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The definition of a gluten-free diet

Posted by plosmedicine on 30 Mar 2009 at 23:41 GMT

Author: Diane R. Lester
Position: Researcher
Institution: Uppsala University
Submitted Date: March 31, 2005
Published Date: March 31, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

I am curious to know more details on the gluten-free (GF) diet followed by clinical study participants. Even as an adherent to this diet, I am unsure how it is defined.
Gluten is present in food in both obvious and 'hidden' forms. 'Hidden' gluten enters foodstuffs in wheat-derived food additives or through factory cross-contamination. Its makes the definition of a GF diet elusive because its presence cannot be discerned from food labels. The strictest GF diet adherent tries to avoid 'hidden' gluten. This is onerous and impinges on one's lifestyle. A wide range of processed foods and food ingredients, as well as medicines and whitening toothpastes, become suspect (1).
'Hidden' gluten is capable of inducing symptoms (eg. mouth ulcers and stomach aches) in sensitive individuals (1), however the general risk it poses to those with celiac disease is unknown and difficult to study. The challenges in detecting gluten are acknowledged. 'Hidden' gluten is likely to be especially difficult to detect because it often has undergone processing that alters its solubility and/or amino acid sequence. For example, flavour enhancers are produced by the hydrolysis and deamidation of wheat protein (2). The resulting hydrolysate might evade current detection methods (3) yet still retain toxicity (4).
Clinical studies on diet in relation to celiac disease are very welcome because there is no other reliable way of demonstrating the risk of a foodstuff. It is impossible to test every foodstuff for risk using clinical methods. However, more detail on the eating habits of study participants with healthy intestinal mucosa might reveal what level of caution is generally advisable toward hidden sources of gluten.

2. Schlichtherle-Cerny et al. (2002) J Agric Food Chem. 50:1515-22
3. Valds et al. (2003) Eur J Gastroenterol Hepatol 15:465-74
4. Arentz-Hansen et al. (2000) J. Exp. Med. 191:603-12

No competing interests declared.