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organize foods into: what has gluten, what doesn't have gluten but's been contaminated, what doesn't have gluten at all, and what had gluten but it was removed
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The exact level at which gluten is harmless for people with celiac disease is uncertain. A 2008 [[systematic review]] tentatively concluded that consumption of less than 10 mg of gluten per day for celiac disease patients is unlikely to cause histological abnormalities, although it noted that few reliable studies had been conducted.<ref name=Akobeng2008>{{Cite journal|author=Akobeng AK, Thomas AG |title=Systematic review: tolerable amount of gluten for people with coeliac disease |journal=Aliment. Pharmacol. Ther. |volume=27 |issue=11 |pages=1044–52 |date=June 2008 |pmid=18315587 |doi=10.1111/j.1365-2036.2008.03669.x}}</ref>
The exact level at which gluten is harmless for people with celiac disease is uncertain. A 2008 [[systematic review]] tentatively concluded that consumption of less than 10 mg of gluten per day for celiac disease patients is unlikely to cause histological abnormalities, although it noted that few reliable studies had been conducted.<ref name=Akobeng2008>{{Cite journal|author=Akobeng AK, Thomas AG |title=Systematic review: tolerable amount of gluten for people with coeliac disease |journal=Aliment. Pharmacol. Ther. |volume=27 |issue=11 |pages=1044–52 |date=June 2008 |pmid=18315587 |doi=10.1111/j.1365-2036.2008.03669.x}}</ref>


== Gluten-free food ==
== The gluten-free diet ==
===Exclusions===
⚫
[[Image:Chenopodium quinoa0.jpg|thumb|[[Quinoa]] is a [[pseudocereal]] that is gluten-free.]]
Gluten-free food is normally seen as a diet for celiac disease, but people with a [[gluten allergy]] (an unrelated disease) should avoid wheat and related grains.
Gluten-free food is normally seen as a diet for celiac disease, but people with a [[gluten allergy]] (an unrelated disease) should avoid wheat and related grains. A gluten-free diet rules out all ordinary [[bread]]s, [[pasta]]s, and many [[convenience food]]s; it also excludes gravies, custards, soups, and sauces thickened with wheat, rye, barley, or other gluten-containing flour. Gluten-free bakery and pasta products are available from specialty retailers.
Meat, fish, poultry, fruit, vegetables, potato, and rice are gluten-free foods.


[[Bread]], which is a staple in many diets, typically is made from grains such as wheat that contain gluten. Wheat gluten contributes to the elasticity of dough and is thus an important component of bread.
⚫
Several grains and [[starch]] sources are considered acceptable for a gluten-free diet. The most frequently used are [[maize|corn]], [[potato]]es, [[rice]], and [[tapioca]] (derived from [[cassava]]). Other grains and starch sources generally considered suitable for gluten-free diets include [[amaranth]], [[arrowroot]], [[millet]], [[montina]], [[lupin]], [[quinoa]], [[sorghum]] (jowar), [[taro]], [[teff]], [[chia seed]], almond meal flour, coconut flour, pea flour, cornstarch and [[yam (vegetable)|yam]]. Sometimes various types of [[bean]], [[Soy flour|soybean]], and [[nut (fruit)|nut]] [[flour]]s are used in gluten-free products to add [[protein]] and [[dietary fiber]].
====Oats====
⚫
{{Further2|[[Gluten sensitivity#The oat controversy|The oat controversy]] and [[Oat sensitivity]]}}
⚫
[[Image:Haverkorrels Avena sativa.jpg|thumb|[[Oats|Oat]] grains in their husks]]
⚫
A gluten-free diet might also exclude [[oat]]s. Medical practitioners are divided on whether oats are acceptable to celiac disease sufferers<ref>{{cite web|url=http://pmj.bmj.com/cgi/content/abstract/82/972/672|title=Celiac disease and oats: a systematic review|publisher=The Fellowship of Postgraduate Medicine|author=N Y Haboubi, S Taylor, S Jones|year=2006}}</ref> or whether they become cross-contaminated in milling facilities by other grains.<ref>[http://www.celiacsociety.com/celiacinfo_diet.asp "The Gluten-Free Diet"], CeliacSociety.com</ref> Oats may be contaminated when grown in rotation with wheat when wheat seeds from the previous harvest sprout up the next season in the oat field and are harvested with the oats. A growing body of evidence suggests that a majority of people with celiac disease and following a gluten-free diet can safely consume pure oats in moderate amounts. The suitability of [[oat]]s in the gluten-free diet is somewhat controversial. Some research suggests that oats in themselves are [[gluten-free]], but they are virtually always contaminated by other grains during distribution or processing. Recent research,<ref>{{cite journal | author = Arentz-Hansen H, Fleckenstein B, Molberg Ø, Scott H, Koning F, Jung G, Roepstorff P, Lundin KE, Sollid LM | title = The Molecular Basis for Oat Intolerance in Patients with Coeliac Disease | journal = PLoS Medicine | volume = 1 | issue = 1 | pages = e1 | date = October 19, 2004 | pmid = 15526039 | pmc = 523824 | doi = 10.1371/journal.pmed.0010001 | url = http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0010001 | publisher = PLoS Medicine | accessdate = July 22, 2006 }}</ref> however, indicated that a protein naturally found in oats ([[avenin]]) possessed peptide sequences closely resembling wheat gluten and caused mucosal inflammation in significant numbers of celiac disease sufferers. Some examination results show that even oats that are not contaminated with wheat particles are nonetheless dangerous, while not very harmful to the majority. Such oats are generally considered risky for children with celiac disease to eat, but two studies show that they are completely safe for adults with celiac disease to eat. The EU Standard provides for special treatment of oats. Acknowledging the high potential of oats to become cross-contaminated, the EU Standard specifies that gluten free oat claims must have been specially produced, prepared and/or processed in a way to avoid cross-contamination.


