Glutens are water-insoluble storage proteins (prolamins) found in wheat, durum wheat (used in pasta), spelt wheat (spelta), polonicum (Polish wheat), Kamut, monoccum (einkorn), farro, triticale (a cross between wheat and rye), and many wild grass species not usually consumed by man. The actual names of toxic proteins are gliadin in wheat, secalin in rye and hordein in barley.
The presence of glutens in flour help to make bread and other baked products. Glutens are also used in special high-protein breakfast foods and other cereal foods and in adhesives and as meal for cattle food. Glutens also may be used in the manufacture of certain amino acids, including glutamic acid and its salt, the seasoning agent monosodium glutamate.
In some people, glutens can provoke malabsorption. This is a group of diseases that interfere with the absorption of vitamins, minerals, proteins, carbohydrates, and fats from the intestinal wall into the body. The most important form of malabsorption is celiac disease (CD) or gluten intolerance when glutens act as toxins.
Symptoms A wide range of symptoms may occur singly or in combination in children and adults:
- Diarrhea, constipation (often both)
- Bloating and gas
- Nausea and vomiting
- Weight loss
- Chronic fatigue syndrome (CFS) and weakness
- Iron deficiency with or without anemia
- Vitamin and/or mineral deficiency
- Mouth ulcers
- Bone/joint pain
- Depression
- Lactose (milk sugar) intolerance
- Easy bruising of the skin
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Additional symptoms in children
- Severe irritability
- Distended abdomen
- Failure to thrive
- Delayed puberty
- Dental enamel defects
- Concentration/learning difficulties
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Celiac disease is considered to be the most underdiagnosed common disease today, affecting 1 in every 130-200 people in North America. New research indicates that celiac disease is twice as common as Crohn's disease, ulcerative colitis and cystic fibrosis combined.
Although there are several blood screening tests for detecting IgA endomysial and IgA tissue transglutaminase antibodies, the only definitive test for diagnosing celiac disease is a small bowel biopsy.
Treatment of the disease is aimed at eliminating gluten from the diet. Substitue grains are corn, rice and buckwheat. Although rice contains orzenin prolamin and corn contains zein prolamin, these prolamins are not toxic to the intestines of people with celiac disease.
Theoretically, gluten-free diet (GFD) is a straightforward treatment for celiac, but applying it in real life is a challenge. However, people with celiac disease should realize that treatment should improve their symptoms and prevent further complication of the disease, including small intestinal cancers, increased risk for type I diabetes, anemia, infertility, miscarriages, depression, thyroid disease, and osteoporosis. The maintenance of GFD is not as simple as it seems, and contamination is very common and is the leading reason for persistence of symptoms in individuals with celiac disease.
Flours allowed in GFD include rice, soybean, corn, soy, potato, tapioca, arrowroot, bean, sorghum, quinoa, millet, buckwheat, teff, nut, and amaranth. Products containing any of these are safe for comsumption by people with CD.
Almost all grains, whether having celiac disease toxicity or not, have proteins capable of producing an allergic reaction in some people. But unlike celiac disease, allergy is not caused by gluten and proteins and its symptoms are different from those of celiac disease. Only wheat and oats have been studied extensively for their toxicity in celiac disease, with wheat being obviously much more toxic than oats. Provided safe, (not contaminated with wheat) oat products are used, the majority of people with celiac disease tolerate oats well.
Rye and barley have many proteins that are almost identical to those in wheat, although they lack an important wheat protein type, the α-gliadin (one of the most toxic studied protein fraction) which makes them less toxic as compared to wheat. All foods with prolamins should not be included in the diet in order to comply with GFD. A wheat-free diet does not mean a gluten-free diet, because gliadin (one of the most toxic wheat protein) equivalents (the secalins in barley and the hordeins in rye) are as toxic to patients with CD as gliadin. Malt is also toxic because it is derived from barley prolamins. Other grains and cereal products that are also toxic include triticale (a wheat-rye hybrid), couscous, kamut, spelt, and semolina.
Hidden glutens While the presence of gluten is evident in baked goods and pasta, a wide variety of products have hidden glutens:
- Broth
- Breading
- Brown rice syrup
- Brown rice syrup
- Coating mixes
- Couscous
- Crouton
- Caramel color
- Cereal products
- Catsup and mustard
- Candy bars
- Chip and dip mixes
- Crouton
- Flavoring in meat products
- Hydrolyzed plant protein
- Hot chocolate mixes or cocoa
- Imitation bacon or seafood marinades
- Instant coffee and tea
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- Malt
- Malt flavoring
- Modified food starch
- Nondairy creamer
- Pastas
- Peanut butter
- Processed meats and poultry
- Salad dressings
- Sausage products
- Sauces
- Some brands of ice cream
- Soup bases
- Sauces
- Soy sauce
- Stuffings
- Tomato sauce
- Vegetable gum
- Vegetable protein (thickener)
- Yogurts with fruit
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Medications, vitamins, and mineral supplements also may contain gluten as an inactive ingredient.
Hidden glutens in common foods
DERMATITS HERPETIFORMS (DH) is another form of celiac disease. It is a chronic skin condition characterized by an intense burning and itching rash. The most common areas affected are the elbows, knees, back of neck and scalp. Many with DH will have no bowel complaints, although a small number of people may have bloating and diarrhea.
Diagnosis for DH is a skin biopsy from unaffected skin next to sore.
Treatment for DH is a strict gluten-free diet and medications to control rash and inflammation.