Avoiding gluten means more than giving up traditional breads, cereals, pasta, pizza, and beer. Gluten also lurks in many other products, including frozen vegetables in sauces, soy sauce, some foods made with “natural flavorings,” vitamin and mineral supplements, some medications, and even toothpaste. This makes following a gluten-free diet extremely challenging.

How we get nutrients from food

Intestinal villi (singular: villus) are finger-like projections made up of cells that line the entire length of your small intestine. Intestinal villi absorb nutrients from the food you eat and then shuttle those nutrients into your bloodstream so they can travel where they are needed.

Villi increase the internal surface area of the intestinal walls making available a greater surface area for absorption. An increased absorptive area is useful because digested nutrients (including monosaccharide and amino acids) pass into the villi through diffusion. Increased surface area increases the effectiveness of diffusion. The villi are connected to the blood vessels so the circulating blood then carries these nutrients throughout your body.

A healthy intestine has an abundance of villi which aid in the absorption of nutrients into the bloodstream.

Continued mal-absorption of nutrients such as calcium, magnesium, vitamin D, B vitamins, and omega-3 fatty acids can contribute to mood disorders, lower energy levels, poor bone health, insomnia, attention problems, and a host of other issues.

Celiac disease flattens intestinal villi

In diseases of the small intestine the villi can become flattened due to the effects of inflammation, and the villi can sometimes disappear. This deterioration is known as villous atrophy, and is often a feature of coeliac disease.

Becoming well-fed but malnourished

Unfortunately, you can be well-fed but malnourished.

Many factors (including coeliac disease) cause intestinal villi to be flattened thus compromising their ability to properly absorb nutrients. It means that even if you are eating a healthy diet, your body may not be benefiting from it.

Celiac people have to adhere to a strict gluten-free diet for their entire life. However, dieting is only a piece of the puzzle when combating celiac disease and the damage it has caused. Other things like exercise, probiotics, and taking a good supplement can help in a way that the diet by itself won’t manage.

A study found that 10 years after going gluten-free, as much as 50% of celiac patients were still suffering from poor vitamin status. This could be due to poor diet, or because regardless of diet, the body is having difficulty absorbing nutrients adequately.

 

Gluten in foods where you least expect it

Although gluten is safe for most people, those with conditions like celiac disease or gluten sensitivity should avoid it to prevent adverse health effects. Many processed foods are made with gluten-containing ingredients which are often added for flavourings or as a thickener. So, check ingredient labels closely. You may find gluten in foods where you least expect it.

Gluten-containing ingredients, such as soy sauce, flour, and malt vinegar are often used as fillers or flavourings. They may be added to sauces, rubs, and marinades that are commonly paired with protein sources.

Some common gluten-containing ingredients that may be added to dairy products include thickeners, malt, and modified food starch.

Also, keep in mind that some alcoholic beverages are made with malt, barley, and other gluten-containing grains and should be avoided on a gluten-free diet.

Processed foods with gluten-containing ingredients

So, what are the processed foods with gluten-containing ingredients?

Here they are:

• Processed meats such as hot dogs, cold cuts, pepperoni, sausage, salami, and bacon
• Processed vegetarian meat substitutes
• Microwavable dinners
• Ground meats
• Any breaded meat, poultry, or fish
• Flavoured milks and yogurts
• Processed cheese sauces and spreads
• Ice cream, which is sometimes mixed with additives that contain gluten
• Canned fruits and vegetables: They may be canned with sauces that contain gluten.
• Frozen fruits and vegetables: Some of them may contain added flavourings and sauces with gluten. Plain frozen fruits and vegies are usually gluten-free.
• Dried fruits and vegetables (Plain, unsweetened, dried fruits and vegetables tend to be gluten-free.)
• Pre-chopped fruits and vegetables: These may be cross-contaminated with gluten depending on where they were prepped.
• Beers, ales, and lagers made from gluten-containing grains
• Non-distilled liquors
• Pre-made smoothies
• Cereals
• Cookies and crackers
• Some chocolates, some chocolate bars, licorice
• Dry soups or soup mixes
• Candies

Spices, sauces, and condiments

Spices, sauces, and condiments often contain gluten but are commonly overlooked. Even though most of them are naturally gluten-free, gluten-containing ingredients are often added to them as emulsifiers, stabilizers, or flavour enhancers. Here is the list:

• Wheat-based soy sauce and teriyaki sauce
• Ketchup, mayonnaise and mustard
• Worcestershire sauce
• Tomato and pasta sauces
• Relish and pickles
• Barbecue sauce
• Salad dressing
• Salsa
• Stock and bouillon cubes
• Marinades
• Gravy and stuffing mixes
• Rice and malt vinegar

Names for gluten-containing ingredients

In processed foods gluten is hidden in many names:

• Hydrolyzed wheat protein
• Wheat-based ingredients, such as wheat protein and wheat flour
• Modified food starch
• Malt
• Maltodextrin
• Malt-based ingredients such as malt vinegar, malt extract, and malt syrup
• Durum
• Einkorn
• Emmer
• Kamut
• Spelt
• Soy or teriyaki sauce
• Enriched flour with added vitamins and minerals
• Farina (milled wheat usually used in hot cereals)
• Graham flour (a course whole-wheat flour)
• Self-rising flour, also called phosphate flour
• Semolina (the part of milled wheat used in pasta and couscous)
• Triticale
• Fu (a dried gluten product made from wheat and used in some Asian dishes)

“Reading the ingredients label on the foods you buy and knowing what to look for are the keys to identifying and avoiding gluten,” says Shelley Case, RD, author of “Gluten-Free Diet: A Comprehensive Resource Guide”.

Gluten-free food labeling

The term “gluten-free” is generally used to indicate a supposed harmless level of gluten rather than a complete absence, however, the exact level at which gluten is harmless is uncertain and controversial.

Foods that are labeled gluten-free, according to the U.S. Food and Drug Administration rules, must have fewer than 20 parts per million of gluten. Foods with these labels may include:

• Naturally gluten-free foods
• Processed foods that don’t have a gluten-containing ingredient
• Foods that haven’t been cross-contaminated with gluten-containing ingredients during processing
• Alcoholic beverages made from naturally gluten-free ingredients, such as grapes or juniper berries

There is no general agreement on the analytical method used to measure gluten in ingredients and food products. The use of highly sensitive assays is mandatory to certify gluten-free food products. The European Union, World Health Organization, and Codex Alimentarius require reliable measurement of the wheat prolamins, gliadins rather than all-wheat proteins.

For example, labels for all food products sold in Canada must clearly identify the presence of gluten if it is present at a level greater than 10ppm. Any intentionally added gluten, even at low levels must be declared on the packaging and a gluten-free claim would be considered false and misleading.

An alcoholic beverage made from a gluten-containing grain (wheat, barley, rye and hybrid grains such as triticale) can carry a label stating the beverage was “processed,” “treated” or “crafted” to remove gluten. However, the label must state that gluten content cannot be determined and the beverage may contain some gluten. These beverages may not be labeled gluten-free.

Celiac disease patients on a gluten-free diet still ingest gluten

Despite the need to protect celiac disease patients against gluten exposure, very little is actually known about the amount of gluten that is unintentionally ingested by patients following a strict gluten-free diet.