⚫
People who merely are "gluten-sensitive" may be able to eat oats without adverse effect,<ref>{{cite journal | author = Størsrud S, Olsson M, Arvidsson Lenner R, Nilsson LA, Nilsson O, Kilander A | title = Adult celiac patients do tolerate large amounts of oats | journal = European Journal of Clinical Nutrition | volume = 57 | issue = 1 | date = May 7, 2002 | pmid = 12548312 | doi = 10.1038/sj.ejcn.1601525 | url = http://www.nature.com/ejcn/journal/v57/n1/full/1601525a.html | accessdate = August 14, 2008 }}</ref> even over a period of five years.<ref>{{cite journal | title = No harm from five year ingestion of oats in celiac disease | last = Janatuinen | first = E K | date = May 1, 2002 | url = http://gut.bmj.com/cgi/gca?allch=&SEARCHID=1&VOLUME=50&FIRSTPAGE=332&FIRSTINDEX=0&hits=10&RESULTFORMAT=1&gca=gutjnl%3B50%2F3%2F332 | journal = GUT Journal Online |author2=T A Kemppainen |author3=R J K Julkunen |author4=V-M Kosma |author5=M Mäki |author6=M Heikkinen |author7= M I J Uusitupa | accessdate = August 14, 2008 }}</ref>
⚫
Almond flour has a low [[glycemic index]]. Despite its name, [[buckwheat]] is not related to wheat. Pure buckwheat is considered acceptable for a gluten-free diet, however, many commercial buckwheat products are mixtures{{citation needed|date=February 2014}} of wheat and buckwheat flours, and thus, not gluten-free. [[Gram flour]], derived from [[chickpea]]s, is gluten-free (this is not the same as [[Graham flour]] made from wheat).


⚫
Given this conflicting information, excluding oats appears to be the only risk-free practice for celiac disease sufferers of all ages,<ref name="csaceliacs organization">{{cite web|url=http://www.csaceliacs.org/InfoonOats.php|title=The Scoop on Oats|publisher=[[Celiac Sprue Association]] (CSA)|date=February 20, 2008}}</ref> however, medically approved guidelines exist for those with celiac disease who do wish to introduce oats into their diet.<ref>{{cite web
⚫
[[Image:Chickpea.jpg|thumb|[[Chickpea]]s]]
⚫
| title=Guidelines for Consumption of Pure and Uncontaminated Oats by Individuals with Coeliac Disease
⚫
Gluten may be used in foods in some unexpected ways, for example it may be added as a [[food additive|stabilizing agent]] or thickener in products such as [[ice-cream]] and [[ketchup]].<ref>{{cite web|url=http://www.ext.colostate.edu/pubs/columnnn/nn030331.html|title=Gluten sensitivity more widespread than previously thought|publisher=Colorado State University Extension|author=Pat Kendall, Ph.D., R.D.|date=March 31, 2003}}</ref><ref>{{cite web|url=http://bidmc.harvard.edu/default.asp?leaf_id=12799|title=Following a Gluten-free Diet|publisher=Beth Israel Deaconess Medical Center|author= |date= A Harvard teaching hospital}}</ref>
⚫
| last=Mohsid
⚫
| first=Rashid
⚫
| date=June 8, 2007
⚫
| url=http://www.celiac.ca/Articles/PABoatsguidelines2007June.html
⚫
| publisher=Professional Advisory Board of Canadian Coeliac Association
⚫
| accessdate=August 14, 2008
⚫
}}</ref>


====Gluten contamination====
A gluten-free diet rules out all ordinary [[bread]]s, [[pasta]]s, and many [[convenience food]]s; it also excludes gravies, custards, soups, and sauces thickened with wheat, rye, barley, or other gluten-containing flour. Gluten-free bakery and pasta products are available from specialty retailers.
⚫
Meat, fish, poultry, fruit, vegetables, potato, and rice are gluten-free foods. Unless manufactured in a dedicated facility and under gluten-free practices, all cereal grains, including oats, may be cross-contaminated with gluten. Grains become contaminated with gluten by sharing the same farm, truck, mill, or bagging facility as wheat and other gluten-containing grains.


⚫
Gluten may be used in foods in some unexpected ways, for example it may be added as a [[food additive|stabilizing agent]] or thickener in products such as [[ice-cream]] and [[ketchup]].<ref>{{cite web|url=http://www.ext.colostate.edu/pubs/columnnn/nn030331.html|title=Gluten sensitivity more widespread than previously thought|publisher=Colorado State University Extension|author=Pat Kendall, Ph.D., R.D.|date=March 31, 2003}}</ref><ref>{{cite web|url=http://bidmc.harvard.edu/default.asp?leaf_id=12799|title=Following a Gluten-free Diet|publisher=Beth Israel Deaconess Medical Center|author= |date= A Harvard teaching hospital}}</ref>
===Contamination of gluten-free foods during processing===
⚫
A gluten-free diet allows for fruit, vegetables, meat, and many dairy products. The diet allows rice, corn, soy, potato, tapioca, beans, sorghum, quinoa, millet, pure buckwheat, arrowroot, amaranth, teff, Montina, and nut flours and the diet prohibits the ingestion of wheat, barley, rye, and related components, including triticale, durum, graham, kamut, semolina, spelt, malt, malt flavouring, or malt vinegar.<ref>American Dietetic Association: Hot topics: gluten-free diets www.eatright.org/search.aspx? Dec. 2009</ref>


The finding of a 2010 study indicates that some inherently gluten-free grains, seed, and flours not labeled gluten-free are contaminated with gluten. The consumption of these products can lead to inadvertent gluten intake.<ref>Journal of the American Dietetic Association. June 2010;939</ref> 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.<ref>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</ref>
The finding of a 2010 study indicates that some inherently gluten-free grains, seed, and flours not labeled gluten-free are contaminated with gluten. The consumption of these products can lead to inadvertent gluten intake.<ref>Journal of the American Dietetic Association. June 2010;939</ref> 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.<ref>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</ref>


There is no general agreement on the analytical method used to measure gluten in ingredients and food products.<ref>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</ref> The ELISA method was designed to detect w-gliadins, but it suffered from the setback that it lacked sensitivity for barley prolamins.<ref>{{cite journal | last1 = Poms | first1 = R. E. | last2 = Klein | first2 = C. L. | last3 = Anklam | first3 = E. | title = Methods for allergen analysis in food: A review | journal = Food Additives and Contaminants | volume = 21 | issue = 1 | pages = 1–31 | year = 2004 | pmid = 14744677 | pmc = | doi = 10.1080/02652030310001620423 }}</ref>
There is no general agreement on the analytical method used to measure gluten in ingredients and food products.<ref>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</ref> The ELISA method was designed to detect w-gliadins, but it suffered from the setback that it lacked sensitivity for barley prolamins.<ref>{{cite journal | last1 = Poms | first1 = R. E. | last2 = Klein | first2 = C. L. | last3 = Anklam | first3 = E. | title = Methods for allergen analysis in food: A review | journal = Food Additives and Contaminants | volume = 21 | issue = 1 | pages = 1–31 | year = 2004 | pmid = 14744677 | pmc = | doi = 10.1080/02652030310001620423 }}</ref>

⚫
In the processing of gluten-containing grains, gluten is removed as shown in the processing flow below:

⚫
{{quotation|Wheat Flour ''(80,000ppm)'' > Wheat Starch ''(200ppm)'' > Dextrin > Maltodextrin > Glucose Syrup ''(<5ppm)'' > Dextrose > Caramel Color}}


Since ordinary wheat flour contains approximately 12% gluten,<ref name=Spersud2008>{{cite book | last = Spersud | first = Erik and Jennifer | title = Everything You Want To Know About Recipes And Restaurants And Much More | publisher = [[Authorhouse]] | date = January 3, 2008 | location = USA | page = 172 | url = http://glutenfreeenterprises.com/index.html | doi = 10.1007/b62130 | isbn = 978-1-4343-6034-2}}</ref> even a tiny amount of wheat flour can cross-contaminate a gluten-free product, therefore, considerable care must be taken to prevent cross-contamination in commercial and home food preparation.
Since ordinary wheat flour contains approximately 12% gluten,<ref name=Spersud2008>{{cite book | last = Spersud | first = Erik and Jennifer | title = Everything You Want To Know About Recipes And Restaurants And Much More | publisher = [[Authorhouse]] | date = January 3, 2008 | location = USA | page = 172 | url = http://glutenfreeenterprises.com/index.html | doi = 10.1007/b62130 | isbn = 978-1-4343-6034-2}}</ref> even a tiny amount of wheat flour can cross-contaminate a gluten-free product, therefore, considerable care must be taken to prevent cross-contamination in commercial and home food preparation.
Line 52: Line 58:
Special care is necessary when checking product ingredient lists since gluten comes in many forms: vegetable proteins and starch, modified food starch (when derived from wheat instead of maize), malt flavoring, unless specifically labeled as corn malt. Many ingredients contain wheat or barley derivatives. [[Maltodextrin]] is gluten-free since it is highly modified, no matter what the source.<ref>{{cite web|title=Gluten Free Living|url=http://glutenfreeliving.com/ingredient.php#maltodextrin Ingredients|accessdate=August 31, 2009}}</ref>
Special care is necessary when checking product ingredient lists since gluten comes in many forms: vegetable proteins and starch, modified food starch (when derived from wheat instead of maize), malt flavoring, unless specifically labeled as corn malt. Many ingredients contain wheat or barley derivatives. [[Maltodextrin]] is gluten-free since it is highly modified, no matter what the source.<ref>{{cite web|title=Gluten Free Living|url=http://glutenfreeliving.com/ingredient.php#maltodextrin Ingredients|accessdate=August 31, 2009}}</ref>


===Oats===
===Inclusions===
⚫
[[Image:Chenopodium quinoa0.jpg|thumb|[[Quinoa]] is a [[pseudocereal]] that is gluten-free.]]
⚫
{{Further2|[[Gluten sensitivity#The oat controversy|The oat controversy]] and [[Oat sensitivity]]}}
⚫
Several grains and [[starch]] sources are considered acceptable for a gluten-free diet. The most frequently used are [[maize|corn]], [[potato]]es, [[rice]], and [[tapioca]] (derived from [[cassava]]). Other grains and starch sources generally considered suitable for gluten-free diets include [[amaranth]], [[arrowroot]], [[millet]], [[montina]], [[lupin]], [[quinoa]], [[sorghum]] (jowar), [[taro]], [[teff]], [[chia seed]], almond meal flour, coconut flour, pea flour, cornstarch and [[yam (vegetable)|yam]]. Sometimes various types of [[bean]], [[Soy flour|soybean]], and [[nut (fruit)|nut]] [[flour]]s are used in gluten-free products to add [[protein]] and [[dietary fiber]].
⚫
[[Image:Haverkorrels Avena sativa.jpg|thumb|[[Oats|Oat]] grains in their husks]]
⚫
[[File:Japanese Rice Bread.JPG|thumb|[[Rice bread]]]]
⚫
A gluten-free diet might also exclude [[oat]]s. Medical practitioners are divided on whether oats are acceptable to celiac disease sufferers<ref>{{cite web|url=http://pmj.bmj.com/cgi/content/abstract/82/972/672|title=Celiac disease and oats: a systematic review|publisher=The Fellowship of Postgraduate Medicine|author=N Y Haboubi, S Taylor, S Jones|year=2006}}</ref> or whether they become cross-contaminated in milling facilities by other grains.<ref>[http://www.celiacsociety.com/celiacinfo_diet.asp "The Gluten-Free Diet"], CeliacSociety.com</ref> Oats may be contaminated when grown in rotation with wheat when wheat seeds from the previous harvest sprout up the next season in the oat field and are harvested with the oats. A growing body of evidence suggests that a majority of people with celiac disease and following a gluten-free diet can safely consume pure oats in moderate amounts. The suitability of [[oat]]s in the gluten-free diet is somewhat controversial. Some research suggests that oats in themselves are [[gluten-free]], but they are virtually always contaminated by other grains during distribution or processing. Recent research,<ref>{{cite journal | author = Arentz-Hansen H, Fleckenstein B, Molberg Ø, Scott H, Koning F, Jung G, Roepstorff P, Lundin KE, Sollid LM | title = The Molecular Basis for Oat Intolerance in Patients with Coeliac Disease | journal = PLoS Medicine | volume = 1 | issue = 1 | pages = e1 | date = October 19, 2004 | pmid = 15526039 | pmc = 523824 | doi = 10.1371/journal.pmed.0010001 | url = http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0010001 | publisher = PLoS Medicine | accessdate = July 22, 2006 }}</ref> however, indicated that a protein naturally found in oats ([[avenin]]) possessed peptide sequences closely resembling wheat gluten and caused mucosal inflammation in significant numbers of celiac disease sufferers. Some examination results show that even oats that are not contaminated with wheat particles are nonetheless dangerous, while not very harmful to the majority. Such oats are generally considered risky for children with celiac disease to eat, but two studies show that they are completely safe for adults with celiac disease to eat. The EU Standard provides for special treatment of oats. Acknowledging the high potential of oats to become cross-contaminated, the EU Standard specifies that gluten free oat claims must have been specially produced, prepared and/or processed in a way to avoid cross-contamination.
⚫
Almond flour has a low [[glycemic index]]. Despite its name, [[buckwheat]] is not related to wheat. Pure buckwheat is considered acceptable for a gluten-free diet, however, many commercial buckwheat products are mixtures{{citation needed|date=February 2014}} of wheat and buckwheat flours, and thus, not gluten-free. [[Gram flour]], derived from [[chickpea]]s, is gluten-free (this is not the same as [[Graham flour]] made from wheat).


