Inspired living

Your guide to gluten-free living

Your guide to gluten-free living

Lately, it seems the term “gluten-free” has attained fad status. Restaurant menus use the marker GF to indicate gluten-free dishes and, where once you might have had to visit a healthfood shop to buy gluten-free alternatives, supermarkets now stock a dizzying array. The majors even have a number of frozen gluten-free crumbed, battered and baked products in their freezer sections. Suddenly, friends are telling you they, or their child, are “going gluten-free”.

Nothing brings out the cynics and sceptics to voice their ridicule like a health fad. Especially when it is one involving foods that tend to be more expensive than the mainstream equivalents, which is certainly the case with manufactured gluten-free alternatives for things like kids’ snacks, breads, biscuits, packet breadcrumbs, cake and bread mixes etc. The sceptics see this as preying on the gullible who fall easily for quackery and popular but unscientific beliefs.

Gluten is the protein found in wheat, rye, barley, triticale (a crossbreed grain) and oats.

Of course, even they would not deny the reality of coeliac disease because it’s well-established that gluten is the trigger for this distressing autoimmune condition and that sufferers have no choice but to go gluten-free if they don’t want to be very sick and very miserable and die early. But it’s becoming clear among health professionals in all spheres that there’s more to gluten sensitivity than coeliac disease and that many people may have a problem with it without knowing it; that it could indeed be the cause of their frequent headaches, aching joints, fatigue or “brain fog”.

More and more, doctors and scientists are seeing, both clinically and in studies, people who don’t have coeliac disease presenting with numerous complaints that go away when they adopt a gluten-free diet. So much so, that first the term “non-coeliac gluten sensitivity” was coined and now the preferred umbrella term for the spectrum of gluten-sensitivity problems is “gluten-related disorders”, simply because many symptoms are the same and certainly the treatment is.

Still, it’s understandable that there would be some resistance to the idea that eating gluten may be harmful to people other than coeliacs. In the modern Western diet, and even some traditional diets, wheat is as ubiquitous as sugar and dairy. Consider all the foods we enjoy that have wheat as a major ingredient: bread, pasta, noodles, dumplings, couscous, bulgur, breakfast cereals, pastries and cakes, not to mention those we often don’t realise have wheat in them, such as soy sauce, baked beans and beer. Why would you go without these foods or pay more for gluten-free alternatives unless you had to? And haven’t we been eating “the staff of life” for thousands of years?

What is gluten?

Gluten is the protein found in wheat, rye, barley, triticale (a crossbreed grain) and oats. Actually, oats have a different type of gluten, called avenin, which many people with gluten sensitivity can tolerate as long as the oats aren’t contaminated by being processed and transported alongside the gluten-containing grains, which they most often are. So, unless certified gluten-free, oats are guilty by association.

While of no value nutritionally, gluten has certain properties that make it a helpful ingredient in cooking. It gives bread dough its elasticity for kneading, holding it in shape without crumbling during cooking, and its lovely chewy texture when baked. Of course, it’s not a cooking ingredient in itself. It’s made up of the proteins glutenin and gliadin, the latter being insoluble except in alcohol and the main troublemaker.

Gluten is a relatively new addition to our diets in that our hunter-gatherer ancestors didn’t eat grains. However, once humans established agriculture, around 10,000 years ago, and found they could grind the seeds of various plants into flours, mix them with liquid and cook them, breads as well as cereals of all kinds became cheap, filling, convenient staples in diets the world over. In fact, wheat alone accounts for 20 per cent of all calories consumed by humans worldwide.

The thing is, now that we can just pluck it from a shelf rather than spend hours grinding, kneading and baking, we have incorporated much more of it into our lives. Typically, most people would have breakfast and lunch based on bread and often have it again as an accompaniment at dinner, with snacks such as biscuits, cakes and pastries in between. In fact, we rely so heavily on bread and other grain-based staples that, when eating out or on the run, it can be very difficult to find breakfast or lunch that isn’t based on a gluten-containing carbohydrate.

Wheat allergy is a rare type of food intolerance characterised by skin, respiratory or gastrointestinal reactions to wheat allergens.

