Most people who eat a gluten-free diet do so for medical reasons; they may have celiac disease, gluten sensitivity, or a wheat allergy. Some health professionals think that wheat may also be implicated in other illnesses, including chronic inflammation, irritable bowel syndrome, and some autoimmune conditions like arthritis; they often recommend wheat-free diets for everyone.
Approximately one in every 133 Americans suffers from celiac disease, the granddaddy of gluten-intolerance problems; far more of us are estimated to have some degree of gluten sensitivity, mostly undiagnosed. Less than one percent of the population has a true wheat allergy.
Eating a gluten-free diet is more involved than simply avoiding wheat, and for people with celiac disease, there is no choice—gluten makes them sick, often very sick, and avoidance is the only solution.
Celiac disease can be silent in the body for years before being “switched on.” Almost anything can be a trigger—illness, surgery, childbirth, stress or infection are common triggers. Celiac disease (CD) is an inherited autoimmune disorder that affects women more often than men and people of Northern European ancestry more often than those with Asian or African roots, though no population is immune. If someone in your immediate family is diagnosed, there is a 10 percent chance that you could have the disease as well. Celiacs often have other autoimmune disorders, especially autoimmune thyroid disease, lupus, Type 1 diabetes or rheumatoid arthritis, and they tend to experience other health problems related to malabsorption of nutrients, including anemia, migraines, bone density disorders, dermatitis and irritable bowel syndrome. Lactose intolerance can be another problem for celiacs. When a person with celiac disease eats food containing gluten, specific proteins that make up gluten found in some grains inflame the small intestine. This inflammation damages the villi that are part of the mucosal lining of the small intestine.Villi are fine, hair-like projections that transfer nutrients to the body; when they are damaged malabsorption of nutrients occurs. Without proper nutrients, the human body does not grow or function well, so children with CD are usually very small for their age and may be described by doctors as “failing to thrive;” regardless of age, most CD patients experience gas, abdominal bloating, diarrhea and fatigue. Nutritional deficiency problems are common, and if left untreated, the disease eventually leads to severe malnourishment and can eventually be fatal. There is no cure or vaccine for celiac disease and the only effective treatment is adhering to a strict gluten-free diet.
Simpler cases of gluten sensitivity can masquerade as skin rashes, mouth sores, fatigue and even vague muscle and joint complaints, although the most common symptoms are digestive, including gas, abdominal cramps, nausea and diarrhea. Some experts believe that about 15 percent of people have undiagnosed gluten sensitivity, and especially wheat sensitivity. There is usually no lasting damage when someone with wheat or gluten sensitivity eats those foods, but some believe that gluten sensitivity can escalate to intolerance if a careful diet is not followed.
According to the Asthma and Allergy Foundation of America, only one to two percent of people have actual food allergies. Typical allergic responses to wheat include swelling or itching of the mouth and throat, sinus or bronchial congestion, hives or skin rashes or digestive symptoms. It is unusual for a wheat allergy to result in anaphylactic shock, but as with all allergies, that is always a possibility. Some wheat allergy sufferers may also be sensitive to gluten in general or allergic to additional grains.
So, if you fall into one of the above groups, simply avoid eating wheat, no problem, end of story, right? Like most of life’s challenges, solving gluten issues is not quite that simple. Gluten is made up of particular proteins found in wheat, rye, and barley. Those grains, or products made from them, are found in huge numbers of processed foods and food additives—sometimes even the adhesive found on postage stamps and envelopes contains gluten! Gluten-free eaters must become avid label readers and learn the names of dozens of common ingredients that could be made from a gluten-containing source. This is a situation that is simplified by eating a whole foods diet—there simply won’t be fillers and additives in your foods to cause you to worry.
The FDA has proposed changes that would affect the labeling of gluten-free products. The new language that is pending final approval reads:
“The Food and Drug Administration (FDA) is proposing to define the term ‘gluten-free’ for voluntary use in the labeling of foods, to mean that the food does not contain any of the following: An ingredient that is any species of the grains wheat, rye, barley, or a crossbred hybrid of these grains (all noted grains are collectively referred to as ‘prohibited grains’); an ingredient that is derived from a prohibited grain and that has not been processed to remove gluten (e.g., wheat flour); an ingredient that is derived from a prohibited grain and that has been processed to remove gluten (e.g., wheat starch), if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food; or 20 ppm or more gluten. A food that bears the claim ‘gluten-free’ or similar claim in its labeling and fails to meet the conditions specified in the proposed definition of ‘gluten-free’ would be deemed misbranded. FDA also is proposing to deem misbranded a food bearing a gluten-free claim in its labeling if the food is inherently free of gluten and if the claim does not refer to all foods of that same type (e.g., ‘milk, a gluten-free food’ or ‘all milk is gluten-free’). In addition, a food made from oats that bears a gluten-free claim in its labeling would be deemed misbranded if the claim suggests that all such foods are gluten-free or if 20 ppm or more gluten is present in the food. Establishing a definition of the term ‘gluten-free’ and uniform conditions for its use in the labeling of foods is needed to ensure thatindividuals with celiac disease are not misled and are provided with truthful and accurate information with respect to foods so labeled. This proposed action is in response to the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA).”