⚫
A gluten-free diet allows for fruit, vegetables, meat, and many dairy products. The diet allows rice, corn, soy, potato, tapioca, beans, sorghum, quinoa, millet, pure buckwheat, arrowroot, amaranth, teff, Montina, and nut flours and the diet prohibits the ingestion of wheat, barley, rye, and related components, including triticale, durum, graham, kamut, semolina, spelt, malt, malt flavouring, or malt vinegar.<ref>American Dietetic Association: Hot topics: gluten-free diets www.eatright.org/search.aspx? Dec. 2009</ref>
⚫
People who merely are "gluten-sensitive" may be able to eat oats without adverse effect,<ref>{{cite journal | author = Størsrud S, Olsson M, Arvidsson Lenner R, Nilsson LA, Nilsson O, Kilander A | title = Adult celiac patients do tolerate large amounts of oats | journal = European Journal of Clinical Nutrition | volume = 57 | issue = 1 | date = May 7, 2002 | pmid = 12548312 | doi = 10.1038/sj.ejcn.1601525 | url = http://www.nature.com/ejcn/journal/v57/n1/full/1601525a.html | accessdate = August 14, 2008 }}</ref> even over a period of five years.<ref>{{cite journal | title = No harm from five year ingestion of oats in celiac disease | last = Janatuinen | first = E K | date = May 1, 2002 | url = http://gut.bmj.com/cgi/gca?allch=&SEARCHID=1&VOLUME=50&FIRSTPAGE=332&FIRSTINDEX=0&hits=10&RESULTFORMAT=1&gca=gutjnl%3B50%2F3%2F332 | journal = GUT Journal Online |author2=T A Kemppainen |author3=R J K Julkunen |author4=V-M Kosma |author5=M Mäki |author6=M Heikkinen |author7= M I J Uusitupa | accessdate = August 14, 2008 }}</ref>


⚫
[[Image:Chickpea.jpg|thumb|[[Chickpea]]s]]
⚫
Given this conflicting information, excluding oats appears to be the only risk-free practice for celiac disease sufferers of all ages,<ref name="csaceliacs organization">{{cite web|url=http://www.csaceliacs.org/InfoonOats.php|title=The Scoop on Oats|publisher=[[Celiac Sprue Association]] (CSA)|date=February 20, 2008}}</ref> however, medically approved guidelines exist for those with celiac disease who do wish to introduce oats into their diet.<ref>{{cite web
⚫
| title=Guidelines for Consumption of Pure and Uncontaminated Oats by Individuals with Coeliac Disease
⚫
| last=Mohsid
⚫
| first=Rashid
⚫
| date=June 8, 2007
⚫
| url=http://www.celiac.ca/Articles/PABoatsguidelines2007June.html
⚫
| publisher=Professional Advisory Board of Canadian Coeliac Association
⚫
| accessdate=August 14, 2008
⚫
}}</ref>


⚫
Several celiac disease groups report that according to the [[American Dietetic Association]]'s ''Manual of Clinical Dietetics'',<ref>[http://www.enabling.org/ia/celiac/ada.html "ADA Publishes Revised GF Diet Guidelines"]</ref><ref>[http://www.celiac.com/articles/11/1/Which-alcoholic-beverages-are-safe/Page1.html "Which alcoholic beverages are safe?" Celiac.com]</ref> many types of alcoholic beverages are considered gluten-free, provided no colourings or other additives have been added as these ingredients may contain gluten. Although most forms of whiskey are distilled from a [[mashing|mash]] that includes grains that contain gluten, [[distillation]] removes any proteins present in the mash, including gluten. Although up to 49% of the mash for [[Bourbon whiskey|Bourbon]] and up to 20% of the mash for [[corn whiskey]] may be made up of wheat, or rye, all-corn Bourbons and corn whiskeys do exist, and are generally labeled as such. Spirits made without any grain such as [[brandy]], [[wine]], [[mead]], [[cider]], [[sherry]], [[port wine|port]], [[rum]], [[tequila]], and [[vermouth]] generally do not contain gluten. While some vineyards use a flour paste to caulk the oak barrels in which wine is aged,<ref>StaVin Barrel Inserts Inc. [http://www.stavin.com/barrelsystems/insert.htm] Retrieved May 18, 2009</ref> tests have shown that no detectable amounts of gluten are present in the wine from those barrels.<ref>Celiac.com, referencing a study from [http://www.celiac.com/articles/23076/1/Is-Wine-Aged-in-Wheat-glued-Oak-Barrels-Gluten-free/Page1.html The Gluten-Free Dietician], retrieved September 29, 2013</ref>
⚫
Unless manufactured in a dedicated facility and under gluten-free practices, all cereal grains, including oats, may be cross-contaminated with gluten. Grains become contaminated with gluten by sharing the same farm, truck, mill, or bagging facility as wheat and other gluten-containing grains.


A small number of vineyards have also used gluten as a clarifying agent, though it is not the standard process; some studies have shown small amounts of gluten to remain in the wine after clarification.<ref>Simonato, Tolin, and Pasini, March 4, 2011 "[http://pubs.acs.org/doi/abs/10.1021/jf104490z?journalCode=jafcau Immunochemical and Mass Spectrometry Detection of Residual Proteins in Gluten Fined Red Wine]," ''Journal of Agricultural and Food Chemistry''</ref> Therefore, some people with celiac or strong gluten sensitivity may wish to exercise caution. [[Liqueur]]s and pre-mixed drinks should be examined carefully for gluten-derived ingredients.
===Alcoholic beverages===

====Traditional foods with gluten removed====
[[Image:Glutenfreies Bier.jpg|thumb|[[Gluten-free beer]]]]
[[Image:Glutenfreies Bier.jpg|thumb|[[Gluten-free beer]]]]
⚫
Gluten-containing grains can be included in the diet if gluten is removed as shown in the processing flow below:


⚫
{{quotation|Wheat Flour ''(80,000ppm)'' > Wheat Starch ''(200ppm)'' > Dextrin > Maltodextrin > Glucose Syrup ''(<5ppm)'' > Dextrose > Caramel Color}}
⚫
Several celiac disease groups report that according to the [[American Dietetic Association]]'s ''Manual of Clinical Dietetics'',<ref>[http://www.enabling.org/ia/celiac/ada.html "ADA Publishes Revised GF Diet Guidelines"]</ref><ref>[http://www.celiac.com/articles/11/1/Which-alcoholic-beverages-are-safe/Page1.html "Which alcoholic beverages are safe?" Celiac.com]</ref> many types of alcoholic beverages are considered gluten-free, provided no colourings or other additives have been added as these ingredients may contain gluten. Although most forms of whiskey are distilled from a [[mashing|mash]] that includes grains that contain gluten, [[distillation]] removes any proteins present in the mash, including gluten. Although up to 49% of the mash for [[Bourbon whiskey|Bourbon]] and up to 20% of the mash for [[corn whiskey]] may be made up of wheat, or rye, all-corn Bourbons and corn whiskeys do exist, and are generally labeled as such. Spirits made without any grain such as [[brandy]], [[wine]], [[mead]], [[cider]], [[sherry]], [[port wine|port]], [[rum]], [[tequila]], and [[vermouth]] generally do not contain gluten. While some vineyards use a flour paste to caulk the oak barrels in which wine is aged,<ref>StaVin Barrel Inserts Inc. [http://www.stavin.com/barrelsystems/insert.htm] Retrieved May 18, 2009</ref> tests have shown that no detectable amounts of gluten are present in the wine from those barrels.<ref>Celiac.com, referencing a study from [http://www.celiac.com/articles/23076/1/Is-Wine-Aged-in-Wheat-glued-Oak-Barrels-Gluten-free/Page1.html The Gluten-Free Dietician], retrieved September 29, 2013</ref> A small number of vineyards have also used gluten as a clarifying agent, though it is not the standard process; some studies have shown small amounts of gluten to remain in the wine after clarification.<ref>Simonato, Tolin, and Pasini, March 4, 2011 "[http://pubs.acs.org/doi/abs/10.1021/jf104490z?journalCode=jafcau Immunochemical and Mass Spectrometry Detection of Residual Proteins in Gluten Fined Red Wine]," ''Journal of Agricultural and Food Chemistry''</ref> Therefore, some people with celiac or strong gluten sensitivity may wish to exercise caution. [[Liqueur]]s and pre-mixed drinks should be examined carefully for gluten-derived ingredients.


⚫
Gluten-free bread is made with ground flours from a variety of materials such as [[almond]]s, [[rice]] ([[rice bread]]), [[sorghum]] ([[sorghum bread]]), [[corn]] ([[cornbread]]), or legumes such as [[bean]]s ([[bean bread]]). Since these flours lack gluten it can be difficult for them to retain their shape as they rise and they may be less "fluffy". Additives such as [[xanthum gum]], [[guar gum]], [[hydroxypropyl methylcellulose]] (HPMC), [[corn starch]], or [[egg (food)|eggs]] are used to compensate for the lack of gluten.<ref>Schober TJ, Bean SR. [http://www.csaceliacs.org/documents/Gluten-freebaking_000.pdf Gluten-free baking: what is happening inside the bread?] USDA.</ref>
⚫
Almost all beers are brewed with malted [[barley]] or [[wheat]] will contain gluten. [[Sorghum]] and [[buckwheat]]-based [[gluten-free beer]]s are available, but remain a niche market. Some low-gluten beers are available, however, there is disagreement over the use of gluten products in brewed beverages: Some brewers argue that in certain beers the proteins from such grains as [[barley]] or [[wheat]] are converted into [[amino acid]]s during the clarification step of the [[brewing]] process and are therefore gluten-free,<ref>{{cite web| year = 2006| url = http://www.celiac.com/st_prod.html?p_prodid=413| archiveurl = http://web.archive.org/web/20060513235929/http://www.celiac.com/st_prod.html?p_prodid=413| archivedate = 2006-05-13| title = Is Beer Gluten-Free and Safe for People with Coeliac Disease?| publisher = Celiac.com}}</ref> although there is evidence that this protein degradation is only partial.<ref>{{cite web| work=Australian barley technical Symposium| year = 2001| url = http://www.regional.org.au/au/abts/1999/sheehan.htm| title = Improved Methods for Determination of Beer Haze Protein Derived from Malt| publisher = Marian Sheehan A, Evan Evans B, and John Skerritt}}</ref> The Swedish government agency Livsmedelsverket carried out a study of the gluten content in a wide range of beers in 2005 and found that the majority of the beers tested contained less than 200 ppm gluten, with several brands containing less than 20 ppm.<ref>{{cite web| work=Livsmedelsverket| year = 2005| url = http://sverigesbryggerier.se/wp-content/uploads/2009/03/ol-ingredienser-gluteninnehall1.pdf|title=Gluteninnehåll i de öl som analyserats vid Livsmedelsverket|language=Swedish}}</ref> However, they also found that many beers have extremely high levels of gluten so. If unsure, coeliacs are advised to avoid beer.


⚫
Almost all beers are brewed with malted [[barley]] or [[wheat]] will contain gluten. [[Sorghum]] and [[buckwheat]]-based [[gluten-free beer]]s are available, but remain a niche market. Some low-gluten beers are available, however, there is disagreement over the use of gluten products in brewed beverages: Some brewers argue that in certain beers the proteins from such grains as [[barley]] or [[wheat]] are converted into [[amino acid]]s during the clarification step of the [[brewing]] process and are therefore gluten-free,<ref>{{cite web| year = 2006| url = http://www.celiac.com/st_prod.html?p_prodid=413| archiveurl = http://web.archive.org/web/20060513235929/http://www.celiac.com/st_prod.html?p_prodid=413| archivedate = 2006-05-13| title = Is Beer Gluten-Free and Safe for People with Coeliac Disease?| publisher = Celiac.com}}</ref> although there is evidence that this protein degradation is only partial.<ref>{{cite web| work=Australian barley technical Symposium| year = 2001| url = http://www.regional.org.au/au/abts/1999/sheehan.htm| title = Improved Methods for Determination of Beer Haze Protein Derived from Malt| publisher = Marian Sheehan A, Evan Evans B, and John Skerritt}}</ref> The Swedish government agency Livsmedelsverket carried out a study of the gluten content in a wide range of beers in 2005 and found that the majority of the beers tested contained less than 200 ppm gluten, with several brands containing less than 20 ppm.<ref>{{cite web| work=Livsmedelsverket| year = 2005| url = http://sverigesbryggerier.se/wp-content/uploads/2009/03/ol-ingredienser-gluteninnehall1.pdf|title=Gluteninnehåll i de öl som analyserats vid Livsmedelsverket|language=Swedish}}</ref> However, they also found that many beers have extremely high levels of gluten so. If unsure, coeliacs are advised to avoid beer.
=== Gluten-free bread ===
⚫
[[File:Japanese Rice Bread.JPG|thumb|[[Rice bread]]]]
⚫
[[Bread]], which is a staple in many diets, typically is made from grains such as wheat that contain gluten. Wheat gluten contributes to the elasticity of dough and is thus an important component of bread. Gluten-free bread is made with ground flours from a variety of materials such as [[almond]]s, [[rice]] ([[rice bread]]), [[sorghum]] ([[sorghum bread]]), [[corn]] ([[cornbread]]), or legumes such as [[bean]]s ([[bean bread]]). Since these flours lack gluten it can be difficult for them to retain their shape as they rise and they may be less "fluffy". Additives such as [[xanthum gum]], [[guar gum]], [[hydroxypropyl methylcellulose]] (HPMC), [[corn starch]], or [[egg (food)|eggs]] are used to compensate for the lack of gluten.<ref>Schober TJ, Bean SR. [http://www.csaceliacs.org/documents/Gluten-freebaking_000.pdf Gluten-free baking: what is happening inside the bread?] USDA.</ref>


