What is Gluten?

Obvious Sources of Gluten

Gluten is a combination of proteins discovered in grains like wheat, barley and rye, including their entire genus, crossbreeds and other forms. The word gluten is derived from Latin meaning “glue” and is a mixture of storage proteins of cereal grains called prolamins and glutenins that are both insoluble in water. For wheat, the prolamins are called gliadins and glutenins and they are the major group of gluten. While barley prolamins are hordein and rye prolamins are called secalin. Whereas, oats by themselves are not gluten but they contain a different type of prolamin called avenin. For those who are very sensitive to gluten, the tiny amount of avenin protein in oat can be a problem for them. But oat products are usually contaminated when planted in the same fields as wheat or when processed in plants with equipments that also produce gluten grains.

Other varieties of wheat include: bulgar/cracked wheat, wheat bran, wheat gem, wheat starch, wholemeal wheat flour, hydrolysed wheat protein, pregelatinized wheat protein, couscous, durum, einkorn, emmer, farina, faro, freekeh, graham flour, kamut, matzo, semolina and spelt. In addition, other grains that contain gluten are: seitan, triticale and Mir (both are cross breeds between wheat and rye). Gluten provides elasticity to dough, assisting it to rise and retains its form resulting in a springy and rubbery consistency for the end product.

The most common type of foods that contain gluten are cereals or grains, flours, breakfast cereals, baked breads, cakes, biscuits, rusks, crackers, pastries, muffins and cupcakes, rolls, scones, crumpets, chapatis or roti, crispbreads, pasta, pizza, ice cream cones, yogurt with cereals, breadcrumbs, instant noodles and other gluten based noodles. In Asian cuisines, particularly Japanese and Chinese cuisines, “fu” is a type of traditional wheat gluten that resembles bread called Yaki-Fu in Japanese and ed khaw-fu in Jiangnan dialect (Chinese) where it was invented. This type of wheat gluten is tough and rubbery and most commonly used as meat substitutes in Asian cuisines for vegetarian, Buddhist monks and macrobiotic cuisines for Zen Buddhism. You will often find these type of “fu” sold in Asian groceries stores as frozen or canned food with the word gluten displayed on the packaging and cans.

Hidden Sources of Gluten

Other than the obvious sources of gluten, gluten is frequently added to many processed and/or prepared food in different disguises like as thickeners, emulsifiers, processing aids, fillers or ingredient ‘carriers’ and food additives. Some examples are: savoury pies, salami, pasties, sausages and other crumbed, battered, and stuffed products; breaded or floured meat and poultry; breaded ham, faggots, haggis, rissoles and scotch eggs; yogurt with muesli or cereals; ice cream toppings; artificial creams, shredded cheese and processed cheeses; sauces like oyster, fish, hoisin, pasta, tomato, Sichuan, black bean, Worcestershire and soy sauce (normally fermented with wheat); chutney, mustard, mayonnaise and relish; marinades and dressings; waffles and croquettes; fruit-pie fillings; gravy mixes and soups; soup stock and dried soup mixes; barley malt, malt syrup and malt vinegar; distilled alcohol and distilled white vinegar; rice vinegar or rice wine vinegar (may have wheat or barley malt added); sweet and savoury snacks and liquorice; imitation crab meat; potato croquettes; snack bars and protein bars; sweeteners; seasoning/flavouring mixes; blended herbs and spices, baking powders and spreads; wheaten corn starch or corn flour; soy bean product like tofu (may have wheat added); hydrolysed vegetable protein, vegetable gum and vegetable starch. Drinks that contain gluten are real ales, beer, lager, stout, malted drinks and vending-machine drinks. Other potential hidden sources of gluten in food additives that may contain wheat are dextrin, dextrose, maltodextrin, modified food starch, pre-gel starch or starch derivatives and natural and artificial flavours.

Other Sources of Gluten

Furthermore, gluten can also be found in different shapes and forms in prescription medicines or over-the-counter medications, supplements, shampoos and conditioners and cosmetics. Communion bread or wafers are not gluten free. Modelling play doughs, stickers, paints and glues for children are also not gluten free. Postage stamps gum using dextrin, purchase and use self-adhesive ones instead to be on the safe side.

