Gluten Intolerance

Gluten intolerance, or gluten sensitive enteropathy, is a disorder in which damage to the surface of the small intestine interferes with the ability to tolerate protein components of certain grains. Diseases in this category include Celiac Sprue, Dermatitis Herpetiformis, and transient gluten sensitivity.

Celiac Sprue
Celiac Sprue, also called nontropical sprue, is a unique food intolerance that provokes an immune system reaction. In Celiac disease, the body reacts to gliadin, a protein found in gluten. This reaction is thought to be caused by interactions between gliadin, the immune system, genetics, as well as viruses. The gliadin protein is present in wheat gliadins, rye secalins, barley hordeins and oat avenins.

Celiac disease can ultimately result in damage to the intestinal lining and decreased ability to absorb nutrients. Symptoms of gluten intolerance vary depending on the extent of the reaction and can range from minimal to severe. They include, but are not limited to, fatigue, iron-deficiency anemia, diarrhea, weight loss, abdominal cramping, gas, distention, and constipation that may alternate with diarrhea. Other nutrient deficiencies are certainly possible due to the malabsorption.

Clearly, identification and prompt treatment of Celiac Sprue is important to avoid these serious health consequences. Diagnosis of Celiac disease is made by small intestinal biopsy and improvement on a gluten free diet. Celiac sprue is not a sensitivity problem that is outgrown and requires a life-time avoidance of those foods containing gliadin. Medications may be helpful in relieving some discomfort associated with the disease.

Dermatitis Herpetiformis
Dermatitis Herpetiformis is a condition associated to Celiac Sprue. Persons presenting with this skin disorder also show sensitivity to gliadin with its associated intestinal symptoms. In fact, institution of a gluten free diet often relieves both the skin lesions and intestinal symptoms. Improvement of the skin lesions may, however, take many years.

Dermatitis Herpetiformis is commonly a lifelong disease that requires medical treatment. Although the severity may wax and wane, complete remission is uncommon and occurs in only 10-20 percent of those affected. Dietary restriction of gluten has a pivotal role and can help lower the requirement for medications and relieve intestinal symptoms.

Treatment
A gluten free diet eliminates all foods and food ingredients that contain any amount of gluten or more specifically gliadin, a protein found in wheat, barley, oats, and rye. Gluten is also found in rice but gliadin is not. Following a gluten free diet results in improvement of the intestinal tract within one week. However, complete recovery may take up to 6 months.

Label reading is extremely important when following a gluten free, gliadin free diet as there are many hidden sources of gliadin. Products labeled gluten free may still contain gliadin. Foods with no label or vague ingredients should be avoided.

As gluten can be found in so many foods on the market, it is important to explore substitute foods and sample menus, in addition to many mail order special gluten free foods. Maintaining a well-rounded and nutritionally complete diet is important in recovery of the intestinal tract and immune system.

Careful reading of labels and ingredient lists on food packages is essential to avoiding gliadin containing gluten foods. Wheat, barley, oats, and rye are used in many foods, especially bakery products. It may be impossible to find gluten-free bakery items on the popular market. However, these foods can be found in health food stores as well as through mail order.

Even with familiar brands, it is very important to read all labels carefully prior to buying or eating a food. Food manufacturers frequently change suppliers and ingredients. It is equally important to read labels when changing brands. Different brands of the same type of food may contain different ingredients.

Review the list of common foods and ingredients containing gluten and help take the guess work out of label reading. Keep this list handy, you never know when you will need to read a food label.

Substitutions for gluten containing foods require some creativity to produce foods with similar tastes and textures. The substitutions offered here are for breads, quick breads, muffins, pizza/focaccia, piecrusts, brownies, a cake, and a few cookies. There are many commercially produced, gluten free pastas that are tasty with good textures. These cannot be substituted cup for cup for wheat flour. Play around with different combinations and figure you will need at least ¼ cup more of these flours in place of wheat in a given recipe.

Breads
Breads can be made by hand, however, a bread machine may make a more consistent and better textured loaf. Xanthan gum (½ tsp) needs to be added to all flour mixtures when making bread for a better mouth feel. Experiment with your own flour mixes to find the right amount of gum that suits your taste.

Identify the foods that will be the most difficult for you to give up, the ones that makeup the bulk of your daily diet, and focus on replacing these first with yummy new alternatives. Cookbooks and recipe resources can give you many more ideas about how to avoid gluten when cooking. For example, ethnic cookbooks commonly offer tasty recipes where the product is not compromised by a food allergy, as traditional ethnic foods are often low in allergenic foods. Remember to read the ingredient list of all foods, especially your condiment and spice mixtures.

Gluten-Free Substitutions

• Rice flour (brown or white)
• Potato Flour
• Corn flour or meal
• Tapioca starch
• Sweet rice flour
• Soy flour or meal
• Bean flour
• Cornstarch
• Potato starch
• Arrowroot starch

Not all flours are appropriate substitutions. Depending on the recipe and desired flavor, flours can be chosen that would enhance the food product.