Food Trends and Gluten - ANFP
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by Brenda Richardson, MA, RDN, LD, CD, FAND
1 HOUR
CE
CBDM Approved
Food Trends
and Gluten Know the Facts
NUTRITION CONNECTION
FOO D T R E N DS IN 2 018 INCLU D E TH E GROW ING U S E OF
G LU T EN- FREE FO O DS AND BE VERAGES
According to popular food and culinary journals, 2018 100 million Americans consuming gluten-free products,
will be a year of new and continuing trends that include most of whom do not have celiac disease. Interestingly,
expansion of Middle Eastern cuisine, product transparency, this continued trend is projected to result in the gluten-
edible flowers, food powders, new methods to process free products market reaching $6.2 billion by 2018. The
and combine ingredients, and increased use of sparkling United States has about 59 percent share in the global
drinks. market.
Growth in use of gluten-free foods and beverages is also Our understanding of these 2018 projected trends
projected as the general public considers foods without helps each of us to also embrace the cultural and ethnic
gluten as options for healthier eating. This is accompanied significance of food which goes beyond daily sustenance.
with the increased diagnosis of celiac disease and gluten As healthcare providers, we must get to know our clients
sensitivities. and be able to assess the nutritional impact of some
of these trends with the possibility of new foods and
Over the past decade, gluten avoidance has become the
beverages. This article will address specifically the growing
most popular dietary trend in the United States, with over
12 NUTRITION & FOODSERV IC E EDGE | January-February 2018
brendar10@juno.com
use of gluten-free foods for autoimmune conditions • Bone/joint pain Brenda Richardson,
as we strive to promote such as type 1 diabetes, MA, RDN, LD, CD,
• Muscle cramps FAND is a lecturer,
nutritional improved rheumatoid arthritis, or
• Easy bruising of the skin author, and owner/
outcomes. thyroid problems. It can president of Brenda
also increase the risk of • Itchy, blistering rash
Richardson, LLC.
C E LIAC D I S E A S E
some gastrointestinal • Tingling or numbness
AND GLUTEN
cancers. in hands and feet
SENSITIVITY
(peripheral neuropathy)
As we discuss the meaning Originally thought to be a
rare disorder, celiac disease • Swelling (edema) of hands
of gluten-free, we first
is now recognized as one of and feet
need to understand how
gluten plays a role in the most common inherited • Migraine headaches
celiac disease and non- diseases. Celiac disease is • Mood swings/depression
celiac gluten sensitivity common in people of North
• Mouth ulcers (canker
(sometimes referred to as American and European
sores)
gluten intolerance). ancestry, as well as in ADDITIONAL
Additional symptoms in
the populations of South RESOURCES
Celiac Disease America, North Africa, children may include:
Celiac disease (CD) is a India, Pakistan, and the • Failure to thrive (delayed • Shelley Case. Gluten
hereditary autoimmune Middle East. growth and short stature) Free: The Definitive
Resource Guide. Case
intestinal disorder that Symptoms and • Irritability and behavioral Nutrition Consulting, Inc.
Regina, Saskatchewan,
affects both children and presentations of celiac changes Canada. 2016.
adults. When an individual disease (CD) may include • Concentration and • Gluten Free
with this disorder consumes the following: Watchdog: www.
learning difficulties glutenfreewatchdog.org
gluten, an immune reaction
• Vitamin and mineral • Delayed puberty • Academy of Nutrition
is triggered in the small
deficiencies (A, D, E, • Dental enamel
and Dietetics.
intestine resulting in an Nutrition Care
K, calcium), iron, folic abnormalities Manual. http://www.
inflammatory response.
acid, and/or vitamin B12 (discoloration, loss of
nutritioncaremanual.org.
Accessed December 6,
Tiny finger-like projections deficiencies tooth enamel) 2017.
or villi in the small intestine • Chronic fatigue and • “Gluten Free” Claims
become inflamed and Diagnosis of celiac disease in the Marketplace:
weakness
eventually damaged is often very difficult Expected Market Trends.
• Abdominal pain, bloating, because of its diverse range
Agriculture and Agri-
from continued exposure Food Canada: www.
and gas of symptoms, some of agr.gc.ca. Accessed
to gluten. As a result,
December 12, 2017.
the body is unable to • Indigestion/reflux which overlap with other
• American Celiac Disease
adequately absorb nutrients, (heartburn) conditions. Many individuals Alliance: https://
especially iron, calcium, • Nausea and vomiting with celiac disease are americanceliac.org/
vitamin D, and folic acid. • Ongoing or intermittent misdiagnosed as having • Celiac Disease
Foundation: www.celiac.