Cross-contamination

In addition to apparent sources of gluten, it is crucial to make sure that gluten free foods are not ‘contaminated’ by foods that comprise of gluten. Looking out for the May contain” statement on food label, for example gluten free foods are manufactured in a factory with equipment and machinery that also manufacture wheat and other allergenic food. Some examples at home or when eating out at restaurants are dishwashing sponge for washing dishes contaminated with gluten; using the same fryer and oil to cook gluten food then subsequently gluten free food; using the same bread machine or toaster for gluten bread and gluten free bread; utilising the same bread cutting/chopping boards or butter dishes with person eating gluten containing bread; even a kiss from a loved one or a lick from your dogs or cats,  who have just eaten gluten and using the same pizza cutter knife for gluten pizza base and subsequently gluten free pizza. Unwrapped gluten free cakes purchased from cake shops that also sell gluten cakes with the same kitchen producing both gluten and gluten free cakes.

Gluten Free Diet

Why Go Gluten Free?

Celiac Disease

Celiac or coeliac disease is an autoimmune disease and a particular kind of food intolerance or simply called gluten intolerance. It is the foremost medical condition whereby sufferers need to adhere to a strict gluten free diet. Gluten triggers an immune respond in celiac disease sufferers causing the body to battle even the tiniest amount of gluten and in the process causing damage to the lining of the small intestine i.e. the “villi” – finger-like projections crucial for absorption of nutrients and fluids from food and drinks consumed. Thereby, causing conditions like anaemia, weak teeth and bones from malnutrition and low calcium as well as digestive problems. Eliminating gluten completely from the diet is the only known lifelong treatment for celiac disease. However, a small number of celiac disease patients do not respond to a strict gluten free diet and still feel really unwell. This condition is called unresponsive celiac disease and may require medication in addition to a gluten free diet.

Recent studies have shown that in Western countries, up to 1% of the population may have celiac disease and predominantly in people with European descent with incidence of celiac disease varying between 1 in 100 persons to 1 in 500 persons. With as many as 80% remained undiagnosed especially those with vague or silent symptoms. It now also emerges that celiac disease is more common in Africa, South America and Asia than formerly thought.

Celiac disease is a genetic disease and normally inherited and can start at any age even for someone who has eaten gluten previously with no problems. Other than genetic predisposition and consumption of gluten, environmental trigger like a traumatic event, for example a car accident, or pregnancy or a viral infection.  Widespread distribution of increasingly more “toxic” grains and much quicker proving phase for bread dough, may initiate celiac disease.

Diagnosis of celiac disease is two folds: Firstly, serologic blood tests screening for celiac disease antibodies called tTG-IgA test. In order for this test to be accurate, gluten must be consumed for minimum of six weeks before taking the test. Secondly, if blood test results is positive, a biopsy of small intestine to check for damage will need to be done by a gastroenterologist in order to confirm diagnosis of celiac disease.

Another gene test available that do not require consumption of gluten is the presence of either or both of genes HLA DQ2 and/or DQ8, as shown in majority of celiac disease sufferers. Biopsy of small intestine for damage still needs to be done for confirmation of celiac disease.

Dermatitis Herpetiformis

Dermatitis Herpetiformis (DH), or Duhring’s disease, is a rare chronic genetic skin condition of red and intensely itchy blisters primarily on elbows, forearms, knees and buttocks even though it can involve any skin area. Some DH sufferers also have mild form of celiac disease. The only treatment for DH is a strict lifelong gluten free diet similar to celiac disease. Even a very tiny trace amount of gluten can flare up the skin rashes again and/or prevent them from healing.

Non-Celiac Gluten Sensitivity (NCGS)

There are some people who suffer from the same symptoms as celiac disease sufferers but have no intestinal damage. The terms used to represent this condition is called non-celiac gluten sensitivity (NCGS) or non-celiac wheat sensitivity (NCWS), whereby symptoms settle through strict gluten free diet.