The other development alongside the proliferation of manufactured baked goods, especially since the 1960s, is significant changes in wheat itself. Modern agriculture has hybridised wheat plants, creating high-yielding semi-dwarf varieties, and bathed them in herbicides, fungicides and pesticides. According to Dr William Davis, renowned US cardiologist and author of Wheat Belly, modern wheat, even organically grown, is “genetically and biochemically light years removed from the wheat of just 40 years ago”. Coincidentally, the incidence of coeliac disease has quadrupled in that 40 years.

US wheat products are different, though, in that they are usually enriched with potassium bromate, a maturing agent that promotes gluten development in doughs. Concerns over the health risks of bromating led to its use being banned in some countries, including Australia, New Zealand, Canada, Japan and the European Union, and voluntary industry withdrawal in others. This has been put forward as one possible explanation for claims by some gluten-sensitive US citizens that when they travel in Europe they can eat pasta, pizza and breads with no ill-effects.

Whether it’s as simple as higher gluten content in grains, as claimed, or there are other factors at play, gluten is being seen more and more as a major trigger of food sensitivity not confined to the unlucky, obviously allergic people. These days, gluten sensitivity is divided into three main categories: allergy, autoimmune and immune-mediated (but not allergic or autoimmune).

Wheat allergy

Wheat allergy is a rare type of food intolerance characterised by skin, respiratory or gastrointestinal reactions to wheat allergens. Dietary wheat allergy in its extreme form can cause anaphylaxis, which is life-threatening, but it’s very rare. The more common forms are caused by inhalation, so are usually occupational hazards.

One of the most prevalent types of wheat allergy is baker’s asthma, which has been recognised since the time of the Roman Empire. Allergic rhinitis is another manifestation. A Polish study found that respiratory symptoms of baker’s asthma were observed in 4.2 per cent of bakery apprentices after only one year and in 8.6 per cent after two years. For allergic rhinitis, it was 8.4 per cent and 12.5 per cent respectively.

Some people experience wheat allergy symptoms if they exercise within a few hours of consuming wheat. This type of reaction can lead to anaphylaxis. Some have the reaction if they take aspirin or other anti-inflammatory drugs before exercising.

How is it diagnosed?
Diagnosis of wheat allergy is usually based on skin-prick tests and blood tests, though both can produce false positive results. A food diary and/or elimination diet may also be appropriate.

How prevalent is it?
Wheat allergy is thought to affect less than 1 per cent of people. It is more prevalent in children than in adults. In fact, it is one of the most common childhood food allergies and may be present in combination with others. However, children tend to grow out of it by around age five. Wheat allergy may be a permanent or transient condition.

Coeliac disease

Coeliac disease (CD) is an immune response to gluten in genetically susceptible people that involves inflammation of the small intestine and damage to the tiny villi that carpet it. Villi produce digestive enzymes and absorb nutrients. The immune system sees gluten as a foreign invader and goes into attack mode. When the villi are flattened and damaged by this attack, they start to lose their ability to aid digestion and nutrient absorption.

This reduction in the functioning of the villi produces gastrointestinal symptoms such as abdominal pain, diarrhoea, constipation, bloating and gas; fatigue, joint pain, recurrent mouth ulcers, weight loss, vomiting and, in young children, failure to thrive. CD is a multi-system disease, not just one of the gastrointestinal tract. In fact, coeliacs don’t always present with gastrointestinal symptoms. Other symptoms can include iron and vitamin deficiencies and osteoporosis as a result of poor nutrient absorption; gynaecological problems, delayed puberty, infertility and miscarriage.

CD is often associated with other autoimmune disorders such as thyroiditis, type 1 diabetes and skin conditions as well as liver disease, irritability, depression, anxiety, peripheral neuropathy and epilepsy.

How prevalent is it?
Finding figures for the incidence of CD is complicated because many people with the coeliac gene go undiagnosed until they develop symptoms that are severe enough that they can no longer ignore them. However, not everyone with the gene develops the disease. One accepted figure for the US is one in 133 people, while a New Zealand study found one in 80. Some experts quote roughly one in 100 for Australians.

Studies also show a significant increase in the incidence of CD. One US study of more than 3000 people over a 15-year period showed that the number of subjects with the disease doubled in that time due to an increasing number of them losing their immunological tolerance over that period. This suggests that a person who tests negative at a given time may test positive some years later. In other words, it’s a progressive condition.

