The Gluten Free Generation

Corinne Smith

Celiac disease is a very prevalent food related disease in this generation. CD is a genetically
acquired autoimmune disease that affects the small intestine. The ingestion of gluten, a protein
found in wheat, rye, and barley, triggers the immune system to damages the lining of the small
intestine. The tiny fingerlike projections, the villi, which line the small intestine, are specifically
damaged (ASGE, 2014). This damage prevents the small intestine from absorbing important
nutrients and preventing malnutrition. Symptoms vary among sufferers, but include digestive
problems like abdominal bloating, diarrhea, and weight loss, a severe skin rash, anemia,
aphthous ulcers, musculoskeletal problems, tingling sensation in the legs duce to nerve damage a
low calcium, missed menstrual periods, and seizures (Cleveland Clinic, 2013). If not treated with
a gluten free diet, the only known treatment to date, celiac disease can leave the sufferer
susceptible to other health problems cancer of the intestine, osteoporosis, miscarriage or
infertility, birth defects, and seizures. CD can be diagnosed a number of ways. First, the doctor
would perform a careful physical examination and discuss the patients medical history to look
for possible related complications. Next, a blood test may be performed to detect gluten
antibodies and iron levels. A high number of antibodies to gluten can diagnose CD and a low iron
count, exhibiting anemia, is a symptom of CD. A stool sample could also be tested to detect the
presence of fat, since CD prevents fat from being absorbed in the small intestine. Lastly, a more
invasive procedure involves taking a small biopsy of the small intestine to look for small
intestine villi damage. Once diagnosed, a gluten free diet is prescribed. This calls for avoiding
any form of wheat, barley, or rye that contains gluten. A gluten free diet should be high in fresh
vegetables, fruits, meats and fish. Gluten-free products are available at almost every grocery
store and off a variety of gluten free products like cereal, pasta, and bread.

There is a 0.75% prevalence of celiac disease and a 5% prevalence of gluten sensitivity1

among adults in the United States (Udis, 2013). Therefore, about 6 in 100 adults are negatively
affected by gluten ingestion and have most likely been prescribed a gluten free diet. This large
prevalence of diagnoses has led to the increased popularity of the gluten free diet. The current
fad diet can be seen in most grocery stores, in the company Udis that makes only gluten free
products, through celebrity statements on the positive effects of a gluten free diet, and the
increase in boutique gluten free bakeries. However, this diet can be harder to follow than one
may think. It is not simply cutting out an entire food group, carbohydrates, but avoiding gluten,
which can be disguised in many forms, and dealing with the non-nutrition related psychological
and social factors.
A gluten free diet is a complete lifestyle change that has to be followed 24/7 in order to see
results. For those following a gluten free diet with gluten sensitivity, the urgency to follow the
restriction is not as high and therefore results in known or unknown ingestion of gluten. In a
study published in the Journal of Human Nutrition and Dietetics, the use of the food label was
looked at and how it contributed to compliance to a gluten free diet. The study looked at two
groups, adults with CD and adults with gluten-sensitivity. It was found that individuals with
gluten sensitivity rely more heavily on the gluten free claim for information about the products,
gluten contents, where as those with CD proved to be more experienced food label readers and
relied more on the ingredients list when finding gluten free foods (Verrill, Zhang & Kane,
2013). For both groups, reading the ingredients list resulted in less difficulty following a gluten
free diet where as simply looking for gluten free claims and eating packaged food, made it
difficult to follow a gluten free diet.
1 A patient may be diagnosed with non-celiac gluten sensitivity when all the diagnosis for CD
comes back negative, but still present symptoms (Holmes, 2013).
3

The results also showed that individuals with gluten sensitivity are 0.26 less likely to be a
member of any celiac disease organization, a factor resulting in the decreased education of a
gluten free diet, which is why they more readily looked to gluten-free claims on food products
instead of the ingredient list. Further, according to the FDA (2014), a gluten free product cannot
contain more than 20 or more parts per million gluten. This can lead to accidental gluten
ingestion if the ingredient list is not thoroughly examined. Gluten may even be hidden in the
label as malt or malt extract, which is derived from barley, or present in prescription drugs. All of
this information shows following a gluten free diet can be difficult for those diagnosed with CD
and those with gluten sensitivity. Educating both groups about the importance of reading food
labels and not just grabbing the gluten free claim on packaged foods, can improve the positive
results of a gluten free diet.
Furthermore, a study published in Springer Links Digestive Diseases and Sciences,
identifies the factors that influence the adherence to a gluten free diet in adults. The purpose of
the study was to identify the factors in order come up with educational interventions to increase
adherence to a gluten free diet in patients. In their results, a positive correlation was reported
between gluten free diet knowledge quiz and adherence; adheres correctly answered a mean of
16.4 of 28 questions compared to 14.2 in nonadheres (Dennis, Leffler, et al, 2009). This data
shows that general knowledge of the gluten free diet is necessary to adhere to the diet. When
regarding travel, social settings, and religious practices, 24% of subjects reported avoiding travel,
44.2% avoiding eating out of the home with friends, and 37% reported avoiding certain religious
practices to adhere to a gluten free diet (Dennis, Leffler, et al, 2009). All of these factors
decrease the level of control the subject had to maintain a gluten free diet; therefore, these
statistics are not surprising and show the urgency to address the issues. Avoidance of certain

