Lately it seems that a Gluten-free diet is the biggest “all healing” discovery of the century.
Gluten-free diets are everywhere. Celebrities tweet about them, grocery stores are filled with products labeled “No Gluten!” and restaurants often offer special menus or items that don’t have any gluten in them.
The most serious disease associated with gluten sensitivity is Celiac disease, which affects 1 in 133 Americans — more than 2 million people — and these individuals should avoid gluten.
Celiac disease was initially described in the first century A.D. by a Greek physician named Aretaeus of Cappadocia. His description: “If the stomach be irretentive of the food and if it passes through undigested and crude, and nothing ascends into the body, we call such persons coeliacs”. Later in 19th century it was discovered that if the patient can be cured at all, it must be by means of changing one’s diet to exclude gluten. 
There is growing evidence that severe gluten sensitivities exist outside the realm of celiac disease. And researchers simply don’t know how many people, who follow a gluten-free diet may actually have a legitimate health complaint vs. a baseless fear of all things gluten, or a misplaced desire to lose weight.
The number of people who follow the gluten-free diet tripled between 2009 and 2014, while the number of cases of celiac disease has remained flat. 
Majority of people feel better when they eliminate gluten and have what we call now “Non-Celiac Gluten Sensitivity”. They notice improvement in intestinal problems, as well as in fatigue, sense of mental fogginess, arthritis, acid reflux, mood swings, even diabetes, and others.
So what is gluten?
Gluten is a general name for proteins found in:
- wheat (wheat berries, durum, emmer, semolina, spelt, farina, farro, spelt, emmer, graham, KAMUT® khorasan wheat and einkorn)
- triticale – a cross between wheat and rye
Gluten helps foods to maintain their shape, acting as a glue that holds grain together and protects it from harsh surroundings. Gluten has been modified through years of cultivation to make grain more resilient to the environment and more productive.
Navigating a gluten-free diet can be tricky, especially for those who are just getting started. However, a well-executed gluten-free diet is crucial for those who need to do so, in order to improve their health.
Hidden Sources of Gluten and Cross-Contamination
Processed and packaged foods and food additives are common places to look for hidden sources of gluten.
Food (or beverage) products and ingredients that may contain gluten include:
- malt (often made from barley)
- instant tea/coffee
- breaded items
- canned soups
- baked beans
- processed meats (i.e. lunch meats, hot dogs)
- colorings/flavorings (i.e. caramel color is often made from barley)
- chips (may contain wheat starch or wheat protein)
- dextrin (often from corn, but may be from wheat)
- modified corn starch
- hydrolyzed plant starch (HPP)
- hydrolyzed vegetable protein (HVP)
- textured vegetable protein (TVP)
Unfortunately, hidden sources of gluten can include non-food items as well. A few examples are lipsticks, medications (like Synthroid), toothpaste, and play dough. Personal care products, paints, envelopes, and pet food may also contain gluten. While these items are not directly ingested, they could be transferred from hands-to-mouth inadvertently. Some people can be sensitive to even small amounts of gluten, which is absorbed thru the skin.
Cross-contamination occurs when food that does not naturally contain gluten comes into contact with it in other ways. Perhaps the most common example is oats, which have an extremely high risk of contamination with gluten during the harvesting and milling process. Because of this, oats are often excluded on a gluten-free diet, unless they are certified gluten-free. In addition to food processing plants, there is also a risk of cross-contamination at home and even more so when eating out at restaurants.
Tips on a Gluten-Free Diet.
- Put a minimum 6-8 week timeframe to stay on the diet, in order to monitor your symptoms, and if you see no changes, than gluten is not the culprit.
- Keep a food journal and review it a few weeks into your gluten-free diet, to ensure you are on the right track; note any changes in your well being.
- Ask your doctor for resources, such as recipe ideas and printouts on gluten-containing foods, safe foods, hidden sources and ways to avoid cross-contamination.
- Always read labels. Products labeled wheat-free are not necessarily gluten-free. They may still contain spelt (a form of wheat), rye, or barley-based ingredients that are not gluten-free. To confirm if something is gluten-free, be sure to refer to the product’s ingredient list.
- Look for whole, nutrient dense foods in order to minimize the risk of vitamin and mineral deficiencies and take dietary supplements as appropriate.
- For emotional eaters, removing foods previously used as comfort foods is particularly challenging and may require additional interventions. Make sure you have “safe” snacksat home and at work.
- Ask your doctor for a gluten enzyme supplement and always keep it on hand to help minimize the effects of unintentional gluten exposure or cross-contamination.
- Early success is important, because the positive improvements in health will speak for themselves and subsequently cement your motivation and long-term compliance.
Keep in mind that a gluten-free diet may not be the healthiest diet, if you follow it incorrectly. It may put you at risk for nutrient deficiencies!
Individuals following a gluten-free diet commonly do not consume adequate amounts of vitamins and minerals, particularly vitamin D, vitamin B12, Folate, Iron, Magnesium, Calcium, and Zinc.
The risk of nutrient deficiencies is greater if gluten-containing foods such as grains are replaced with highly refined gluten-free alternatives.
Gluten-free processed foods are typically also lower in fiber, as well as have a higher glycemic index (a value assigned to foods based on how slowly or how quickly those foods cause increases in blood glucose levels). 
Simple change such as aiming for a minimum of 5 servings of vegetables and 2 servings of fruits a day will provide the needed phytonutrients.
The inclusion of “pseudo-grains” such as amaranth, buckwheat, rice (brown, wild black), millet, quinoa, sorghum, teff, depending on individual tolerance, can also help mitigate the risk of nutrient deficiencies.
Although it can be a hard transition, there are many great resources currently available on gluten-free diets online  and at your doctor’s office. Following these tips will not only help you with a smooth transition to a gluten-free diet, but it will also help to set you up for long-term success on a gluten-free lifestyle.
For more information on gluten and other healthy lifestyle tips, please schedule an appointment with Dr. Koganski at 215-750-7000 or www.NewtownInternalMedicine.com/contact
 Fasano A, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States. Archives of Internal Medicine. 2003;163(3):268-292
 Stefano Guandalini. A Brief History of Celiac Disease. www.cureceliacdisease.org/wp-content/uploads/SU07CeliacCtr.News_.pdf
 Rok Seon Choung, et al. Less Hidden Celiac Disease But Increased Gluten Avoidance Without a Diagnosis in the United States Findings From the National Health and Nutrition Examination Surveys From 2009 to 2014. Mayo Clin Proc. January 2017;92(1):30-38 n http://dx.doi.org/10.1016/j.mayocp.2016.10.012
 Vici, G et al. Gluten free diet and nutrient deficiencies. A review. Clin Nutr. 2016 Dec; 35(6): 1236-41