The Food Allergen Labeling Act of 2004 mentioned above is responsible for ensuring that the eight foods that are most commonly implicated in food allergies—milk, soy, eggs, wheat, tree nuts, peanuts, fish and shellfish—must now be listed on labels in plain English. The listing can be for an ingredient—flour (wheat), or as a disclaimer—“Contains Wheat.”
It is interesting to note that the new FDA proposal is for voluntary labeling of gluten-free products; there is nothing requiring products containing gluten to be identified, except as noted in the FALCPA 2004 language. It remains the responsibility of the consumer to be alert for problematic ingredients.
Kamut, spelt, semolina, triticale, emmer and einkorn are all types of wheat, and all are off-limits on a gluten-free diet. Seitan and couscous are two popular foods made from wheat; many cereals contain these grains as well and most brands of pasta are made with semolina or durum wheat. Modified food starch is found in countless processed foods; it is sometimes made from wheat. There are many grains that can replace wheat in the diet, including amaranth, rice, quinoa, buckwheat or kasha, millet and corn. The Bulk aisle is the place to find these grains at the Co-op if you are unfamiliar with them. Most are available already milled into flour for baking, or you can grind the whole grains yourself as needed. Packaged flours from these grains are available with the baking supplies in Aisle 4.
If you are switching to a gluten-free diet, it is time to replace the barley in your soup pot with something new—rice, quinoa, or buckwheat are good choices. The barley flakes will have to go too, but quinoa flakes are a great substitute; other gluten-free choices for warm cereals include polenta or millet. If you usually buy multigrain cereals, remember to check the ingredient list for barley, wheat and rye. Barley is another grain that is found in many processed foods, often as the sweetener barley malt syrup. It is often contained in the ubiquitous “hydrolyzed vegetable (or plant) protein” and in many other flavor enhancers and coloring agents. Historically, much of the world’s barley crop has been earmarked for beer, but recently many brewing companies, big and small, have introduced gluten-free beers—check with your favorite supplier.
Rye is used mostly as flour in breads and crackers and is fermented to make some kinds of whiskey, vodka and beer. It is not often a hidden ingredient in foods, but label reading is still necessary.
Oats are controversial in a gluten-free diet; research indicates that oats themselves are probably safe for many people with celiac disease or gluten sensitivity, but oats are often contaminated with gluten from other grains planted nearby or processed in the same mills. According to The Gluten-Free Nutrition Guide by Tricia Thompson, M.S., RD, there are currently five mills in North America that produce oats that have been tested and found to be gluten-free. The Co-op has carried Bob’s Red Mill gluten-free rolled oats in the past, but the manufacturer temporarily suspended sales of this product due to questions about quality. Merchandising Manager Dean Kallas told me in mid-January that our distributor had Bob’s Red Mill gluten-free oats available again, so by the time you read this they should be back on the shelf. Be sure to consult with your health practitioner before adding oats to a gluten-free diet.
There are many hidden sources of gluten in processed foods. Avoid things that list any of the following ingredients: natural flavorings, caramel color, soy sauce, binders, flavor or spice extracts, unidentified starches, brewer’s yeast, monosodium glutamate, maltodextrin, and many preservatives. A few of these ingredients may sometimes be safe, depending on where and how they are made; regulations vary from country to country. Gluten can often be found in blue cheese, TVP, canned soups and soup mixes, salad dressings, condiments, processed meats and meat substitutes, frozen foods and packaged snack foods. As with flavorings and additives, the inclusion of gluten in these products can vary so to be safe, contact the manufacturer and ask very specific questions about sources of ingredients, cross-contamination of equipment, other products made in the same facility, and testing or certifications. If a company can’t—or won’t—answer your questions, you probably want to avoid their products.
Eating out poses similar challenges in avoiding gluten. Chain restaurants often use institutional-sized versions of processed packaged and frozen foods, baking mixes and condiments. If you can, call before visiting a restaurant and ask the manager or chef about gluten-free options. (This tactic will be most successful if you do not call at mealtime!) If you are uncertain about the offerings, order simple, safe foods and be sure to (politely) inform your server that wheat, barley and rye in any form will make you ill; ask them to share that information with kitchen staff, too—you need your meal prepared with clean utensils, on a clean grill or pan and nothing should be cooked in a fryer that is used for breaded foods. There are several online sources of dining cards that can be given to restaurant staff to explain your needs—www.selectwisely.com and www.celiactravel.com are two sources.
If you are enjoying a meal with relatives or friends, explain your situation carefully and offer to bring food that you can share with everyone. Chances are good that your hosts will want you to enjoy a pleasant and safe meal in their home and will be open to working within your needs.
