be roux-based and contain flour). When in doubt, stick to simple, fresh foods and ask for dishes without sauces or gravies.

At home, be aware of possible cross-contamination with foods containing gluten. Wash cutting boards and utensils thoroughly. Use squeeze bottles of condiments whenever possible to avoid contaminating the condiment jar by inserting a utensil that previously contacted gluten-containing foods. Bread crumbs may stick to the insides of toasters (or the toaster oven rack) and may contaminate gluten-free items. Of course, always read the ingredients list when buying packaged food!

There are many gluten-free products out there (breads, cookies, snack bars, etc.). These products may come in handy at times, but are not necessary. Focus on naturally gluten-free foods, especially since many gluten-free products are highly processed and have a higher fat content.

At this point, you may notice that following a gluten-free diet also eliminates many sources of whole grains. For this reason, I do no generally advise anyone to follow a gluten-free diet unless there is a particular reason for doing so – i.e. symptoms related to suspected gluten sensitivity, wheat allergy or a diagnosis of Celiac disease. "Gluten-free" does not automatically mean "healthy." But with some experimentation and practice, it is possible to eat a delicious and healthful gluten-free diet. 

Good luck!


  1. Some people who have a family history of diabetics immediately follow this gluten-free lifestyle to avoid developing the disease. It may not always work, but it is still worth trying out.

  2. This is great, I always see that ingredient in toothpastes all the time. Thanks.