=== Regulation and labels===
=== Regulation and labels===

Revision as of 21:11, 9 August 2014

Meat
Fruit and vegetables

Further information: The oat controversy and Oat sensitivity

A gluten-free diet (GF diet) is a diet that excludes foods containing gluten. Gluten is a protein composite found in wheat (including kamut and spelt), barley, rye and triticale. A gluten-free diet is the only medically accepted treatment for celiac disease.[1] Celiac disease is an autoimmune disease attacking the small intestine due to the presence of gluten.[2][3] Dermatitis herpetiformis (DH) is an autoimmune blistering disorder associated with gluten sensitivity, and is treated with a gluten-free diet.[4] People with these diseases are considered gluten intolerant. Some people have wheat allergy and are tolerant to gluten.[5] Gluten sensitivity is another reason people will choose to go gluten-free.[2]

Some people 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.[6][7] A significant demand has developed for gluten-free food in the United States whether it is needed or not.[8] Peter H.R. Green, MD, director of the Celiac Disease Center at Columbia University stated that the gluten-free market is expanding greatly.[citation needed] This expansion is extremely valuable for those with celiac disease or other medical reasons, such as gluten intolerance or sensitivity. However, a gluten-free diet does not hold the same benefits for the general public.

The exact level at which gluten is harmless for people with celiac disease is uncertain. A 2008 systematic review tentatively concluded that consumption of less than 10 mg of gluten per day for celiac disease patients is unlikely to cause histological abnormalities, although it noted that few reliable studies had been conducted.[9]

The gluten-free diet

Exclusions

Gluten-free food is normally seen as a diet for celiac disease, but people with a gluten allergy (an unrelated disease) should avoid wheat and related grains. A gluten-free diet rules out all ordinary breads, pastas, and many convenience foods; it also excludes gravies, custards, soups, and sauces thickened with wheat, rye, barley, or other gluten-containing flour. Gluten-free bakery and pasta products are available from specialty retailers.

Bread, which is a staple in many diets, typically is made from grains such as wheat that contain gluten. Wheat gluten contributes to the elasticity of dough and is thus an important component of bread.

Oats

Further information: The oat controversy and Oat sensitivity
Oat grains in their husks

A gluten-free diet might also exclude oats. Medical practitioners are divided on whether oats are acceptable to celiac disease sufferers[10] or whether they become cross-contaminated in milling facilities by other grains.[11] Oats may be contaminated when grown in rotation with wheat when wheat seeds from the previous harvest sprout up the next season in the oat field and are harvested with the oats. A growing body of evidence suggests that a majority of people with celiac disease and following a gluten-free diet can safely consume pure oats in moderate amounts. The suitability of oats in the gluten-free diet is somewhat controversial. Some research suggests that oats in themselves are gluten-free, but they are virtually always contaminated by other grains during distribution or processing. Recent research,[12] however, indicated that a protein naturally found in oats (avenin) possessed peptide sequences closely resembling wheat gluten and caused mucosal inflammation in significant numbers of celiac disease sufferers. Some examination results show that even oats that are not contaminated with wheat particles are nonetheless dangerous, while not very harmful to the majority. Such oats are generally considered risky for children with celiac disease to eat, but two studies show that they are completely safe for adults with celiac disease to eat. The EU Standard provides for special treatment of oats. Acknowledging the high potential of oats to become cross-contaminated, the EU Standard specifies that gluten free oat claims must have been specially produced, prepared and/or processed in a way to avoid cross-contamination.

People who merely are "gluten-sensitive" may be able to eat oats without adverse effect,[13] even over a period of five years.[14]

Given this conflicting information, excluding oats appears to be the only risk-free practice for celiac disease sufferers of all ages,[15] however, medically approved guidelines exist for those with celiac disease who do wish to introduce oats into their diet.[16]

Gluten contamination

Meat, fish, poultry, fruit, vegetables, potato, and rice are gluten-free foods. Unless manufactured in a dedicated facility and under gluten-free practices, all cereal grains, including oats, may be cross-contaminated with gluten. Grains become contaminated with gluten by sharing the same farm, truck, mill, or bagging facility as wheat and other gluten-containing grains.

Gluten may be used in foods in some unexpected ways, for example it may be added as a stabilizing agent or thickener in products such as ice-cream and ketchup.[17][18]

The finding of a 2010 study indicates that some inherently gluten-free grains, seed, and flours not labeled gluten-free are contaminated with gluten. The consumption of these products can lead to inadvertent gluten intake.[19] 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.[20]

There is no general agreement on the analytical method used to measure gluten in ingredients and food products.[21] The ELISA method was designed to detect w-gliadins, but it suffered from the setback that it lacked sensitivity for barley prolamins.[22]

Since ordinary wheat flour contains approximately 12% gluten,[23] even a tiny amount of wheat flour can cross-contaminate a gluten-free product, therefore, considerable care must be taken to prevent cross-contamination in commercial and home food preparation.

Many so-called gluten-free products, such as chicken bouillon, corn cereal, and caramel ice cream topping, have been found to have been contaminated with gluten.[24] For example, in an investigation reported by the Chicago Tribune on November 21, 2008, Wellshire Farms chicken nuggets labeled "gluten-free" were purchased from a Whole Foods Market and samples were sent to a food allergy laboratory at the University of Nebraska.[25] Results of the testing indicated gluten was present in levels exceeding 2,000 ppm. After the article was published, the products continued to be sold. After receiving customer inquiries, however, more than a month later, the Whole Foods Market removed the product from their shelves. Wellshire Farms has since replaced the batter used in their chicken nuggets.[26]

Pure chocolate is gluten free but additives with gluten or contamination from the use of machines which previously processed gluten containing food is possible. Several vendors produce chocolate labeled "gluten free".[27]

Some non-foodstuffs such as medications and vitamin supplements, especially those in tablet form, may contain gluten as an excipient or binding agent.[28][29] People with gluten intolerances may therefore require specialist compounding of their medication.[23]

Special care is necessary when checking product ingredient lists since gluten comes in many forms: vegetable proteins and starch, modified food starch (when derived from wheat instead of maize), malt flavoring, unless specifically labeled as corn malt. Many ingredients contain wheat or barley derivatives. Maltodextrin is gluten-free since it is highly modified, no matter what the source.[30]

Inclusions

Quinoa is a pseudocereal that is gluten-free.