The prevalence of CD in a particular population is thought to broadly parallel the amount of wheat consumed in the diet. For example, the incidence is low in Japan and Southeast Asia where rice is the staple grain; it’s also low in sub-Saharan Africa where maize is the cereal of choice. Even within Europe, it’s lower in Denmark, Estonia and Finland where lower amounts of gluten are consumed in infancy than in Sweden, where gluten consumption during infancy is higher.

How is it diagnosed?
Blood tests are carried out to confirm the presence of gliadin and anti-transglutaminase antibodies caused by the reaction to gluten. Sometimes, as in the case of children, antibody levels can fluctuate, so there may need to be another blood test a few months after the first.

A gene test can be useful, as virtually all people with coeliac disease are positive for the gene test; however, only one in 30 people who test positive to the gene actually develop coeliac disease and some argue that a positive gene test on someone without symptoms may cause the person to unnecessarily live under a cloud when they may never develop the disease.

Once blood testing is done, a biopsy of the small intestine may be taken via an endoscopy to establish certainty and ascertain whether the typical damage to the villi is present. Finally, improvement of symptoms on a gluten-free diet is further proof of a CD diagnosis. Coeliac disease is considered a permanent condition.

Gluten ataxia

Gluten ataxia is a form of CD in which the immune response is an attack on the cerebellum, which over time causes irreversible damage. This can affect things like gait and gross motor skills. Up to 60 per cent of people with gluten ataxia have evidence of cerebellar atrophy (shrinkage), as seen in MRIs.

It’s important to note that gluten ataxia is only a recently defined condition and not all of the medical profession accepts it yet. Therefore there’s no accepted way to test for it or diagnose it, although experts in the field of gluten-related disease have recently developed a consensus on how to test for it, which involves using CD blood testing.

It’s not known how many people have gluten ataxia. Ataxia affects 8.4 people in 100,000 in the US, so an even smaller number suffer from gluten ataxia. Dr Marios Hadjivassiliou, a consultant neurologist at Sheffield Teaching Hospitals in the UK, who first described gluten ataxia, says as many as 41 per cent of all people with ataxia with no known cause might, in fact, have gluten ataxia. Other estimates have placed those figures in the range of 11.5 per cent to 36 per cent.

In addition, many people who have CD or non-coeliac gluten sensitivity also complain of neurological symptoms such as balance problems, peripheral neuropathy and migraine, which often improve or disappear when they go on a gluten-free diet. For anyone diagnosed with gluten ataxia the diet must be very strict as even small amounts can continue to do neurological damage, plus neurological symptoms of gluten sensitivity usually take longer to improve than gastrointestinal symptoms. Some sufferers say their symptoms stabilise but never actually improve.

Dermatitis herpetiformis

This is a form of CD that affects the skin with an extremely itchy, blistering rash that usually appears in the same places on the body of the sufferer each time it breaks out. It can present anywhere but it usually affects the scalp, elbows, knees, back and buttocks. It’s more common in men than women by about two to one and is rare in children under 10.

Around 15–25 per cent of people with coeliac disease also have dermatitis herpetiformis (DH) and, although many DH sufferers don’t experience classic intestinal symptoms, 90 per cent of them are likely to have intestinal damage from gluten consumption, so an endoscopy may also be recommended in addition to the skin biopsy that establishes the existence of the condition.

There is a high correlation between DH and autoimmune thyroid conditions, with around 20–30 per cent of people with DH developing thyroid disease.

Because of the high risk of intestinal damage, a strict lifelong gluten-free diet is the only safe treatment for DH.

Non-coeliac gluten sensitivity

In recent years, scientists and doctors have begun to acknowledge another form of gluten intolerance in people who have similar symptoms to those of coeliacs but test negative for CD — hence the term non-coeliac gluten sensitivity (NCGS or just GS). People with NCGS don’t have the antibodies for CD or the typical villi damage, though they may experience some minor intestinal damage that repairs itself on a gluten-free diet. Eating gluten when you’re sensitive to it can lead to intestinal permeability, or leaky gut, which is thought to lead to autoimmune conditions, other food sensitivities and more.

