Gluten – What We All Should Know

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

2. 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

3. 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.

4. 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

5. 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)

6. 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

7. 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.

8. 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

9. 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

11. 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

12. 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.

13. 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.

14. 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

15. 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

16. 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

21. 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…

22. 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

23. 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.

24. 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

25. How Can I Avoid Gluten? The best way to avoid Gluten is to avoid all PROCESSED/PREPARED/PACKAGED foods, unless they are specifically formulated to be Gluten-free. • 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

26. 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

27. 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

28. 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’sDz, Lupus, Scleroderma, etc.) • If you has Colitis or another form of IBS

29. 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.

30. 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.

31. 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.