Most nutrition experts suggest basing a healthy, gluten-free diet on vegetables, fruits, nuts and seeds. Meat, poultry, eggs and fish can be added if you are not vegetarian, but check the labels for added ingredients. Eat dairy products if you enjoy them and are not lactose intolerant. Beans of all kinds are a great way to add fiber and nutrients to a gluten-free diet and are a vegetarian source of protein, but remember to read labels if you are buying prepared foods like canned beans or dried soup mixes. Many grains are safe for those with gluten intolerance; learning how to use unfamiliar grains is important for keeping breads, pasta and the occasional sweet treat in your meal plans. The key to shopping is to read the label on every product you buy, every time you buy it! Some manufacturers produce gluten-free and non-gluten-free items with similar packaging, requiring consumer awareness with every purchase and ingredients do change with no warning.
My guess would be that bread products are the biggest challenge most people face when switching to a gluten-free diet. Whether it’s light and fluffy or filled with chewy, nubbly grains, most of us have some distinct preferences when it comes to our daily loaf. For years, gluten-free bread had pretty dismal reviews, but that is changing. There are many more gluten-free flours available for both commercial and home bakers including flours made from beans. When gluten-free baking incorporates a mix of these flours, the finished products taste better, slice more neatly and have better texture. Guar gum and xanthan gum are often included to improve texture. The selection of cookbooks and websites devoted to gluten-free baking has grown too—check out Gluten-Free Quick and Easy by Carol Fenster, Ph.D. or The Gluten-Free Gourmet Bakes Bread by Bette Hagman (or any of Hagman’s other gluten-free books). These books are usually available on our shelves near the Salad Bar, and there are countless websites to choose from.
The Co-op stocks an ever-increasing assortment of gluten-free products. Many are things recommended by customers and staff members who have experience choosing gluten-free foods, so you can be sure they will be tasty! Our Willy Street Co-op Production Kitchen bakers provide a steady supply of goodies made without gluten that you can find near the Juice Bar, but keep in mind that our Kitchen is not a certified gluten-free facility. Lynn Olson, Cooperative Services Manager, loves the Kitchen’s Pumpkin Cake made without gluten and staff member Marcus Dushack gives a thumbs-up to the Willy Street Co-op Pumpkin Apple Muffin made without gluten.
In addition to the gluten-free grains and flours in the Bulk aisle, there is an assortment of baking mixes and flours in Aisle 4, including selections from Bob’s Red Mill, Arrowhead Mills, Gluten Free Pantry, and Pamela’s. You’ll also find gluten-free flavor extracts and chocolate chips along with xanthan gum and gluten-free egg replacer to help you turn out goodies that taste great. Pasta is comfort food for many folks and gluten-free offerings are found in Aisle 3 and the Bulk aisle; while Tinkyada brown rice pasta is a favorite with many staff members, the offerings from DeBoles and Lundberg’s are also good choices. Quinoa pasta comes from Ancient Harvest and the cooking instructions are slightly different—once again, read the label! Rice noodles are a staple in Southeast Asian recipes; Thai Kitchen is the brand we stock.
A variety of gluten-free breads are available in a cooler near the frozen desserts, and gluten-free hamburger and hot dog buns are located in Frozen foods. If you are looking for prepared meals or entrees that are gluten-free check out the offerings from Amy’s Kitchen in the freezers—you are sure to find something you like with choices ranging from mac and cheese to shepherd’s pie and enchiladas. Amy’s Kitchen also makes frozen pizzas with wheat-free rice crusts.
The cereal aisle also offers gluten-free selections. Kids of all ages will enjoy Amazon Frosted Flakes and Gorilla Munch; Rice Twice, Cinnamon Crunch, and Corn Flakes are a few of the other gluten-free choices available.
Pamela’s cookies are a tasty gluten-free sweet treat; for something savory try Brown Rice Snaps from Edward & Sons or any of the flavors by Mary’s Gone Crackers or Lundberg Rice Cakes. LaraBars are a gluten-free option for energy bars, dense with fruit and nuts.
There are plenty of choices for gluten-free condiments and seasonings too, including Annie’s Naturals salad dressings and mustards, Arora Indian seasonings, Bragg Liquid Aminos, and Spectrum’s line of mayonnaise.
There are many products throughout the store that qualify as being gluten-free, but simply are not labeled in that way, so check the labels for every type of food that you like to eat; one brand may have added gluten and another may not.
Addie Greenwood is one staff member who follows a strict gluten-free diet for the sake of her significant other. She has a great list of recommendations in the sidebar and you will find all gluten-free recipes in the Recipe pages of this issue of the Reader. The Co-op has had many requests over the years to compile a list of all the gluten-free products we carry. This is finally coming together; at the time of this writing, plans call for the list to be available for customers by March 1st. When you use our gluten-free list, please keep in mind that manufacturers sometimes change products without warning. While we will do our best to keep the list as updated as possible, we recommend that you maintain vigilance in reading labels.