Food Intolerance

Food intolerance are often confused with food allergies. Gluten intolerance or wheat intolerance are food intolerance. Some other examples of food intolerance are lactose intolerance – a lack of the enzyme called lactase and are very common in the Asian population. In many instances, celiac disease sufferers also have lactose intolerance and they feel better on a lactose or even dairy free diet in addition to going gluten free.  Other food ingredients added or chemicals in food can cause symptoms, for instance tyramine in red wine and matured cheese can possibly cause flushing and or migraine and the preservative called sulphur dioxide added to food, commonly to grapes, may exacerbate asthma.

Other causes of food intolerance particularly wheat intolerance is higher circulating levels of markers of intestinal damage called “leaky gut syndrome” and improper immune system stimulation. The offender seems to be proteins found in wheat called amylase trypsin inhibitors (ATIs), causing the lining of the bowel to become leaky, permitting these proteins to permeate the gut wall and enter the blood stream as well as travel to other organs and initiate immunological reactions. ATIs have been indicated to aggravate autoimmune diseases like multiple sclerosis (MS), lupus, Sjogren’s (Sicca) syndrome, rheumatoid arthritis, asthma, Crohn’s disease, autoimmune thyroiditis or Hashimoto’s disease (hypothyroidism), fibromyalgia, as well as other conditions like eczema, non-alcoholic fatty liver disease, irritable bowel syndrome (IBS) and chronic fatigue syndrome. Disturbance in the natural balance of beneficial bacteria in the bowel may also contribute to these types of food intolerance. Identifying food intolerance like gluten and wheat intolerance and removing them from your diet by substituting with other food can be the most effective treatment.

Symptoms connected to celiac disease and non-celiac gluten sensitivity (NCGS) or gluten intolerance are: stomach bloating, pain and cramping; diarrhoea and/or constipation; unexplained fatigue or chronic fatigue; headaches and migraine; mouth ulcers and sore tongue, skin problems like psoriasis and eczema; joint pains; hair loss; vomiting, nausea and loss of appetite; malnutrition; infertility and repeated miscarriage; “foggy mind” and depression and anxiety. Also may aggravate behavioural problems like attention deficit hyperactivity disorder (ADHD) and autism in children.

Food Allergy

Others with wheat allergy also respond badly to the proteins found in wheat and need to choose to have a wheat free diet or a gluten free diet. Food allergy happens when too much antibodies known as immunoglobulin E (IgE) are produced when allergens are inhaled or eaten. This condition is known as “atopic” and is usually genetic. Common allergens are: eggs, milk, wheat, soy, corn, tree nuts, peanuts, shellfish, fish, sesame, medications, sulphites, pollens, dust or animal fur. Atopic people have immediate or delayed allergic reactions, for example rashes, swelling of face, runny nose, wheezing, flushing and even life-threatening cases of anaphylaxis.

 

Gluten Free Food

Going gluten free may seem like a disheartening mission at first because it just seems like gluten is everywhere, added to almost all processed and prepared food. But nowadays, there are many specially produced gluten free convenience food and products made from gluten free ingredients. These gluten free products include butter, cakes, bread, biscuits, cookies, flour mixes, pasta, cereals and pizza base. All kinds of gluten free sauces and dressings are also manufactured particularly for people on a gluten free diet. These include gluten free soy sauce, hot sauces, tomato sauce and paste, salad dressings, mustard, Worcestershire sauce and many Asian sauces (Refer to my Guide to Stocking a Gluten Free Lactose Free Asian Pantry). You can easily find a range of safe gluten free food in health food and gluten free aisles of supermarkets, health food stores and even online specialty stores.

The diagnosis of celiac disease and gluten intolerance does not mean the end of healthy and delicious food. Having a balanced diet is vital for everyone and including people who are on gluten free diets. This is to improve nutrient absorption and lower risks of any potential health problem. To make sure that your chosen processed or packaged foods are gluten free, read all food labels and ingredients cautiously, looking out for “may contain” statements. When eating out, it is important to verify that foods are gluten free. Refer to official gluten free food and restaurant directories and endorsed products list from your national celiac societies or support groups.

Naturally Gluten Free Food

Majority of our essential foods for instance poultry, red meat, fish, seafood, eggs, fruits and fresh or frozen vegetables are naturally gluten free. In addition, dairy and soya bean products like soy milk and tofu plus plain nuts and seeds are also naturally gluten free.