NCGS is thought to be an innate immune response rather than an adaptive response, meaning it is immune-mediated but doesn’t have an immunological memory, as in an autoimmune disease. However, it shares many of the same symptoms as CD, though there’s a greater prevalence of non-gastrointestinal symptoms. These include behavioural changes, bone or joint pain, muscle cramps, numbness in the legs, arms or fingers, headache, brain fog and chronic fatigue. Symptoms generally appear within six hours to a couple of days after ingesting gluten.

Cells called intraepithelial lymphocytes (IELs), described as the soldiers guarding the inner lining of the intestine, protecting against food getting into the bloodstream, are normally under 25 per cent of epithelial cells. In NCGS patients the figure is 25–40 per cent and in CD above 40 per cent. The increase is an indication of a perceived threat. This suggests increased permeability of the intestinal wall and inflammation, as in CD.

When the intestinal wall is more permeable, other proteins, such as casein (in dairy), for example, may cross through and cause further sensitivity problems. In other words, one food sensitivity can lead to other food sensitivities.

It’s now believed there’s an association between NCGS and autoimmune diseases. NCGS is frequent in first-degree relatives of people with CD and it’s recommended that all first-degree relatives of anyone with diagnosed NCGS be screened for CD.

How prevalent is it?
It’s very unclear what the incidence of NCGS may be. All sorts of figures are proposed but they are only guesses. There is a well-established crossover with irritable bowel syndrome (IBS), however, and in a 2011 northern European study, 28 per cent of people with IBS met the criteria for NCGS, documented by a double-blind, placebo-controlled challenge. Population surveys in northern Europe in 2012 and 2013 showed the prevalence of IBS in the general population to be 16–25 per cent. So the incidence of NCGS is likely to be significantly higher than that of CD, at least 6 per cent or higher.

Between 2004 and 2010, 5896 patients were seen at the Center for Celiac Research at the University of Maryland. Of that number 347 (6 per cent) met the criteria for NCGS. Their symptoms included abdominal pain (68 per cent); eczema and/or rash (40 per cent); headache (35 per cent); “foggy mind” (34 per cent); fatigue (33 per cent); diarrhoea (33 per cent); depression (22 per cent); anaemia (20 per cent); numbness in the legs, arms or fingers (20 per cent); and joint pain (11 per cent).

New Zealand paediatric gastroenterologist and world-renowned expert on gluten-related conditions, Dr Rodney Ford, has speculated that “gluten-related disorders are likely to affect up to one-third of the population….” In fact, he says, many people believe no one should be eating wheat or gluten.

It’s a very contentious issue, though, and mainstream nutritionists are, generally speaking, vehemently opposed to the idea of people who don’t have a known sensitivity giving up gluten due to the belief that they would be missing some important nutrients and fibre. Others, such as proponents of the paleo way of eating, argue that our paleolithic ancestors did very well without grains and that we don’t need them.

Some practitioners believe that most people with a gluten-related disorder either self-diagnose and self-treat or are never diagnosed and never ask their physicians whether it could be the source of symptoms, perhaps because it doesn’t occur to them or, in some cases, for fear of having their suspicion brushed off or ridiculed. It’s thought to be more common in females (four times as many) and young to middle-aged adults. The number of children affected is unknown.

This doesn’t necessarily imply that huge numbers of us are gluten-sensitive or that indeed there aren’t plenty of us who don’t have a problem with it. However some of the experts speaking at the recent Gluten Summit, such as world-renowned paediatric gastroenterologist Dr Alessio Fasano, who heads the US Center for Celiac Research, expressed a belief that 100 per cent of humans are sensitive to gluten, while neurologist Dr David Perlmutter, for example, called it at 30 per cent.

How is it diagnosed?
Currently there are no specific tests to diagnose gluten sensitivity. When both allergy and autoimmune factors are ruled out, it is diagnosed by gauging the effects of putting the patient on a gluten-free diet for a period followed by controlled reintroduction of gluten. If the symptoms disappear when gluten-free and reappear when the gluten is back, the advice would be to follow a gluten-free diet permanently.

Anyone self-diagnosing gluten sensitivity and adopting a gluten-free diet to prove their suspicions needs to be aware that they cannot be tested for coeliac disease while gluten-free as the antibodies will not be present.

It’s not known whether NCGS is a permanent or transient condition, though it’s suspected that it may be permanent.

