Pastas

  • Processed luncheon meats
  • Sauces, gravies
  • Self-basting poultry
  • Soy sauce or soy sauce solids
  • Stuffing, dressing
  • Thickeners (roux)
  • Communion wafers
  • Herbal supplements
  • Drugs & over-the-counter medications
  • Nutritional supplements, vitamins, & mineral supplements
  • Playdough: A potential problem if hands are put on or in the mouth while playing with playdough or are not washed after use.

Source: Gluten Intolerance Group of North America. *Bread crumbs used in Japanese cooking.

disorders (including thyroid disease and type 1 diabetes), arthritis, miscarriage, and birth defects.

Who's at risk? As a genetic disorder, gluten intolerance is more common among people with European roots. The actual incidence in the United States is unknown but may run as high as 1 in every 133 Americans. The challenge is: Gluten intolerance is often misdiagnosed, and its varying symptoms often imitate other health problems. Often it goes undetected until triggered by other body stresses: perhaps surgery, a viral infection, or pregnancy.

The symptoms? They vary. Weakness, appetite loss, weight loss, chronic diarrhea, and abdominal cramps and bloating are common; some experience a painful rash, muscle cramps, or joint pain. Among women, gluten intolerance may interfere with the menstrual cycle. For children, gluten intolerance is especially risky. Unless well managed, gluten intolerance can affect a child's behavior and ability to grow and learn. Chronic irritability is a warning sign. For growth and development, a child's high energy and nutrient needs require adequate nourishment.

Gluten intolerance can occur at any age. Symptoms may appear first during infancy when cereal is started. Most cases are diagnosed in adulthood, often ten years after the first symptoms. Temporary lactose intolerance may accompany gluten intolerance, at least until the condition is under control and the small intestine heals. Healing may take months or years.

Primary treatment for gluten intolerance is a lifelong, strict eating regimen; a gluten-free diet is a "must." Once gluten is eliminated, the small intestine can heal. Nutrient absorption then improves; symptoms disappear. Those with gluten intolerance can live a long, healthy life. If you think you have gluten intolerance, ask your physician for a diagnosis.

Which Foods for Gluten Intolerance?

Gluten in wheat, rye, barley, and perhaps oats is damaging. To manage gluten intolerance, these four grains, and any food or food component made from them, must be avoided. Even trace amounts of gluten in the diet can damage the small intestine.

Avoiding wheat is probably the biggest challenge for people with gluten intolerance. That's because wheat is the main ingredient in so many foods: baked foods, bread, breakfast cereal, breaded foods, crack ers, pretzels, and pasta, among others. Gluten-containing ingredients show up as additives (thickeners, fillers, and stabilizers) in many other products, too, including batter-dipped vegetables, scalloped potatoes, canned soup, lunch meat, pudding, beer, salad dressing, canned tuna—and even some medications, toothpastes, and mouthwashes.

Gluten-containing ingredients may be hard to detect because they may appear under a different name or as part of another ingredient. See "Label Lingo: Words That May Indicate Gluten" in this chapter. The U.S. Food and Drug Administration is working on labeling regulations to help consumers more easily identify gluten-free products. Knowing how to identify gluten is important for using ingredients' information from food manufacturers. Technically, "gluten" describes the protein component of grain. Although rice and corn contain gluten, it's in a different form, so it's not harmful. Avoid gluten from barley, rye, wheat, and perhaps oats.

Eating Gluten-Free!

Coping with gluten intolerance requires a strict eating regimen. While it's hard to follow at first, this condition can be managed with food choices, not medication. If you—or someone you know—deals with gluten intolerance, these are some guidelines to follow:

  • Consult a registered dietitian who can help you learn how to live with gluten intolerance—and enjoy eating! See "How to Find Nutrition Help..." in chapter 24 for tips on finding a qualified nutrition expert.
  • Use grains and other starchy foods without gluten: amaranth, arrowroot, beans (legumes), buckwheat, corn, garfava, millet, Montina, nut flours, potato, quinoa, rice, sorghum, soy, tapioca, and tef. Skip oats since they may be produced and harvested in equipment used for handling wheat. As a result, cross-contamination may be a problem.
  • Look for gluten-free grains, flour, and food products in stores. Today more gluten-free food products are available than ever before. Can't find them in your grocery store? Check specialty or health food stores. Mail-order outlets also can be a source of alternate flours for baking, as well as prepared foods, mixes, grains, and specialty ingredients.
  • Read food labels carefully! Many commercially prepared foods—baked, frozen, and canned—have gluten-containing ingredients. These are among the many foods that may or may not be a problem: flavored and frozen yogurt, rice crackers, luncheon meats, egg substitutes, French fries (especially in restaurants), salad dressings, pudding mixes, canned soups, flavored teas, candies, seasoning mixes, tortilla chips, and Worcestershire sauce. Spotting ingredients and additives with gluten must become second nature. Check the ingredient list in "Label Lingo: Words That May Indicate Gluten" in this chapter.
  • Know the origin, composition, and production of ingredients. For example, flavored chips may be dusted with an ingredient made with wheat. Since the amount is less than 2 percent by weight, the ingredient may not be listed on the label. Another example: vinegars, distilled from grain, are okay except for malt vinegar in the United States. Malt vinegar is a problem because malt by definition in the United States is barley; it may be added to or used as the starting mash to produce malt vinegar. Ingredients used in prepared foods, such as marinades and barbecue sauce, may have malt vinegar, too.
  • Substitute gluten-free flour for wheat flour in food prep. Use corn, rice, soy, arrowroot, tapioca, or potato flours, or perhaps a mixture, instead of wheat flour. These flours are gluten-free. Because they give a dif-
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