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A gluten-free diet is recommended amongst other things in the treatment of celiac disease and wheat allergy. It is a diet completely free of ingredients derived from gluten-containing cereals: wheat (including kamut and spelt), barley, rye, and triticale, as well as the use of gluten as a food additive in the form of a flavoring, stabilizing or thickening agent. Additionally, the diet may exclude oats. Some people for whom the diet is recommended can tolerate oat products and some medical practitioners say they may be permitted,^[1] but there is controversy about including them in a gluten-free diet because studies on the subject are incomplete.^[2]

Contents 1 Gluten-free food 1.1 Cross-contamination issues 1.1.1 Controversy over oats 1.2 Accuracy of "gluten-free" labels 1.3 Alcoholic beverages 2 Medical benefits 3 See also 4 Notes

[edit] Gluten-free food

Although gluten is commonly associated with wheat, not all wheat products contain gluten. For instance highly processed wheat glucose has been found to contain no detectable gluten (ie less than 5 parts per million gluten).^{[citation needed]}

Several grains and starch sources are considered acceptable for a gluten-free diet. The most frequently used are maize, potatoes, rice, and tapioca (derived from cassava). Other grains and starch sources generally considered suitable for gluten-free diets include amaranth, arrowroot, millet, montina, lupine, quinoa, sorghum (jowar), sweet potato, taro, teff, chia seed, and yam. Various types of bean, soybean, and nut flours are sometimes used in gluten-free products to add protein and dietary fiber. In spite of its name, buckwheat is not related to wheat; pure buckwheat is considered acceptable for a gluten-free diet, although many commercial buckwheat products are actually mixtures of wheat and buckwheat flours, and thus not acceptable. Gram flour, derived from chickpeas, is also gluten-free.

Hemp seed is a gluten free source of energy with digestible edestin protein, a good balance of essential fatty acids, dietary fiber, as well as vitamins and minerals such as Vitamin E, Iron, Zinc, Copper and Magnesium.

Gluten is also used in foods in some unexpected ways, for example as a stabilizing agent or thickener in products like ice-cream and ketchup^{[3] [4]}

People wishing to follow a completely gluten free diet must also take into consideration the ingredients of any over-the-counter or prescription medications and vitamins. Also, cosmetics such as lipstick, lip balms, and lip gloss may contain gluten and need to be investigated before use.

[edit] Cross-contamination issues

Special care is necessary when checking product ingredient lists since gluten comes in many forms: vegetable proteins and starch, modified food starch (when derived from wheat instead of maize), malt flavoring, and glucose syrup. Many ingredients contain wheat or barley derivatives. Maltodextrin, formerly thought to contain gluten, is now generally considered gluten free. [1]

Although many foods contain gluten, it is not always included in ingredients lists. This lack of inclusion, is because gluten is not used in the formulation of the product, but in the preparation (or manufacturing) of listed ingredients. One example is the dusting of the conveyor belts in the production facilities with gluten products to prevent the foods from sticking during processing.

[edit] Controversy over oats

The suitability of oats in the gluten-free diet is still somewhat controversial. Some research suggests that oats in themselves are gluten free, but that they are virtually always contaminated by other grains during distribution or processing. However, recent research^[5] indicated that a protein naturally found in oats (avenin) possessed peptide sequences closely resembling wheat gluten and caused mucosal inflammation in significant numbers of celiac disease sufferers. Some examination results show that even oats which are not contaminated with wheat particles, are nonetheless dangerous to about 10 percent of celiacs, while not very harmful to the majority. Such oats are generally considered risky for celiac children to eat, but two studies show that they are completely safe for celiac adults to eat, ^[6] even over a period of five years.^[7] Given this conflicting information, excluding oats appears to be the only risk free practice for celiac disease sufferers of all ages.^[8] However, medically approved guidelines exist for those celiacs who do wish to introduce oats into their diet.^[9]

Unless manufactured in a dedicated facility and under gluten-free practices, all cereal grains, including oats, can be cross-contaminated with gluten. Grains become contaminated with gluten by sharing the same farm, truck, mill, or bagging facility as wheat and other gluten-containing grains. Therefore, removing all flours and grains from the diet may be the only way to guarantee a complete absence of gluten in the diet.

[edit] Accuracy of "gluten-free" labels

Standards for "gluten-free" labelling have been set up by the "Codex Alimentarius"; however, these regulations do not apply to "foods which in their normal form do not contain gluten".^[10]

The legal definition of the phrase "gluten-free" varies from country to country. Current research suggests that for persons with celiac disease the maximum safe level of gluten in a finished product is probably less than 0.02% (200 parts per million) and possibly as little as 0.002% (20 parts per million).