Gluten and behaviour in children

As mentioned elsewhere, there is a proven over-representation of ADHD among people with CD and that includes children. Autism, too, has been studied for dietary effects, particularly in reference to gluten-free, casein-free (GFCF) diets.

One study of 270 individuals included 149 children diagnosed with autism. All the children were put on a GFCF diet and their behaviour was assessed by parents, doctors and some teachers a month after beginning the diet, then every three months for a year. Blood tests were also carried out with a finding that 87 per cent of the children had high-titre antibodies to gliadin. Improvement in both physiologic and behaviour measures was reported in 81 per cent of the children within three months of beginning the diet.

Other studies have shown similar improvements in behaviour, non-verbal cognitive levels and motor problems, and that children with autism are at high risk for amino acid deficiencies and may benefit from a diet designed to address this. Autism has also been linked to early doses of antibiotics in babies and toddlers, which in turn has been linked to gut problems, including pathogenic bacteria in the gut.

But what of children not diagnosed with any spectrum disorders? The evidence for the effects of gluten on non-coeliac children without a spectrum diagnosis is largely anecdotal, but there is a plethora of it. Parents describe a tendency in their children to anger easily, be unable to deal with frustration, have screaming tantrums where they are “unreachable” and behave aggressively towards other children, all of which, they say, settles or disappears completely when gluten is eliminated.

Some parents describe a Jekyll and Hyde effect and say that without gluten they have a different child. So next time you see a child in a raging tantrum in the shopping centre, consider that it may be because they are having a reaction to the muffin they ate earlier.

Cardiovascular disease and gluten sensitivity

Dr Mark Houston, one of America’s foremost specialists in hypertension, who also specialises in nutrition (an uncommon combination), speaking at the recent Gluten Summit, says gluten-related disorders will become predominant as a risk factor for cardiovascular disease. Gluten sensitivity can also cause good cholesterol to be inactive or dysfunctional, he says.

Dr Houston believes it may be reasonable to test everyone for gluten sensitivity because it’s essential to address gut health when treating any patient. In his talk at the summit he said, “If you don’t know how to clean up the digestive tract, you can never be a good cardiovascular physician and get your patients fixed.”

Autoimmune disease is a newly considered factor in the development of endothelial dysfunction, peripheral vascular disease, coronary heart disease, heart failure and other cardiovascular illnesses. According to Dr Houston, “The blood vessel has an infinite number of insults, but only three finite responses to the insults. These are inflammation, oxidative stress and vascular autoimmune dysfunction.”

Certain antibodies that are markers of CD can affect the endothelium (the inner lining of the blood vessels) due to an autoimmune response to gluten. When the gluten-sensitive person eats it, the body sees the gluten protein as an invader and responds in the ways mentioned. The blood vessel is an “innocent bystander”, but it develops disease in response to the assault.

Dr Houston said he has found that, for example, idiopathic cardiomyopathy (swelling of the heart) in the gluten-sensitive patient is reversed when the patient is put on a strict gluten-free diet, as are some other cardiovascular problems.

Conditions aggravated by gluten

Research has shown that when people with NCGS have gastrointestinal symptoms such as diarrhoea and bloating, though there may not be the same intestinal damage as in CD, it’s believed there can be increased gut permeability from constant exposure to gluten. It’s also thought that intestinal permeability precedes the onset of several autoimmune diseases, perhaps all. Below are just a few conditions shown to be aggravated by gluten or to have a strong connection to gluten sensitivity.

It was been found in studies on mice by the Mayo Clinic that gluten affected the intestinal biome (flora) of the animals and that the intestinal biome plays a large part in the development of type 1 diabetes (the autoimmune type). A gluten-free diet was shown to protect against type 1 diabetes in the mice and that when gluten was added back into their diets the protective effect was reversed.

Researchers have found that coeliacs are three times more likely to suffer from eczema and their relatives are twice as likely to have it, indicating a possible link between gluten sensitivity and eczema. This is backed up by an abundance of anecdotal reports by eczema sufferers who say their eczema disappears when they eliminate gluten. However, not all find relief.

