Gluten is the Latin word for glue. In food science, gluten is a protein composite found in wheat and related grains, including barley and rye. Yet this protein that gives elasticity and viscosity to foods, giving the final food product a chewy texture, is some people's worst enemy. Thomas Attard is a consultant paediatrician gastroenterologist explains why when I ask him about coeliac disease and gluten related disorders in children.

Professor Attard explains that, through agriculture practice over time, contemporary cereals, including wheat, have evolved into types that are significantly richer in gluten than they were in earlier millennia. This has had an impact on the incidence of gluten-related health problems.

Speaking about coeliac disease in particular, Professor Attard said the disease is becoming more common across the Western world and the Mediterranean, and traditionally unaffected populations like India and China. This is because of increased affluence (which means more exposure to refined wheat products that are rich in gluten), heightened awareness of the condition, and better access to more reliable diagnostic testing modalities. "This has resulted in epidemic-scale increases in coeliac disease, he says. "There may be as many as five to eight undiagnosed coeliacs for every known case."

While coeliac disease is becoming more visible, currently wheat allergy and NCGS (non-coeliac gluten sensitivity) are not. This is set to change as awareness and educational efforts are underway. Prof Attard said one aspect of management that should be emphasised is the reversion to naturally gluten-free food as opposed to normally gluten-containing foods that are made with gluten-free substitutes. The latter, attractive as they may be because they offer food choices that are identical to the general population's, implies more processing, a far more expensive selection of foods and, sadly, a much greater opportunity for fraud.»

On the other hand, a naturally gluten-free diet takes advantage of the wide range of gluten-free foods and preparation techniques that can be used to create satisfying, healthy and economical meals. Furthermore a naturally gluten-free diet takes advantage of more culturally congruent foods, including fresh local and organic grown produce.

What happens when people with coeliac disease eat foods containing gluten? Their immune system responds by damaging the finger-like villi of the small intestine. When the villi become damaged, the body is unable to absorb nutrients into the bloodstream, which can lead to malnourishment. Coeliac disease is an autoimmune digestive disease that damages the villi of the small intestine and interferes with absorption of nutrients from food. Essentially, every time a person with coeliac disease consumes gluten, the body attacks itself.

If left untreated, people with coeliac disease can develop further complications such as other autoimmune diseases, osteoporosis, thyroid disease, and cancer. Symptoms related to coeliac disease include diarrhoea, excessive wind or constipation, nausea, vomiting, recurrent stomach pain, iron deficiency, vitamin B12 or folic acid, tiredness and/or headaches, sudden or unexpected weight loss, mouth ulcers, hair loss, skin rash, tooth enamel problems, joint and/or bone pain, depression, osteoporosis, type 1 diabetes and other autoimmune diseases.

Gluten-free reviews and recipes www.beatthegrain.com (A&H note: this information should not be used as a substitute for advice from a properly qualified healthcare practitioner.)

Common foods that contain gluten 

• barley, and anything with the word barley in it, such as barley malt beer
• bleached flour
• blue cheese, as it is sometimes made with bread mould)
• bread flour
• bulgur wheat
• cake flour
• communion wafers
• cracker meal
• croutons
• couscous
• durum
• farina
• faro
• glutenin
• graham flour
• kamut
• malt, and anything with the word malt in it, such as rice malt, malt extract or malt flavouring)
• malt beverages
• matzo, which is made with wheat)
• orzo
• pasta - all varieties made with wheat, wheat starch, barley, rye or any ingredient on this list
• rye, and anything with the word rye in it
• semolina
• soy sauce - check the ingredients as some brands use wheat spelt
• suet
• tabbouleh
• teriyaki sauce - check ingredients as some brands use wheat) triticale
• triticum
• vital gluten
• wheat*, and anything with the word wheat in it,such as wheat grass, wheat berries, wheat germ, wheat starch, wheat bran and wheat flour

*Buckwheat is the only exception.

Food additives that contain gluten

• abyssinian hard (a wheat product)
• amp-isostearoyl hydrolysed wheat
• brewer's yeast
• cereal binding
• cereal extract
• dextrimaltose
• dinkel
• disodium wheatgermamido Peg-2 sulfosuccinate
• edible starch
• einkorn
• emmer
• filler
• fu
• granary flour
• mir
• udon (wheat noodles)
• whole-meal flour

Foods & food additives that MAY contain gluten

If a food contains one of the following ingredients and does not have the gluten-free symbol on it, do not consume it before contacting the mother company to ask for more information about the product.

• artificial colour
• artificial flavouring
• bouillon cubes
• brown rice syrup
• candy
• caramel colour
• colouring
• dextrins
• dried fruit (may be dusted with wheat)
• flavoureded coffee
• flavoureded vinegar
• flavoureding
• food from bulk bins at the grocery store
• food starch
• French fries
• glucose syrup
• gravy cubes
• ground spices (wheat is sometimes added to prevent clumping)
• hydrolysed plant protein (HPP)
• hydrolysed vegetable protein (HVP)
• ice cream
• maltodextrin
• maltose
• miso
• modified starch
• monoglycerides and diglycerides
• monosodium glutamate (MSG)
• mustard powder - some brands contain gluten so check the ingredients
• natural flavouring
• oats - look for gluten-free oats
• processed cheese - check the ingredients
• processed meats - cold cuts, hot dogs, sausages, and canned meats that contain wheat, barley, rye, oats, gluten fillers or stabilisers
• rice malt
• rice syrup
• salad dressing
• seasonings (including powdered flavouredings and dustings on chips, nuts, popcorn, rice mixes, and rice cakes)
• smoke flavouring
• soba noodles
• starch
• stock/bouillon cubes
• surimi (imitation seafood)
• textured vegetable protein (TVP)
• vegetable starch
• vitamins
• pain killers

COELIAC DISEASE