Gluten – What We All Should Know Dr. Rich Sheerin DC, CSCS Adjunct Professor of Anatomy and Physiology – Monmouth University and Brookdale Community College

What is Gluten?  Gluten is a protein located in the endosperm within grass- type grains such as wheat, barley and rye  It’s actually a combination of 2 proteins: Gliadin and Glutenin

 Gluten is formed when agitation (pressure, kneading, etc.) causes Gliadin and Glutenin to combine.  The resulting protein - Gluten is thick and elastic (think “gooey”)  Gluten gives elasticity to dough and pasta, helps it rise and keep its shape and adds a chewy texture to the final product.

 Gluten can be dried and broken down into a powder and added to baked goods and pasta to “improve” their texture  Gluten is also an ideal filler/thickener for processed foods as it is plentiful, cheap to produce and dense  This overuse of Gluten makes it very hard to eliminate or avoid Gluten, especially if one consumes prepared or processed foods

A Word on Fermentation  When yeast is added to dough, fermentation occurs and Gluten will trap the bubbles of Carbon Dioxide created – this makes dough lighter and “fluffier” (more on this later)

Where Do We Find Gluten?  All grains theoretically contain it, but the form of Gluten found in the following grains can be troublesome:  Wheat – including spelt, kamut and triticale  Barley  Rye

Why These Grains?  Answer still unclear but these grains are all genetically related  Human intervention/farming practices  The “original” GMO  Wheat has six sets of chromosomes and 95,000 genes. In comparison, humans have just two sets of chromosomes and about 20,000 genes.

Gluten in the Body  In laboratory tests, wheat proteins have stimulated immune system cells, intestinal cells and neurological system cells to release inflammatory molecules called cytokines that can overexcite the immune system

Cytokines and Inflammation  Cytokines are signals to the immune system to send help ASAP – think of a flare gun to a shipwreck survivor  Upon “seeing the flare” the immune system sends its fighting cells to the rescue, causing inflammation  When we consume large amounts of Gluten, this inflammatory response can be magnified

Cytokines and Inflammation  In some individuals, this response is magnified and can cause local tissue destruction and illness  Further still, some individuals exhibit higher levels of inflammation and immune response when exposed to gluten  The above are the basis of Gluten Sensitivity and Gluten Allergy/Intolerance

Cytokines and Inflammation  Studies have also shown that breaking down gliadin and glutenin produces even shorter chains of amino acids—the building blocks of proteins—some of which may behave like morphine and other opiates.  Perhaps these molecules explain some of the lethargy exhibited by people who do not have celiac disease but are nonetheless sensitive to wheat.

Gluten and Illness  We are ALL sensitive to gluten on some level.  Too much of any substance can and often will cause dysfunction in the body.  When gluten is digested in the GI tract, it splits back into Gliadin and Glutenin. In some people, Gliadin is treated a severely hostile invader and the body will go above and beyond to destroy it.

Gluten Intolerance and Celiac Disease  Non-Celiac Gluten Sensitivity (NCGS)  More common (at least 6% of Americans) hard to definitively diagnose  Symptoms vary by patient and in severity and include: Headache Bloating Fatigue Skin rashes/sensitivity Mouth ulcerations Diarrhea/Constipation

Gluten Intolerance and Celiac Disease  Celiac Disease  Much less common (1% of Americans)  Symptoms vary by patient and in severity and include: Headache Bloating Fatigue Skin rashes/sensitivity Mouth ulcerations Diarrhea/Constipation

Celiac Disease  In true Celiac Disease, the immune response is so severe that it can destroy the lining of the small intestine.  This disrupts normal nutrient absorption and can cause large molecules to “leak” into the bloodstream. (“Leaky Gut”)  The immune system then attacks these large, foreign molecules and the inflammation spreads throughout the body via the bloodstream

Symptoms of Celiac Disease Those as in NCGS as well as:  Joint pain  Increased lipids and glucose in blood stream  Anxiety/depression  Migranes/headache  Tingling in hands/feet  Infertility  Anemia  And many others…

Gluten Sensitivity and Celiac Disease  Celiac Disease can be diagnosed via blood testing  Gluten Antibodies (the body’s self-made recipe to destroy invaders) are present in your blood sample in high quantities  Endoscopy or biopsy of the small intestine can help confirm or rule out the diagnosis

How Can I Avoid Gluten?  Eliminate ALL wheat, kamut and rye intake  Limit oats, millet and teff as these are often processed in facilities that handle wheat  READ YOUR LABELS!!! In the US, unlike other countries, the FDA does not require manufacturer’s to disclose whether or not a food product contains Gluten.

How Can I Avoid Gluten? Hidden sources/alternate names of Gluten include, but are not limited to:  Durum/Semolina  MSG  Malto-dextrose, malt, malt vinegar  Caramel color  Hydrolyzed vegetable protein  Modified food starch  Bulgar  Lecithins  Triticale/triticum

How Can I Avoid Gluten?  Beer  Breads  Cakes and pies  Candies  Cereals  Cookies and crackers  Croutons  French fries  Gravies  Matzo  Pastas  Processed luncheon meats  Salad dressings  Sauces, including soy sauce  Seasoned rice mixes  Seasoned snack foods, such as potato and tortilla chips  Self-basting poultry  Soups and soup bases  Vegetables in sauce The best way to avoid Gluten is to avoid all PROCESSED/PREPARED/PACKAGED foods, unless they are specifically formulated to be Gluten-free.

Gluten Free Food Choices  Beans  Seeds and Nuts (unprocessed and unroasted)  Eggs  Red and White meats (not battered or breaded)  All Fish (not battered or breaded)  All Fruits and Vegetables  Most Dairy Products

Gluten Free Grains/Cereals/Starches  Rice  Amaranth  Arrowroot  Buckwheat  Corn and cornmeal  Flax  Gluten-free flours (rice, almond, soy, corn, potato, bean)  Hominy (corn)  Millet  Oats  Quinoa  Rice  Sorghum  Soy  Tapioca  Teff

Is Gluten Free Right For Me?  If you’ve experienced a combination of gluten sensitivity symptoms chronically or episodically over a greater than 6 month period.  If you have a familial history of Celiac Disease or NCGS  If you’re Diabetic (ID and NIDDM)  If you’re being treated for CVD  If you’ve been Dx with an autoimmune disease (rheumatoid arthritis, psoriasis, fibromyalgia, Chron’s Dz, Lupus, Scleroderma, etc.)  If you has Colitis or another form of IBS

How Do I Implement Gluten Free Eating?  Create a journal that records your meals for 3-5 days and your how your body feels/symptoms at least 4x/day – approx. 30 minutes after meals is best. Record information on bowel movements (color, consistency, frequency) if an issue.  Eliminate ALL sources of Gluten in your diet for a minimum of 2-4 weeks while continuing to chronicle symptoms and bowel movements.

How Do I Implement Gluten Free Eating?  If improvement is noted, continue on for an additional 4 weeks and re-introduce gluten containing products ONE AT A TIME, recording your body’s reaction after each food.  A new gluten containing food every 48 hours should allow you to judge your tolerance.

If You’re Ready to Know  If you are considering a gluten elimination diet to help determine if you have a gluten intolerance of Celiac disease, speak to your doctor first.  Your doctor may ask you to wait until after testing, because celiac can only be detected if you have been eating gluten in your current diet.