Several grains and starch sources are considered acceptable for a gluten-free diet. The most frequently used are corn, potatoes, rice, and tapioca (derived from cassava). Other grains and starch sources generally considered suitable for gluten-free diets include amaranth, arrowroot, millet, montina, lupin, quinoa, sorghum (jowar), taro, teff, chia seed, almond meal flour, coconut flour, pea flour, cornstarch and yam. Sometimes various types of bean, soybean, and nut flours are used in gluten-free products to add protein and dietary fiber.

Rice bread

Almond flour has a low glycemic index. Despite its name, buckwheat is not related to wheat. Pure buckwheat is considered acceptable for a gluten-free diet, however, many commercial buckwheat products are mixtures[citation needed] of wheat and buckwheat flours, and thus, not gluten-free. Gram flour, derived from chickpeas, is gluten-free (this is not the same as Graham flour made from wheat).

A gluten-free diet allows for fruit, vegetables, meat, and many dairy products. The diet allows rice, corn, soy, potato, tapioca, beans, sorghum, quinoa, millet, pure buckwheat, arrowroot, amaranth, teff, Montina, and nut flours and the diet prohibits the ingestion of wheat, barley, rye, and related components, including triticale, durum, graham, kamut, semolina, spelt, malt, malt flavouring, or malt vinegar.[31]

Chickpeas

Several celiac disease groups report that according to the American Dietetic Association's Manual of Clinical Dietetics,[32][33] many types of alcoholic beverages are considered gluten-free, provided no colourings or other additives have been added as these ingredients may contain gluten. Although most forms of whiskey are distilled from a mash that includes grains that contain gluten, distillation removes any proteins present in the mash, including gluten. Although up to 49% of the mash for Bourbon and up to 20% of the mash for corn whiskey may be made up of wheat, or rye, all-corn Bourbons and corn whiskeys do exist, and are generally labeled as such. Spirits made without any grain such as brandy, wine, mead, cider, sherry, port, rum, tequila, and vermouth generally do not contain gluten. While some vineyards use a flour paste to caulk the oak barrels in which wine is aged,[34] tests have shown that no detectable amounts of gluten are present in the wine from those barrels.[35]

A small number of vineyards have also used gluten as a clarifying agent, though it is not the standard process; some studies have shown small amounts of gluten to remain in the wine after clarification.[36] Therefore, some people with celiac or strong gluten sensitivity may wish to exercise caution. Liqueurs and pre-mixed drinks should be examined carefully for gluten-derived ingredients.

Traditional foods with gluten removed

File:Glutenfreies Bier.jpg
Gluten-free beer

Gluten-containing grains can be included in the diet if gluten is removed as shown in the processing flow below:

Wheat Flour (80,000ppm) > Wheat Starch (200ppm) > Dextrin > Maltodextrin > Glucose Syrup (<5ppm) > Dextrose > Caramel Color

Gluten-free bread is made with ground flours from a variety of materials such as almonds, rice (rice bread), sorghum (sorghum bread), corn (cornbread), or legumes such as beans (bean bread). Since these flours lack gluten it can be difficult for them to retain their shape as they rise and they may be less "fluffy". Additives such as xanthum gum, guar gum, hydroxypropyl methylcellulose (HPMC), corn starch, or eggs are used to compensate for the lack of gluten.[37]

Almost all beers are brewed with malted barley or wheat will contain gluten. Sorghum and buckwheat-based gluten-free beers are available, but remain a niche market. Some low-gluten beers are available, however, there is disagreement over the use of gluten products in brewed beverages: Some brewers argue that in certain beers the proteins from such grains as barley or wheat are converted into amino acids during the clarification step of the brewing process and are therefore gluten-free,[38] although there is evidence that this protein degradation is only partial.[39] The Swedish government agency Livsmedelsverket carried out a study of the gluten content in a wide range of beers in 2005 and found that the majority of the beers tested contained less than 200 ppm gluten, with several brands containing less than 20 ppm.[40] However, they also found that many beers have extremely high levels of gluten so. If unsure, coeliacs are advised to avoid beer.

Regulation and labels

Regulation of the label gluten-free varies by country. Most countries derive key provisions of their gluten free labeling regulations from the Codex Alimentarius which divides gluten free food as:

  • Food that is gluten free (20 ppm or less of gluten) by composition
  • Food that has become gluten free (20 ppm or less of gluten) through special processing.
  • Reduced gluten content, food which includes food products with between 20 ppm 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.

European Union

Following the 2008 update of the Codex Standard, the European Union adopted its own regulations, substantially based on it. The EU’s Commission Regulation No 41/2009[41] delineates the categories as:

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

Canada

Health Canada considers that foods containing levels of gluten not exceeding 20 ppm as a result of cross-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.[42]

Australia

The Australian government recommends[43] 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

United States

Until 2013 anyone could use the gluten free claim with no repercussion. 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.

Celiac disease and other medical reason

Celiac disease is the primary reason that one would switch to a gluten-free diet. Celiac disease is an autoimmune disease, affecting between about 0.06 to 1% of all Americans. In patients with celiac disease, gluten causes the immune system to attack the intestinal lining of the small intestine. Over time this then triggers the small intestine to lose the ability to absorb nutrients into the body, such as fiber and vitamins. If gone untreated the lack of nutrients can initiate other health problems that include osteoporosis, iron-deficiency anemia, other autoimmune disorders, extreme fatigue, infertility, neurological problems and, in rare cases, lymphoma of the small intestine. Symptoms rarely occur, but if they do, they include diarrhea, anemia, bone pain, and a severe skin rash called dermatitis herpetiformis. Because of the lack of symptoms, it is believed only five to ten percent of people with celiac disease are diagnosed.[2][3]

Dermatitis herpetiformis (DH) is a type of celiac disease that causes the immune system to attack the skin rather than the small intestine. When it attacks the skin it produces inflammation, irritation, redness. This creates a chronic itchy and bumpy rash to appear. Typically, this appears after the intake of gluten. People with DH are advised to adhere to a gluten-free diet.[2]

Gluten sensitivity is the inability and trouble for a person to metabolize gluten. This results in digestive distress, which can cause symptoms such as diarrhea, gas, bloating, constipation, and bowel discomfort. These digestive symptoms occur after the intake of gluten. Gluten sensitivity is far less severe and does not appear to have any long term effects. A reduced-gluten or gluten-free diet is suggested to prevent the discomfort.[2][3]

Popularity and nonceliac health effects

Gluten-free fad diets have become popular. This may be because celiac disease was under diagnosed or because people are unnecessarily turning to the diet as a food fad. There appears to be an increased incidence of celiac disease, with one study which looked for antibodies from 1950s American blood samples finding that celiac disease is about four times more common now as it was then.[44] Many are adopting gluten-free diets to treat celiac disease-like symptoms in the absence of a positive test for celiac disease.