Rheumatoid arthritis
In a study published in 2010, 85 patients who had been diagnosed with RA were tested for the presence of antibodies associated with CD, with 16 testing positive for one type, 29 for another and 14 for another. The researchers concluded that it’s possible that CD may be the correct diagnosis in a patient with polyarthritis (in several joints), even if the patient meets the criteria for rheumatoid arthritis, and that CD should therefore be considered when diagnosing patients with polyarthritis. Even if a patient tests negative for CD, gluten sensitivity should be considered and a gluten-free diet trialled to assess whether arthritis symptoms improve.

Multiple sclerosis
While there hasn’t been much research on the link between gluten and MS, one Spanish clinical study on 72 MS patients, 126 of their first-degree relatives and 123 health subjects found that CD was present in 11.1 per cent of the MS patients compared with 2.4 per cent of the control subjects. CD was even more prevalent (32 per cent) in the first-degree relatives of the MS patients. Further, all the MS patients with CD were put on a gluten-free diet and “improved considerably both with respect to the gastrointestinal and to the neurological symptomatology in the follow-up period”. Again, there is plenty of anecdotal reporting of improvement in symptoms when gluten-free.

It has long been known that people with CD are more likely to have ADHD than the general population. In one 2004–2008 study of 67 Italians with ADHD, 10 tested positive for CD. Once they were put on a gluten-free diet, those with CD showed marked improvement in their behaviour and functioning compared with before the coeliac diagnosis and initiation of the gluten-free diet, leading researchers to conclude that CD is markedly over-represented among patients presenting with ADHD and that a gluten-free diet significantly improved ADHD symptoms in patients with CD. Further, that coeliac disease should be included in the ADHD symptom checklist.

Going gluten-free

In the US, to be labelled gluten-free, a food or drink must contain less than 20ppm (parts per million). In Australia and New Zealand it is currently <3ppm, which is undetectable, though there is ongoing debate about changing to the Codex limit of 20ppm, which is opposed by some gastroenterologists and others.

As gluten is one of the eight major allergens, the Food Standards Australia and New Zealand (FSANZ) code requires clear labelling of gluten derivatives but doesn’t dictate format. However, FSANZ produces a guide for food manufacturers with recommendations such as allergen listing should be in plain English, clearly legible (preferably in bold type) and grouped together.

If a manufacturer cannot guarantee there is no cross-contamination, a voluntary “May be present:” statement should be included directly below the ingredients list, according to FSANZ, though it also states: “Precautionary labelling should ONLY be used after a thorough risk assessment. Precautionary statements must NEVER be used as a substitute for good manufacturing practice (GMP) or as a generic disclaimer. Every attempt must be made to eliminate or minimise cross contact by GMP.”

Both Coeliac Australia and Coeliac New Zealand have a crossed grain logo (see their websites) for products they endorse as having gluten content <20ppm, though those products still must be <3ppm to be labelled gluten-free as per the FSANZ code. Both organisations say products with the crossed grain logo are safe, even if not labelled gluten-free.

Gluten-free diet
Among the speakers at the Gluten Summit there was no love for modern wheat, but with some there wasn’t a lot for other grains, either, mostly on the basis that they still have high GIs, also require a lot of processing to make them edible and, in the case of corn and corn-derived ingredients, in particular, may be genetically modified.

It was claimed that some makers of gluten-free manufactured foods put taste before nutrition in trying to create things that look and taste like the wheat-based item that everyone else enjoys. The general warning was that corn starch, rice flour, tapioca starch and potato starch increase blood sugar, too, and can cause weight gain and other negative health consequences.

Still, everyone likes variety in their eating options, not to mention convenience, and no kid wants to feel totally left out at school lunchtimes, so these foods may be considered fine in moderation, especially if made of all-natural ingredients. According to forecasting by consumer analyst group Datamonitor, the Australian gluten-free industry is set to skyrocket to about AU$105 million (US$92 million) by 2015 with the worldwide market set to grow by US$1.2 billion (AU$1.37 billion) in the same period, to a total worth of over US$4.3 billion (AU$4.9 billion). We can only hope that nutritional factors take the lead.

Despite the variety and convenience found on the supermarket shelves, it’s recommended that a strict gluten-free diet is first begun by eating only foods that are naturally gluten-free, which may include rice, corn, quinoa etc in their natural form. Some manufactured GF foods have additives that can cause a reaction, which can make it seem like the diet isn’t working, so it’s recommended that if you want GF cakes, biscuits, breads etc, you make your own with good-quality GF flours. Manufactured foods can be added later when the benefits of being gluten-free are proven. It’s also suggested to supplement with vitamins and minerals for a while as gastrointestinal reactions in gluten can cause some people to be low in some nutrients.

