To Gluten Free, Or Not To Gluten Free, That Is The Question.

March 2nd 2023   By Carin Clegg, APD

Chances are you know at least one person who chooses to eat gluten free.  In clinic, I see many people who have already taken foods out of their diet without the expertise of an Accredited Practising Dietitian to educate and guide them.  Consequently, very frequently I see:

- symptom management is not optimal long term

- people have developed certain beliefs around foods that are not true

- the diet is over-restricted and/or the wrong foods are taken out or kept in

- a lot of time and energy has been wasted on restricting the diet

- there are nutrition deficiencies.

One of the diet restrictions I see often is gluten free. Part of the reason gluten free is so well known is because of the increased numbers of allergies and Coeliac Disease over the last few decades combined with requirement by food labelling laws to keep people informed and safe.

Regarding allergies, food labelling laws in Australia require the foods which are more commonly known to cause severe allergic reactions in people to be declared on the food label. This includes wheat and products made with wheat such as bread and other bakery products, pasta, cous cous, flours and breakfast cereals. Other names or varieties of wheat include atta, burghal, bulgar, durum, einkorn, emmer, farina, farro, freekeh, triticale, spelt and kamut.  In the case of a wheat allergy, even traces may need to be excluded if one has a serve reaction such as anaphylaxis.

Food labelling laws in Australia require foods to be labelled regarding their gluten and oat content because gluten and sometimes uncontaminated oats (specifically the gluten-like avenin protein in oats) cause damage in the small bowel of people with Coeliac disease.   A strict gluten free diet is the treatment.  Gluten containing grains include wheat, barley and rye.

In Australia a food can be labelled ‘gluten free’ if these is no detectable gluten in the food or the ingredients have not been derived from foods containing gluten or oats. Because of such sensitive testing, down to less than 3 parts per million (ppm), Australians have the strictest gluten free laws.  In Europe, gluten free is 20ppm.  So people living with Coeliac Disease in these countries eat a low enough gluten level to not cause harm to health, whilst many people in Australia seemingly worry over such tiny amounts of gluten in their diet unnecessarily.

It is essential if Coeliac disease is suspected that a blood test and a small bowel biopsy be done with adequate amounts of gluten in the diet. If the biopsy shows small bowel damage a gluten free diet is recommended and repeat blood test and biopsy in 6 months later is required to diagnose or rule out Coeliac Disease. It is important to note that there can be other causes for small bowel damage such as intestinal lymphoma, infectious enteritis (eg giardiasis) drug associated enteropathy, eosinophilic enteritis, malnutrition, acquired immune deficiency syndrome enteropathy, bacteria overgrowth to name a few.

People who are not diagnosed with Coeliac Disease or a wheat allergy but find food upsets their body are likely food intolerant.  People who have a wheat intolerance are likely to react to more than 3-4 different food triggers, although wheat tends to be a major trigger of symptoms, particularly gut symptoms.  Often people with food intolerance have other symptoms such as itchiness, rashes or hives, sinus problems, headaches and migraines, reflux, sleep disturbance, concentration issues, fatigue and/or mood changes to name a few.

Whether you have a wheat intolerance or not, it is a great idea to have a good variety of grains in your diet, not only for your nutritional health to get a wide range of nutrients but also to make eating with friends or family members with food intolerance easier for everyone. Remember, it can 14 to 20 times for your tastebuds to like a new food so keep giving it a go.

Rye and barley, do contain less gluten than wheat so tend to be better tolerated if you are wheat intolerant. Rye breads are delicious and barley goes well in a soup or salad.

Oats also tend to be well tolerated by people with wheat intolerance so you need not give up your porridge or muesli! Alternative grains you can use instead of oat porridge include polenta (cornmeal), quinoa and rice.

Other gluten free grains to include in your diet are:

- rice (white brown, wild) and rice noodles: so think of stir fries, curries and laksas, pilaffs, fried rice, risottos, paella, soups and casseroles like beef stroganoff, apricot chicken

- corn or polenta

- amaranth, quinoa and millet: great substitutes for rice and to put with rice or even in a salad

-buckwheat: fantastic as a stir fry or a salad mix and the commercially available pancake mix is also a great option.

- millet: great substitute for rice or barley

- and not technically a grain, tapioca or sago: as that good old fashioned custard type dessert.

Other substitutes for flours which are also used in gluten free pastas include soy, corn or maize, chickpea or bessan, arrowroot/tapioca/sago, lupin, almond meal or other nut flours.

So, before you or anyone you know makes any major changes to their diet, go see your Dietitian!  An experienced Accredited Practising Dietitian (APD) will help to:

- conduct a nutrition assessment

- give dietary education on your condition, diet and testing

- advise on appropriate dietary modification according to medical advice or evidence-based practice

- to assist with identifying food triggers quickly and accurately

- ensure foods are not avoided unnecessarily, particularly for a long time

- ensure nutritional adequacy, preventing deficiencies and chronic disease

- provide ongoing guidance and support with dietary changes.

- work with you to help you manage diet related symptoms or conditions optimally

If you or someone you know feel food is an issue come along to our Food Allergy or Intolerance? Workshop this month to get a better understanding of what might be going on food wise for you and find out what the best [ath is to get back in cotrol of your symptoms.

All the details are on our Facebook Page so you can refer and bring your friends an dyou can book via Eventbrite.