Gluten-free diet – what to know about it

Article by  Karolina Jakiel

What is gluten?

The definition formulated by FAO / WHO defines gluten as a protein fraction that is as insoluble in water and 0.5 M NaCl present in wheat, rye, barley, oats and their derivatives, as well as in hybrid varieties, i.e. triticale

In the medical sciences, a more concise gluten definition is used, which applies only to the ethanol soluble prolamin fraction, including

-wheat – gliadin

-rye – secalin

-barley – hordein

Damage to small intestine cells after ingestion of cereal products naturally containing gluten depends on the amount of nitrogen in the prolamin fraction, as well as their composition and amino acid sequence.

Based on studies have been conducted, it was shown that fragments with a small amount of proline are not harmful to people with hypersensitivity to gluten, and that the most toxic is the proline-rich sequence at the gliadin N-terminus.

Gluten-free diet

A gluten-free diet consists of eliminating products containing gluten, prolamin found in wheat, barley and rye from the everyday diet.

People on a gluten-free diet should eliminate such products as: barley (barley groats, pearl barley) wheat and its products, bulgur grits, semolina, couscous, spelled, rye and triticale.

It is also recommended to eliminate oat products due to the likelihood of grain contamination in the production process.

In addition, people on a gluten-free diet should not buy ready-made meat dishes, breaded meat, vegetable fish, dairy products with the addition of cereals or barley malt, wheat germ oils, cakes and pastries from gluten-free cereals, cereal coffee, baking powder, soy sauce.

However, gluten-free foods contain much less protein, B vitamins, magnesium, iron, zinc, copper and fiber. However, they contain higher amounts of fat, saturated fatty acids, trans fatty acids, salt and sugar.

Indications for using a gluten-free diet

-> Celiac disease is a genetically determined food hypersensitivity to gluten found in cereals. It is recognized as a systemic autoimmune disease and is characterized by the presence of specific antibodies in the serum, the presence of HLA-DQ2 or HLA-DQ8 haplotype and enteropathy.

This disease consists in disorders of digestion and intestinal absorption, leads to the disappearance of intestinal villi, which prevents the absorption of nutrients from food.

This disease affects people of all ages: children, but also adults, who initially were asymptomatic.

It is also found to be more frequent in women than in men.

Typical symptoms include chronic or recurrent diarrhea, bloating, nausea, abdominal pain, stinky stools with undigested food leftovers, sudden or unintentional weight loss. Less characteristic symptoms are weakness, chronic fatigue, irritability, depression, anemia.

->Duhring desease-  dermatitis herpetiformis is a cutaneous manifestation of gluten intolerance. It is called the dermal form of celiac disease and often occurs in the same families where celiac disease sufferers.

Ailments mainly affect skin eruptions and pruritus, and to a lesser extent, bowel disorders. Skin lesions are most often located on the knees, elbows, near the sacrum, the buttocks, the area of the shoulders, the face and the scalp.

This disease affects mainly children, however, there are cases of its occurrence in adults.

->Non-celiac gluten sensivity (NCGS) the type of food intolerance caused by gluten intake associated with the occurrence of symptoms in patients who were excluded celiac disease and intolerance to gluten. The most common symptoms are abdominal pain, persistent flatulence, unjustified anxiety and sleep disturbances, headaches, fatigue, diarrhea and muscle pain. The condition for NCGS diagnosis is the effectiveness of using a gluten-free diet and the return of symptoms after the gluten has been implemented. This disease entity, however, requires further research.

-> Allergy to wheat can occur in two forms: immediate (IgE-dependent) and delayed (IgE independent). Allergy to wheat can be manifested by skin reactions, ailments in the digestive and respiratory system. WHO has announced 21 allergens responsible for allergy to wheat.

The unfounded implementation of a gluten-free diet in a healthy person

Gluten-free diet is increasingly used by health conscious people, this is largely due to marketing activities promoting gluten-free products and emerging pseudoscientific information. A study by Marcason shows that there is no evidence of the benefits of a gluten-free diet to reduce body weight. This diet contains a small amount of fiber and is associated with the probability of a shortage of nutrients.

In other studies, it was concluded that reduced intake was associated with a reduced amount of fiber in the diet, which contributed to an increased risk of cardiovascular disease.

In 2017 the American Heart Association concluded that a higher intake of gluten, including fiber, was associated with a lower risk of developing type 2 diabetes.

Research by Jenkins et al. shows that higher fiber intake has a positive effect on lowering triglycerides and LDL cholesterol.

The elimination of products containing gluten from the diet adversely affects the intestinal flora, which has been confirmed in people with celiac disease

More information:

-Marcason W. Is there evidence to support the claim that a gluten-free diet should be used for weight loss? J Am Diet Assoc. 2011; 111(11): 1786

-Lebwohl B, Cao Y, Zong G, et al. Long term gluten consumption in adults without celiac disease and risk of coronary heart disease: prospective cohort study. BMJ. 2017; 357: j1892

-Lebwohl B, Hu F, Sampson L, et al. Low gluten diets may be associated with higher risk of type 2 diabetes. American Heart Association Meeting Report Presentation. 2017; 11.

-Jenkins DJ, Kendall CW, Vuksan V, et al. Effect of wheat bran on serum lipids: influence of particle size and wheat protein. J Am Coll Nutr. 1999; 18(2): 159–165

-Jenkins DJ, Kendall CW, Vidgen E, et al. High-protein diets in hyperlipidemia: effect of wheat gluten on serum lipids, uric acid, and renal function. Am J Clin Nutr. 2001; 74(1): 57–63,

-Caminero A, Nistal E, Herrán AR, et al. Differences in faecal bacteria populations and faecal bacteria metabolism in healthy adults and celiac disease patients. Biochimie. 2012; 94(8): 1724–1729

-De Palma G, Nadal I, Collado MC, et al. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult human subjects. Br J Nutr. 2009; 102(8): 1154–1160 

Karolina Jakiel – master of dietetics specialist in psychodietetics.
She obtained her master’s degree at the University of Rzeszow in Poland, completed post-graduate studies in psychodietetics at the University of Social Sciences and Humanities (SWPS University) in Katowice in Poland.
During her studies, she participated in numerous courses and trainings, among others: diagnostics in the office of a dietician, insulin resistance, psychodietetics, sports dietetics, oncological dietetics, and diet for the elderly.
During her studies she took an active part in the activities of the Scientific Circle of Dieticians at the University of Rzeszow.
She is interested in healthy eating and shares her ideas through her profile in social media.

About Dr Antonella Grima

Dr. Antonella Grima M.D. M.Sc. Pg.Dip. is the founder of the Health and Nutrition Centre in Luqa, Malta. She is a Medical Doctor specialised in Public Health as well as a Registered Nutritionist. Read More >

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