Eating out gluten-free
Thanks to the so-called gluten-free “fad”, it’s becoming much easier to find GF options for dining out, with many menus these days indicating gluten-free choices, though it’s been pointed out that restaurateurs are people, too, and like most of us would have kids, partners or friends on gluten-free diets. Even some pizza chains are offering GF crusts and toppings.

There are also directories of coeliac-friendly restaurants and cafes on the various coeliac support websites as well as websites like the Gluten Free Eating Directory (see resources). However, despite the best intentions of these eateries, people who are sensitive to minute amounts of gluten may still need to ask questions like does the gluten-free food have a separate preparation area, pots and utensils to avoid cross-contamination?

Also, it should be said that separating out the gluten-containing elements of a meal doesn’t make that meal gluten-free — eg picking the croutons out of a Caesar salad. That salad is still contaminated by tiny particles of wheat from the croutons.

The good, the bad & the suspect

Allowed Avoid Avoid unless labelled gluten-free





Corn and cornmeal (non-GM)

Dairy products in natural form




Gluten-free flours (rice, soy, corn, potato, bean)

Meats, fish & poultry (not crumbed, battered or marinated in shop-made marinade)



Oats certified gluten-free









All food and drinks containing:

Barley (malt, malt flavouring and malt vinegar are usually made from barley)

Battered foods


Crumbed foods

Durum flour


Graham flour

Ice-cream cones


Malted milk

Oats unless certified gluten-free



Soy sauce


Triticale (a cross between wheat and rye)





Cakes, pies & pastries





Drinking chocolate

Fish (canned) in sauce

Flavoured potato chips, corn chips & other snackfoods



Imitation meat or seafood



Meat in sauce


Processed luncheon meats

Salad dressings

Sauces, including soy sauce



Seasoned rice mixes

Self-basting poultry

Soups and soup bases

Vegetables in sauce

Vegie burgers


Other products that may contain gluten

  • Food additives, such as malt flavouring, modified food starch, hydrolysed protein, vegetable gum/starch and others
  • Medications and vitamins that use gluten as a binding agent
  • Playdough
  • Cosmetics
  • Mouthwashes and toothpastes

10 signs you may be gluten-sensitive

1. Digestive issues such as gas, bloating, diarrhoea and constipation.

2. Keratosis pilaris (also known as “chicken skin”) on the back of your arms. This tends be as a result of a fatty-acid deficiency and vitamin A deficiency secondary to fat-malabsorption caused by gluten damaging the gut.

3. Fatigue, brain fog or feeling tired after eating a meal that contains gluten.

4. Diagnosis of an autoimmune disease such as Hashimoto’s thyroiditis, rheumatoid arthritis, ulcerative colitis, lupus, psoriasis, scleroderma or multiple sclerosis.

5. Neurologic symptoms such as dizziness or a feeling of being off-balance.

6. Hormone imbalances such as PMS, PCOS or unexplained infertility.

7. Migraine headaches.

8. Diagnosis of chronic fatigue or fibromyalgia. These diagnoses simply indicate your conventional doctor cannot pinpoint the cause of your fatigue or pain.

9. Inflammation, swelling or pain in your joints such as fingers, knees or hips.

10. Mood issues such as anxiety, depression, mood swings and ADD.

Source: Dr Amy Myers, MD, founder and Medical Director of Austin UltraHealth


Wheat Belly, William Davis, MD
Grain Brain, David Perlmutter, MD
The Gluten Connection, Shari Lieberman
Gut and Psychology Syndrome, Dr Natasha Campbell-McBride
Nourishing Traditions, Sally Fallon
The Gluten Syndrome, Dr Rodney Ford
Coeliac Australia, coeliac.org.au
Coeliac New Zealand, coeliac.org.nz
Gluten Free Eating Directory, glutenfreeeatingdirectory.com.au
Gluten Free Living, glutenfreeliving.co.nz



Kerry Boyne

Kerry Boyne loves good food and is the managing editor of WellBeing.