The existence of gluten sensitivity in non-celiac individuals remains contentious. A double-blind experiment conducted in 2013 concluded that non-celiac gluten sensitivity does not exist, and that the symptoms are caused by the nocebo effect.[45] However, a prior, less rigorous, study in 2011 by the same authors concluded that there is a condition related to gluten other than celiac disease that was named "non-celiac gluten sensitivity".[46] In either case, for those without celiac disease or gluten sensitivity, the diet may be unnecessary.[47][48] There are a wide variety of names which have been used in medical literature for gluten-related disorders which are different from celiac disease. Some of them are confusing and ambiguous. "Non-celiac gluten sensitivity" is the recommended umbrella term for conditions where symptoms different from celiac disease result from ingestion of gluten.[49]

Despite some advocacy, evidence of the diet's efficacy as an autism treatment is poor.[50] Despite vigorous marketing, a variety of studies, including a study 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.[51]

Deficiencies linked to maintaining a gluten-free diet

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.[52] Additionally, because gluten-free products are not always available, many gluten-sensitive enteropathy (GSE) patients do not consume the recommended number of grain servings per day. People who change their standard gluten-free diet to implement gluten-free oats at breakfast, high fiber brown rice bread at lunch, and quinoa as a side at dinner have been found to have significant increases in protein (20.6 g versus 11 g), iron (18.4 mg versus 1.4 mg), calcium (182 mg versus 0 mg), and fiber (12.7 g versus 5 g). The B vitamin group did not have significant increases, but were still found to have improved values of thiamine, riboflavin, niacin, and folate.[53] These dietary changes can greatly reduce a GSE patient's risk for anemia (especially iron deficiency anemia) and low blood calcium levels or poor bone health.

Oats can increase intakes of vitamin B1, magnesium, and zinc in celiac disease patients in remission.[54]

Selenium deficiency in gluten-free diet, combined with malabsorption of selenium in patients with uncontrolled celiac disease is considered a direct factor in the development of comorbid autoimmune thyroid diseases for celiac patients.[55][56]

See also

References

  1. ^ Hischenhuber, C.; Crevel, R.; Jarry, B.; Maki, M.; Moneret-Vautrin, D. A.; Romano, A.; Troncone, R.; Ward, R. (2006). "Review article: safe amounts of gluten for patients with wheat allergy or coeliac disease". Alimentary Pharmacology and Therapeutics. 23 (5): 559–575. doi:10.1111/j.1365-2036.2006.02768.x. PMID 16480395.
  2. ^ a b c d e Lewis, Shannon. "Three Reasons to Go Gluten Free and Three Reasons Not to". Related Forms & Information. Province Health & Services. Retrieved March 30, 2014.
  3. ^ a b c Jaret, Peter. "The Truth About Gluten". WebMD. WebMD. Retrieved March 30, 2014.
  4. ^ http://emedicine.medscape.com/article/1062640-overview
  5. ^ http://www.mayoclinic.org/diseases-conditions/wheat-allergy/basics/definition/con-20031834
  6. ^ Gaesser, G. A.; Angadi, S. S. (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.
  7. ^ De Palma, Giada (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 July 25, 2013. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  8. ^ 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.
  9. ^ 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.
  10. ^ N Y Haboubi, S Taylor, S Jones (2006). "Celiac disease and oats: a systematic review". The Fellowship of Postgraduate Medicine.{{cite web}}: CS1 maint: multiple names: authors list (link)
  11. ^ "The Gluten-Free Diet", CeliacSociety.com
  12. ^ Arentz-Hansen H, Fleckenstein B, Molberg Ø, Scott H, Koning F, Jung G, Roepstorff P, Lundin KE, Sollid LM (October 19, 2004). "The Molecular Basis for Oat Intolerance in Patients with Coeliac Disease". PLoS Medicine. 1 (1). PLoS Medicine: e1. doi:10.1371/journal.pmed.0010001. PMC 523824. PMID 15526039. Retrieved July 22, 2006.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  13. ^ Størsrud S, Olsson M, Arvidsson Lenner R, Nilsson LA, Nilsson O, Kilander A (May 7, 2002). "Adult celiac patients do tolerate large amounts of oats". European Journal of Clinical Nutrition. 57 (1). doi:10.1038/sj.ejcn.1601525. PMID 12548312. Retrieved August 14, 2008.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ Janatuinen, E K; T A Kemppainen; R J K Julkunen; V-M Kosma; M Mäki; M Heikkinen; M I J Uusitupa (May 1, 2002). "No harm from five year ingestion of oats in celiac disease". GUT Journal Online. Retrieved August 14, 2008.
  15. ^ "The Scoop on Oats". Celiac Sprue Association (CSA). February 20, 2008.
  16. ^ Mohsid, Rashid (June 8, 2007). "Guidelines for Consumption of Pure and Uncontaminated Oats by Individuals with Coeliac Disease". Professional Advisory Board of Canadian Coeliac Association. Retrieved August 14, 2008.
  17. ^ Pat Kendall, Ph.D., R.D. (March 31, 2003). "Gluten sensitivity more widespread than previously thought". Colorado State University Extension.{{cite web}}: CS1 maint: multiple names: authors list (link)
  18. ^ "Following a Gluten-free Diet". Beth Israel Deaconess Medical Center. A Harvard teaching hospital. {{cite web}}: Check date values in: |date= (help)
  19. ^ Journal of the American Dietetic Association. June 2010;939
  20. ^ 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
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  22. ^ 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.
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  38. ^ "Is Beer Gluten-Free and Safe for People with Coeliac Disease?". Celiac.com. 2006. Archived from the original on May 13, 2006.
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  48. ^ Oct. 18, 2012 Sarah Auffret, Arizona State University (October 18, 2012). "Gluten-free fad not backed by science | Management content from". Western Farm Press. Retrieved December 6, 2013.{{cite web}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
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  50. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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