circumstances led to 40.9% of participants feeling increased stress and social strain due to
adherence to a gluten free diet (Dennis, Leffler, et al, 2009). All of this data leads to productive
targets for intervention to improve adherence to a gluten free diet. First and foremost, individuals
must be educated on celiac disease and the specific restrictions of a gluten free diet. Addressing
situations where there is limited control, individuals could be given informational cards or a list
of gluten free friendly establishments. These educational resources would lead to increased
adherence to a gluten free diet and improved psychological factors.
A gluten free diet has been found very hard to follow, but for patients with celiac disease
and gluten sensitivity, it is the only know prescription to treat the symptoms. However, according
to the Nature Clinical Practice: Gastroenterology and Hepatology, other therapeutic options are
being explored. For example, an oral enzyme supplementation that accelerates gastrointestinal
breaking down of gluten could be taken before meals. Though none of the proposed treatments
have yet been proven to work, some are showing promise in treatment of other gastrointestinal
diseases, like cytokine therapy2 and selective adhesion molecule inhibitors that interferes with
inflammatory reactions (Sollid & Khosla, 2009). These advancements can one day lead to
alternative treatments for celiac disease other than the gluten free diet and increase the
improvement of symptoms.
Due to the growing prevalence of celiac disease among adults and other age groups, the
issue of treatment is urgent in many medical fields including nutrition. Though the best option
for treatment to date, it can be concluded that a gluten free diet is difficult to adhere to and
requires intensive education and resources to increase its positive effects. As a dietician, it is their
2 Cytokines are proteins that play a role in regulating immunological homeostasis an
inflammatory processes, it is being used to treat a range of infectious and autoimmune diseases
(Cutler& Brombacher, 2014).

duty to provide this education and availability of support groups and other resources to make the
sufferer feel as comfortable as possible adhering to gluten free diet, while bioengineers work to
find an alternative treatment.
References
Celiac Disease. (2014, August 1). Retrieved April 4, 2016, from
http://www.asge.org/press/press.aspx?id=556
Cutler, A., & Brombacher, F. (2014, January 1). Cytokine Therapy. Retrieved April 4, 2016, from
http://www.ncbi.nlm.nih.gov/pubmed/16387674
Diseases & Conditions: Celiac Disease. (2013, March 5). Retrieved April 4, 2016, from
http://my.clevelandclinic.org/health/diseases_conditions/hic_celiac_disease
Gluten Intolerance Group- Safe Chains. (n.d.). Retrieved April 6, 2016, from
http://inspiredeats.net/gluten-free-restaurants/gig-approved-gfree-restaurants/
Gluten and Food Labeling: FDA's Regulation of "Gluten-Free" Claims. (2014, June 5). Retrieved
April 4, 2016, from
http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm367654.htm
Holmes, G. (1, January 18). References. Retrieved April 7, 2016, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017515/
Leffler, D., Edwards-George, J., Dennis, M., Schuppan, D., Cook, F., Franko, D., ... Kelly, C.
(2009, June 1). Factors that Influence Adherence to a Gluten-Free Diet in Adults with
Celiac Disease - Springer. Retrieved April 3, 2016, from
http://link.springer.com/article/10.1007/s10620-007-0055-3/fulltext.html
Sollid, L., & Khosla, C. (2009, January 1). Future Therapeutic Options for Celiac Disease.
Retrieved April 3, 2016, from

http://www.nature.com/nrgastro/journal/v2/n3/full/ncpgasthep0111.html
Udi's Gluten Free Bread | Gluten Free Foods & Recipes. (n.d.). Retrieved April 4, 2016, from
http://udisglutenfree.com/
Verrill, L., Zhang, Y., & Kane, R. (2013). Food label usage and reported difficulty with following
a gluten-free diet among individuals in the USA with coeliac disease and those with
noncoeliac gluten sensitivity. Journal of Human Nutrition and Dietetics, 479-487.
Retrieved April 4, 2016, from
http://onlinelibrary.wiley.com/store/10.1111/jhn.12032/asset/jhn12032.pdf?
v=1&t=i39ei17j&s=61f045516f5fd19cbb4de35cb57a8d547b866eff