Australian standards reserve the "gluten free" label for foods with less than 5 parts per million of gluten, as this is the smallest amount currently detectable. In the processing of gluten-containing grains, gluten is removed (shown in the processing flow below)

Wheat Flour (80,000ppm) > Wheat Starch (200ppm) > Dextrin > Maltodextrin > Glucose Syrup (<5ppm) > Dextrose > Caramel Color

Since ordinary wheat flour contains approximately 12% gluten,^[11] even a tiny amount of wheat flour can cross-contaminate a gluten-free product. Therefore, considerable care must be taken to prevent cross-contamination in both commercial and home food preparation.

This diet rules out all ordinary breads, pastas, and many convenience foods; it also excludes gravies, custards, soups and sauces thickened with wheat, rye, barley or other gluten-containing flour. Many countries do not require labelling of gluten containing products, but in several countries (especially Australia and the European Union) new product labelling standards are enforcing the labelling of gluten-containing ingredients. Various gluten-free bakery and pasta products are available from speciality retailers.

In the United States, gluten may not be listed on the labels of certain foods because the U.S. Food and Drug Administration has classified gluten as GRAS (Generally Recognized As Safe).^[12] Requirements for proper labelling are being formulated by the USDA. It is currently up to the manufacturers of "gluten free" food items to guarantee such a claim. "A final rule that defines the term gluten-free and identifies the criteria that would enable the food industry to use that term" is scheduled to be released by the FDA on August 2nd, 2008 ^[13]. Many so-called gluten free products have been found to have been contaminated with gluten (such as chicken bouillon, corn cereal, caramel ice cream topping, ^[14].

In the United Kingdom, only cereals currently need to be labelled, while other products are voluntary.^[15] For example, sausages commonly contain Butcher's Rusk, a grain-derived food additive.^[16] Furthermore, while UK companies selling food prepared on their own premises are given guidance by the Food Standards Agency, they are not required to meet any labeling requirements.^[17]

Lastly, some non-foodstuffs such as medications and vitamin supplements, especially those in tablet form, may contain gluten as an excipient or binding agent.^[18][19] People with gluten intolerances may therefore require specialist compounding of their medication.^[11]

[edit] Alcoholic beverages

Most specialists^[who?] now consider all distilled forms of alcohol safe to drink, provided no colourings or other additives have been added as these ingredients may contain gluten. Although most forms of whiskey are distilled from a mash that includes grains that contain gluten, distillation removes any proteins present in the mash, including gluten. Although up to 49% of the mash for Bourbon and up to 20% of the mash for corn whiskey may be made up of barley, wheat, or rye, all-corn Bourbons and corn whiskeys do exist, and are generally labeled as such. Spirits made without any grain such as brandy, wine, mead, cider, sherry, port, rum, tequila and vermouth do not contain gluten, although some vineyards use a flour paste to caulk the oak barrels in which wine is aged, so some celiacs may wish to exercise caution. Liqueurs and pre-mixed drinks should be examined carefully for gluten-derived ingredients.

Almost all beers are brewed with malted barley or wheat and will contain gluten. Sorghum and buckwheat-based gluten-free beers are available, but remain very much a specialty product. Some low-gluten beers are also available, however there is disagreement over the use of gluten products in brewed beverages: Some brewers argue that the proteins from such grains as barley or wheat are converted into amino acids during the brewing process and are therefore gluten-free,^[20] however there is evidence that this claim is false.^[21]

[edit] Medical benefits

The gluten-free diet must be strictly followed by sufferers of celiac disease^[22] and dermatitis herpetiformis.^[23]

The scientific literature on the link between gluten and autism is mixed and there is no substantial research on in utero causality. There have been too few adequately designed, large-scale controlled studies and clinical trials to state whether the diet is effective.^[24] A small single blind study has documented fewer autistic behaviors in children fed a gluten-free, casein-free diet, but noted no change in cognitive skills, linguistic ability, or motor ability.^[25] This study has been criticized for its small sample size, single-blind design which may have skewed results on the basis of a "parent placebo effect".^[26] A 2006 double-blind short-term study found no significant differences in behavior between children on a gluten-free, casein-free diet and those on regular diets.^[27] A long term double-blind clinical trial sponsored by the National Institute of Mental Health ran from 2004 until November 2008; as of January 2009, results are not yet available^[28].

[edit] See also

Wikibooks Cookbook has a recipe/module on Gluten-Free

• Gluten-free, casein-free diet
• Autism therapies
• Glutamate
• Wheat gluten (food)
• Specific Carbohydrate Diet

[edit] Notes

v • d • e Gluten sensitivity Conditions general: Wheat allergy · Oat sensitivity nervous system: GS idiopathic neuropathies digestive system: Coeliac disease · GSE associated conditions integumentary system: Dermatitis herpetiformis Antibodies Anti-gliadin antibodies · Anti-transglutaminase antibodies HLA-DQ HLA-DQ2 · HLA-DQ8 Other Gluten immunochemistry · Gluten-free diet