Also, malabsorption of diarrhea and/or other disorders such as org
carbohydrates (e.g., lactose, constipation irritable bowel syndrome • National Celiac
which is the carbohydrate (IBS), lactose intolerance, Association: http://www.
• Lactose intolerance csaceliacs.org/
in milk), protein, and other ulcers, and/or chronic
• National Foundation
nutrients may occur. • Weight loss (note that fatigue syndrome. It has for Celiac Awareness:
CD also can occur in been shown that individuals www.celiaccentral.org
Untreated celiac disease overweight or obese
can lead to increased risk individuals) Continued on page 14
N U TR I TI O N & FO O DS E RV I C E EDGE | January-February 2018 13
Continued from page 13
with celiac disease see Gluten sensitivity is digested, short-chain
multiple physicians over characterized by a carbohydrates that can
an average of 11 years wide variety of both cause bloating, gas, and
before receiving a definitive intestinal and extra- other digestive symptoms.
diagnosis. intestinal symptoms Currently the dietary
including abdominal pain, approach of FODMAP
Currently, the only bloating, gas, diarrhea or as a treatment for non-
treatment for celiac disease constipation, unexplained celiac gluten sensitivity is
is a strict gluten–free diet anemia, headaches, “foggy controversial and additional
for life. Following the diet mind,” depression, chronic research is needed.
will result in improved fatigue, skin rash, leg
health and well-being, W H AT I S G L U T E N ?
numbness, and joint pain.
as well as greatly reduce To a baker, gluten is the
the risk of celiac-related Due to limited substance in flour that,
complications. In some understanding of the when combined with a
cases complete healing may pathophysiology, the liquid, is responsible for
not occur, especially if the only way to determine if creating the sticky, elastic
villous atrophy is severe. someone may have non- texture of raw dough. But
celiac gluten sensitivity is to what exactly is gluten?
Non-Celiac Gluten first rule out celiac disease In simple terms, gluten
Sensitivity and wheat allergy, and then is the general name for
The phenomenon of gluten observe the response to a specific protein fractions
sensitivity in the absence gluten-free diet and a gluten (prolamins and glutelins)
of celiac disease is not challenge. in wheat, barley, and rye.
new; it was first described Treatment for individuals And while other grains
in medical literature in with non-celiac gluten contain prolamins (e.g.,
the late 1970s. Since then, sensitivity is to follow a zein in corn, sometimes
GLUTEN
adverse reactions to gluten gluten-free diet to alleviate referred to as “corn
continue, despite testing symptoms; however, gluten;” orzenin in rice), SENSITIVITY IS
negative for celiac disease. whether gluten must be these proteins are not CHARACTERIZED
This has led to further strictly avoided for life (as harmful to persons with
research and increased celiac disease or non-celiac by a wide variety
is necessary with celiac
publication on the subject. disease) is at present gluten sensitivity. of both intestinal
Non-celiac gluten sensitivity unknown. and extra-intestinal
What Items Contain
(sometimes referred to as Recently there has also Gluten? symptoms including
gluten intolerance or gluten been research on the All types of wheat including abdominal pain,
sensitivity) continues to be role of fermentable spelt, kamut, einkorn,
widely debated. Still unclear oligosaccharides, bloating, gas, diarrhea
emmer, farro and durum,
is whether individuals are disaccharides, as well as barley, rye, and or constipation,
reacting to gluten or to monosaccharides, and triticale contain gluten. In
some other component polyols (FODMAP) unexplained anemia,
addition to baked products,
in foods. On the other carbohydrates in the headaches, “foggy
cereals, and pastas made
hand, individuals with digestive symptoms seen from these grains, here are mind,” depression,
so-called non-celiac gluten in non-celiac sensitivity. some examples of gluten-
sensitivity actually may have FODMAPS are the chronic fatigue, skin
containing items that must
undiagnosed celiac disease. fermentable, poorly be avoided: rash, leg numbness,
and joint pain.
14 NUTRITION & FOODSERV IC E EDGE | January-February 2018
• Bulgur in wheat, rye, and barley. However, the main reason for
• Couscous reactions to oats is that they frequently are contaminated
with gluten-containing grains during seeding, growing,
• Freekeh
harvest, storage, transportation, and milling. Thus,
• Wheat bran consumption of regular commercial oats is not safe for
• Wheat flour individuals with celiac disease. Fortunately, there are
• Wheat germ companies around the world that produce gluten-free
oats, although the methods used vary among growers and
• Wheat gluten
millers.
• Wheat-based semolina
Based on clinical studies over the past 20 years, research
• Fu (dried gluten product sold in thin sheets or thick
has revealed that consumption of pure, uncontaminated
round cakes)
oats is safe for the majority of individuals with celiac disease.
• Seitan
• Orzo What Can Be Served on a Gluten-Free Diet?