Gluten Free Grains/Flours

There are many grains that are gluten free: all rice including white rice, black rice, basmati rice (brown and white), brown rice, jasmine rice, wild rice, glutinous rice (white and black), sorghum, millet, quinoa, amaranth, corn or maize (preferably non-gmo), teff, rice bran, sago, tapioca, arrowroot, polenta, Indian rice grass (montina), buckwheat (despite wheat in its name), potato, gluten free couscous made from brown rice and gluten free oats (as specified on food label). Gluten Free flours include: rice, glutinous rice (white and black), tapioca flour/starch, arrowroot, potato flour/starch, mung bean (green bean) flour/starch, chestnut, corn or maize flour/starch, buckwheat, flaxseed, chick pea (channa), sorghum, soya, flaxseed, besan/gram, almond, hazelnut and gluten free flour mixes.

Other Gluten Free Products

Gluten free derivatives, sauces, seasonings and sweeteners are Tamari soy sauce and all other gluten free sauces (Refer to my Guide to Stocking a Gluten Free Lactose Free Asian Pantry). Seasonings include pure salt, pepper, individual herbs, blend of individual herbs, stevia, honey, agave syrup, pure maple syrup, brown rice syrup, corn syrup, vinegar (refer balsamic vinegar* note below), baking soda, baking powder, cream of tartar, curry powder, yeast, essences, molasses, nut butters, dextrose/dextrin, glucose/glucose syrup, guar gum, xantham gum**, locust bean gum and monosodium glutamate (MSG). Drinks that are gluten free are alcohol like wine, champagnes, sherries, spirits (including malt whisky), liqueurs, ports, vermouths, ciders, perries, gin, brandy, rum, tequila and gluten free beer. Other gluten free drinks are tea, pure coffee, cocoa, rice milk, soy milk, fizzy drinks, juices and soft drinks.

*For Balsamic Vinegar, even though it is made from grapes but it is aged in barrels built with wood and wheat or rye flour paste is used to seal those barrels could result in cross contamination of the balsamic vinegar. But this could only affect people who are highly sensitive to trace gluten. If not, balsamic vinegar should be safe for those on a gluten free diet.

**Xanthan Gum is gluten free and turns stretchy when wet. It is normally added to make gluten free bread, cakes and pastries softer and less crumbly.

 
Support groups for celiac (coeliac) disease and dermatitis herpetiformis (DH):

AUSTRALIA 

www.coeliac.org.au

NEW ZEALAND

www.coeliac.co.nz

UNITED STATES

www.celiac.org

CANADA

www.celiac.ca

UNITED KINGDOM

www.coeliac.co.uk

SINGAPORE

www.glutenfree.sg

Celiac Associations Around The World



2 Responses

  1. patti
    | Reply

    i was diagnosed with type 2 diabetes in Dec. put on a pill and counting carbs. salads hurt my gut, so any things i cannot identify hurt me causing diarrhea, weakness and just feeling bad. Is gluten free ok for diabetics? I need to feel better for sure

    • daphnegoh
      | Reply

      People with diabetes are generally encouraged to follow a healthy balanced diet. I would strongly recommended that you seek the guidance of a qualified dietitian who also specialises in the management of diabetes.

      Low fodmap diet for diabetes include eating low GI starchy carbohydrates. Avoiding carbohydrates with high GI like potato and oat and wheat based bread. Essentially means avoiding gluten bread. Choosing low GI carbohydrates like sweet potato and basmati rice, avoiding sudden spike in blood sugar levels. Processed gluten free products often can contain hidden high sugar content as well. Do your own gluten free baking and opt for naturally gluten free food like meat, seafood, low fodmap fruits and vegetables.

      If you find that you can’t tolerate certain food like salad, it may be helpful to do elimination diet with the help of a dietitian to rule out any food sensitivity and food intolerance or even food allergies. Also, you may want to check for Celiac disease by talking to your GP or gastroentrologist for diagnosis. Hope this is helpful for you and that you will be on the road to feeling better soon. :)

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