Celiac disease has traditionally been clinically considered and then investigated with patients presenting with gastrointestinal (GI) symptoms. In gluten dependent conditions, the gluten free diet (GFD) is the only valid therapy till-date which decreases disease activity, improves health, alleviates quality of life and treats/prevents the associated complications.

However GFD, the mainstay of treatment for celiac disease, is increasingly being adopted by people without a diagnosis of celiac disease. Just believing that gluten is bad for health, people have started to abstain themselves from wheat, barley, rye, wheat-contaminated oats and products made from these grains.

Anyone who is NOT suffering from celiac disease should consider few facts before moving onto GFD, such as:

1. Wheat, barley, etc though be gluten-bearing still make substantial contribution to diet and health, particularly providing dietary fibers, B vitamins (B1, B2, B3, B6, B9) and mineral micronutrients, notably iron, zinc, and selenium.
2. GFDs are significantly lower in protein, magnesium, potassium, vitamin E, folate, calcium and sodium.
3. GFD products are lower in protein than standard products.
4. GFD bread products are significantly higher in fat and fiber.

GFD diet is a specialized diet which is a part of therapy. Such products have to be fortified for missing nutrition such vitamins, minerals etc. The concept of balanced diet still stays, whose definition clearly states “the diet that doesn’t under or over nourishes the person, and/or makes the person sick or unwell”.

Eating a balance diet is the key to good health. Everyone should make the correct choice based on needs and not by following the market trend.

Reference:
1. Lerner, A.; et.al. Navigating the Gluten-Free Boom: The Dark Side of Gluten Free Diet. Front Pediatr. 2019, 7, 414.

“if the patient can be cured at all, it must be by means of diet.”

Gluten comes from the Latin word for ‘glue’ which highlights the elastic property of the dough especially during fermentation. Bubbles of carbon dioxide when released from fermenting yeast become trapped by the sulphur linked visco-elastic protein, ensuring a light honeycombed texture for the dough. Moreover, the elastic nature of gluten holds particles of the dough together, preventing crumbling during rolling and shaping. Hence, gluten plays a vital role in the production of baked goods.

The gluten content varies between grains, although the exact gluten content present in these foods is not easily available, the grains can be divided as containing gluten or not.

• Grains with gluten – wheat (including varieties like durum, spelt, kamut and farron, also products like semolina; 75-85% of protein), barley (5-6%), rye, triticale and oats.
• Gluten-free grains – corn, millet, rice, sorghum.
• Gluten-free pseudo-cereals – amaranth, buckwheat, quinoa.

Chemically, gluten is the composite name given to the protein in wheat, rye, barley and oats, but more specifically it is Gliadin (in wheat), Hordein (in barley), Secalin (in rye) and Avenin (in oats). The first three proteins are similar kinds so their effects are reported, but Avenin is a different kind of protein. People do suffer from oats as Avenin is part of oats biochemistry. Gluten-free oats in market correspond to oats that they are free from wheat (and/or rye, barley) Gliadin i.e. there is no measurable contamination.

“To regulate the food is the main part of the treatment”. -Samuel Gee, 1888

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Gluten is word commonly seen on various food products. People prefer to use “Gluten-free” products as it is felt that gluten is not very good for health. So, what exactly is this GLUTEN and why wheat-eaters are so concerned?

Gluten word signify group of seed storage proteins found in certain cereal grains which helps foods hold their shape. In common talk, “gluten” pertains only to wheat proteins, but chemically it refers to the combination of prolamin and glutelin proteins naturally occurring in many grains. Some of these grains have been demonstrated capability of triggering celiac disease; hence in medical terminology such grains capable of causing celiac disease all contain gluten.

Gluten is a protein found in wheat, barley, rye and some oats cultivator. Most cereals, breads, pastas, beers, soya sauce, even ice-creams contain gluten. The protein content of wheat is between 7% and 22%, with gluten constituting about 80% of the total protein of the seed.

People face a lot of issues when they consume a gluten-rich food. The most common ones are:

1. Celiac disease, an autoimmune condition in which gluten damages the small intestine,
2. Nonceliac gluten sensitivity is a food intolerance that leads to discomfort after eating gluten.

When people with celiac disease consume gluten, their immune system attacks and damages the lining of their small intestine. With repeated exposure to gluten, the body becomes less able to absorb nutrients into the bloodstream. Nonceliac gluten sensitivity is considered less severe than celiac disease. Eating gluten does not damage the intestine, but people may experience discomfort after eating gluten.

The spectrum of gluten related disorders includes celiac disease in 1-2% of the general population, non-celiac gluten sensitivity in 0.5-13% of the general population, as well as dermatitis herpetiformis, gluten ataxia and other neurological disorders. These disorders are treated by a gluten-free diet.

References:
1. Zis, P.; et.al. Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease. Curr Treat Options Neurol (Review). 2019, 21(3), 10. doi:10.1007/s11940-019-0552-7.
2. Lundin, K. E.; et.al. Coeliac disease and autoimmune disease-genetic overlap and screening. Nat Rev Gastroenterol Hepatol. 2015, 12(9), 507-15. doi:10.1038/nrgastro.2015.136.

Gluten comprises 75–85% of the total protein in bread wheat.

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