Why do we see “gluten-free” on menus and food packages?  Gluten is a protein found in a number of common grains such as wheat, barley and rye.  It makes dough sticky so that breads and pastries don’t fall apart easily.  There are two main reasons for avoiding gluten.  First, about 1% of the global population suffers from celiac disease, which is an intestinal disease triggered by gluten ingestion.  The second reason is dietary preference.  Some people believe that a gluten free diet promotes a low carbohydrate diet which will improve a person’s overall health; however, these benefits are controversial to some people.  

 

What is celiac disease?  The presence of gluten in the bowel causes an inflammatory response in the lining of the small intestine which causes celiac disease.  Although it is an immune response to the presence of gluten, it is not considered a true food allergy, but rather an autoimmune disease due to the fact that the immune cells (in this case gluten-reactive T-cells) attack the normal lining of the bowel, and does not trigger an IgE-mediated histamine release.  Regardless of the precise medical terminology, if you have celiac disease and a server at a restaurant asks you if you have an allergy to gluten, just say YES as this means that they will be more careful in safeguarding against cross contamination in the food preparation process.

 

People with celiac disease can have symptoms such as diarrhea, constipation, weight loss, abdominal pain, distention, bloating and poor absorption of nutrients.  Diagnosis of celiac disease can be made by a doctor (a gastroenterologist) who can perform a flexible scope exam and biopsy of the lining of the small bowel.  

 

Celiac disease and wheat allergies are not the same.  A person can have a wheat allergy without having celiac disease.  A person with a wheat allergy may be allergic to a component of wheat that is not gluten.  As a result, a person with a wheat allergy may still be able to consume barley and rye without an allergic reaction, despite the fact that barley and rye also contain gluten.  If your family member does have a wheat allergy and not celiac disease, often it it still easier to look for “gluten free” food anyways, due to the fact that it has now become such a common term.  Just be aware that there might be a few instances where a person with a wheat allergy might be able to have some foods containing gluten due to the fact that the gluten is not from wheat.

 

A few examples of food that might contain gluten, but not from a wheat source, include miso paste and some beers (not that your child should be drinking beer).  Miso is a common component of Japanese food which sometimes uses barley and therefore is labelled as containing gluten.  Most beers also contain gluten because barley is the most common grain used in making beer, but not all beers have wheat.  What makes it difficult to determine whether a beer contains wheat or not, is the fact that the alcohol industry in the United States is not regulated by the FDA and therefore does not have to list its ingredients.  The European Union, on the other hand, has regulations requiring the listing of ingredients.  In fact, Germany has a 500 year old beer purity law, the Reinheitsgebot, which requires beer to be made only from four ingredients: water, barley malt, hops and yeast.  If a beer in Germany contains wheat, it must be labeled as such.

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Despite the fact that celiac disease and wheat allergies are two distinct medical processes, it is often easier for people to lump them together since the overlap in the food restrictions is so great.  So even if your child has a wheat allergy and not celiac disease, asking for gluten free food is an easy way to keep your child safe.