• Udon A wide variety of naturally gluten-free foods such as fruits,
vegetables, nuts, seeds, legumes (dried beans, lentils,
• Barley malt
peas, soybeans), eggs, plain meat, poultry, fish, seafood,
• Barley malt extract/barley malt syrup yogurt, and cheese can be included in a gluten-free diet.
• Barley malt flavoring In addition, there are many gluten-free flours, cereals, and
• Malt vinegar starches that can be substituted for wheat, rye, and barley
• Brewer’s yeast (see below). Distilled alcoholic beverages and wines are
also allowed; however, beer derived from barley must be
• Beer made from barley, wheat, or rye
avoided. All vinegars are gluten-free except for malt vinegar
In addition, gluten-containing ingredients often are (made from barley and is not distilled) and some rice
present in many other foods and beverages such as: vinegars (if derived from wheat or barley and not distilled).
• Broths, bouillons, soups Gluten-free flours, cereals, and starches that can be
• Sauces substituted for wheat, rye, and barley include:
• Soy sauce • Amaranth
• Marinades • Arrowroot
• Salad dressings • Buckwheat
• Gravy • Corn
• Prepared meats (e.g., burgers, hot dogs, sausages) • Flax
• Meat substitutes (e.g., vegetarian burgers, sausages) • Pulse flours (bean, lentil, pea)
• Imitation crab or lobster • Mesquite flour
• Snack foods • Millet
• Candy (e.g., licorice, chocolates, chocolate bars) • Nut flours (almond, chestnut, hazelnut, pecan)
• Flavored coffees and teas • Potato flour
Product labels and ingredient lists are important to read in • Potato starch
helping select safe gluten-free options. • Quinoa
• Rice (black, brown, glutinous/sweet, purple, red, white,
What About Oats?
wild)
Historically, oats were restricted from the gluten-free diet
• Rice bran
because it was thought that their avenin prolamin caused
intestinal damage similar to that caused by the proteins Continued on page 16
N U TR I TI O N & FO O DS E RV I C E EDGE | January-February 2018 15Continued from page 15
• Rice polish Fortunately, the gluten-free CONCLUSION work on proper diagnosis,
• Sago marketplace has expanded Predictions for culinary assessment, and effective
rapidly, especially over the trends in 2018 include an nutrition treatment, to
• Sorghum
past few years. Whereas increase in the diverse include resident education
• Soy historically only a handful of and involvement. For the
use of gluten-free foods.
• Sweet potato flour small specialty companies Due to the complexities individual with sensitivity
• Tapioca (cassava/manioc) made gluten-free products, of the gluten-free diet, the to gluten, nutritionally
today many manufacturers Certified Dietary Manager adequate, tasty meals
• Teff
of all sizes offer a wide and Registered Dietitian and snacks are critical for
• Gluten-free specialty range of options. should collaboratively positive outcomes. E
products
1 HOUR
CE Questions CE
CBDM Approved
NUTRITION CONNECTION
Reading Food Trends and Gluten: Know the Facts and successfully completing these questions online has been approved for
1 hour of continuing education for CDM, CFPPs. CE credit is available ONLINE ONLY. To earn 1 CE hour, purchase the online CE
quiz in the ANFP Marketplace. Visit www.ANFPonline.org/market, select “Publication,” then select “CE article” at left, then
search the title “Food Trends and Gluten: Know the Facts” and purchase the article.
1. Over the past decade, gluten avoidance has become the 5. Gluten is the general name for specific ______ fractions
most popular dietary trend in the United States, with over (prolamins and glutelins) in wheat, barley, and rye.
____ million Americans consuming gluten-free products. A. Adhesive
A. 50 B. Carbohydrate
B. 75 C. Protein
C. 100
6. All types of wheat including spelt, kamut, einkorn, emmer,
2. Celiac disease (CD) is a ______ intestinal disorder that farro, and durum, as well as barley, rye, and triticale contain
affects both children and adults. ______.
A. Viral A. Gluten
B. Hereditary autoimmune B. Fat
C. Contagious C. Neoplasms
3. Untreated celiac disease can lead to increased risk 7. In addition to baked products, cereals and pastas made
for autoimmune conditions such as type 1 diabetes, from these grains, gluten-containing ingredients often
rheumatoid arthritis, or thyroid problems. It can also are present in many other foods and beverages making it
increase the risk of some ______ cancers. important to carefully read
A. Gastrointestinal A. Food labels
B. Oral B. Ingredient lists
C. Skin C. Both A and B
4. Gluten sensitivity in the absence of celiac disease with
adverse reactions to gluten is referred to as
A. Celiac II
B. Non-celiac sensitivity or gluten intolerance
C. Gout
16 NUTRITION & FOODSERV IC E EDGE | January-February 2018You can also read
