Topic 3 Gluten Intolerance

What is gluten?

Gluten is a protein found in wheat, rye, oats, and barley. Biesiekierski (2017) defines gluten as “a complex mixture of hundreds of related but distinct proteins, mainly gliadin and glutenin”. Gluten acts like a binding agent and is commonly used to add moisture, texture, and flavour to processed foods, mainly to doughs, pasta, biscuits, pastries, and cakes (ibid.).

  • tiredness
  • stomach-aches
  • muscle cramps
  • leg numbness

When the immune system is triggered, reaction to gluten leads to coeliac disease (or gluten enteropathy). According to Rich et al. (2019), coeliac disease is a chronic “autoimmune disorder of the small intestine caused by a combination of genetic and environmental factors”. It affects the small intestine and presents various symptoms such as “diarrhoea, steatorrhea, weight loss, bloating, flatulence, abdominal pain, […] abnormal results on liver function tests, iron deficiency anaemia, bone disease, and skin disorders” (ibid.). People suffering from coeliac disease may also have other nutrient deficiencies such as “anaemia, osteoporosis, failure to thrive in children” (ibid.).

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  • Coeliac disease may be the cause of dermatitis herpetiformis, a skin condition, “cerebellar ataxia, infertility and miscarriage, chronic fatigue, and associated autoimmune disorders, such as diabetes and thyroiditis, Addison disease, Sjögren syndrome, autoimmune hepatitis, and primary biliary cirrhosis” (Rich et al., 2019).
  • Gluten sensitivity may also lead to enteropathy not related to coeliac disease. According to Rich et al. (2019), this condition manifests through “a set of poorly characterized gut and extraintestinal symptoms that lack the defining features of coeliac disease yet respond to a gluten-free diet”. There is no current cure available for coeliac disease, other than gluten restricted diet (avoiding wheat, barley, and rye in particular) (ibid.).
  • Crohn disease is “a chronic idiopathic inflammation of the gut characterized by transmural involvement of the bowel wall (mucosa, muscle layer, and serosa)” the cause of which is currently unknown (ibid.). However, it is associated with gluten sensitivity. It affects the bowels and most people suffering from it require operation (ibid.). Crohn disease is a painful condition, it involves “abdominal pain, altered bowel habits, and rectal bleeding” (ibid.). “Fever, unexplained weight loss, fatigue, anaemia, and growth retardation (in children)” (ibid.) are some additional symptoms of this disease. Crohn disease may also be the cause of “arthritis, uveitis, inflammatory skin lesions […] and stomatitis (ibid.).

Since there is no current cure for gluten sensitivity, scientists, medical experts, and nutritionists propose various dietary plans and alternatives to gluten.

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Gluten is found in common grains, such as wheat, barley, and rye (Diez-Sampedro et al., 2019). A gluten-free diet is based on gluten containing foods’ avoidance:

  • Wheat
  • Barley
  • Rye
  • Triticale (a cross between wheat and rye)
  • Oats, in some cases

We must underline that the people who choose gluten-free products when it is not required, may have multiple nutritional deficiencies including fibre, iron, zinc, potassium, and B vitamins’ deficiency (Jones, 2017). Gluten-free products tend to be higher in fat which can lead to chronic diseases like CVD, diabetes, or hypertension. The key to making mealtimes less depressing after a diagnosis or prescribed diet is to find a substitute that works as a viable alternative. For example:

  • Bread: can be substituted by gluten-free rolls or loafs, corn tortillas, or rice crackers.
  • Pasta: can be substituted by rice, quinoa, or chickpea pasta, arborio rice, polenta, or rice noodles.
  • White flour and wheat: can be substituted by nut flours, rice flour, chickpea flour, yellow or white cornmeal.

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For people who suffer from coeliac disease, it is important to avoid exposure to gluten and to prevent cross-contamination when preparing food at home . Here is a list of tips to keep in mind:

  • Store gluten-free and gluten-containing foods in different places.
  • Keep cooking surfaces and food storage areas clean.
  • Wash dishes and cooking equipment thoroughly.
  • Toast bread in the oven (or consider separate toasters) to avoid cross-contamination.

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Nowadays, it is easier to find restaurants and bars in which gluten-free menus are available and the kitchen staff is aware of the food handling procedures in place to cater for people who need a strict gluten free diet. Some suggestions for making a healthy and safe menu for people suffering from coeliac disease (Schaibly, 2013):

Once the potential allergy risks on the menu have been determined, it is recommended to provide a gluten-free version of the menu. To achieve good response, it is important to ensure that the menu includes real, delicious food rather than gluten-free dishes that seem to lack flavour or substance. To set a good menu and provide healthy dishes, restaurants and food handlers can collaborate with organisations dedicated to coeliac disease and gluten-free lifestyle (ibid.).

It is highly recommended to check the labels and nutritional facts of prepacked products to determine items that contain gluten. Likewise, to identify gluten-containing ingredients in the kitchen and isolate them. Gluten-free products must be placed in a separate section of the kitchen. It is also essential to separate items in the storage and walk-ins to make sure there is no cross-contamination (ibid.).

During food preparation, separation and hygiene are key. Each person in the kitchen must be aware when an order needs to be made gluten-free, they should wear gloves and use separate equipment. Restaurants should have fryers and equipment (ovens, warmers, etc.) labelled for gluten-free cooking only. A gluten-free kit including sanitized tongs, spatulas, grill brushes, sauté pans, a cutting board is also an easy way to make sure that sanitized tools are ready for use when a guest orders a gluten-free menu item (ibid.).

The key to keep the kitchen always properly sanitized is cleaning multiple times throughout each day and making sure all equipment is sanitized after each use will make the process flow smoothly (ibid.).

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Watch the video below to understand how foods with allergens, e.g. gluten, should be handled