The grain group covers approximately 70-80% of the daily energy intake in our country. Wheat, rye, oats, corn and barley are examples of foods in the grain group. Gluten is the name given to the main storage protein found in wheat. It provides the elastic structure in the bread dough and gives it a spongy structure. There are health problems that occur with gluten consumption. The most common of these problems is celiac disease. Gluten is strictly prohibited in the diet in diseases such as celiac, gluten ataxia, dermatitis herpetiformis, wheat allergy, gluten sensitivity. Gluten can be eliminated from the diet due to depression, migraine, autism and neurological disorders. In recent years, gluten-free diet has been applied in the treatment of many diseases such as schizophrenia and fibromyalgia. In addition, gluten-free diet is applied as a lifestyle change. As a result, gluten-free diet, which is applied both as a treatment and as a diet, is preferred by many people.
Although gluten-free diet may seem difficult at first, it becomes easier to adapt to the diet over time. The support of the person’s environment is also important during the gluten-free diet. The family needs to follow the rules of food preparation, and friends need to know about the gluten-free diet and its reasons. At this point, responsibility falls on the person who practices the gluten-free diet. For example, when you go to your friend, you can prepare and carry your own food and tell your friend about cross-contamination and the symptoms it may cause in you. In this way, consciousness can develop and the persistent environmental pressure on food can be reduced. Since the food intake will be greatly restricted while eating gluten-free, the nutrition program should be prepared in a way that is sufficient in terms of macro and micronutrients. Thanks to the products that have become widespread in our country in recent years, gluten-free nutrition becomes easier. Many products offer gluten-free alternatives. Diversity is the key to balance and nutrition must be varied. You should definitely create alternatives instead of products that you cannot consume. Otherwise, after a while, psychological problems may develop with the psychology of restraint. For example, if you like pizza, how about trying amaranth-based pizza?
What can I eat on a gluten-free diet?
Wheat and wheat derivatives such as couscous, pasta, semolina and vermicelli are included in the prohibited food group in gluten-free diet. Kamut, which is also called barley, malt, rye, spelt, triticale and khorasan wheat, should not be included in the diet. Spices, white vinegar, sauces, flavorings, modified food starch and oats are in the group that needs attention against any risk. Thickeners and flavorings in many products on the market may contain gluten. For this reason, the label should be carefully considered when choosing a product. Oats naturally do not contain gluten, but may contain cross-contamination. For this reason, gluten-free oats should be consumed when preferred. In fresh fruits and vegetables, in the pulses group such as lentils, chickpeas, and dry beans; in dairy products such as milk, yogurt, kefir; in protein sources such as meat, chicken, fish, eggs; in nuts such as almonds, walnuts, hazelnuts; Fats and oils do not contain gluten. For this reason, the consumption of products in this group is free. Celiac patients may have difficulty digesting lactose, especially in the newly diagnosed period, as they have intestinal sensitivity. For this reason, dairy products can be eliminated from the diet for a while. Rice, potatoes, corn, millet, sorghum, buckwheat, quinoa, amaranth, teff seeds are also in the free group and are good carbohydrate sources to get the energy that should come from carbohydrates. Consuming enough carbohydrates is very important for the functions in our body. Nutritional habits such as gluten-free bread consumption, adding buckwheat and amaranth to salads should be acquired. At the same time, you can diversify your diet by including various recipes such as cookies made with quinoa barren, gluten-free flour types (such as gluten-free buckwheat flour, almond flour, hazelnut flour). Sugar, which is a source of simple carbohydrates, is also in the free group. Sugar consumption should be kept at a low level for a healthy diet. The World Health Organization recommends that sugar consumption be below 10% of daily energy and even lower than 5%.
First Degree Relatives Attention!
Celiac disease is genetically based, so it is more common among individuals with a family history of celiac disease. If any individual has a first-degree relative with celiac disease, that individual has an increased risk of developing celiac disease. This condition is seen in 5-10% of family members of individuals diagnosed with celiac disease. Individuals with a family history of celiac disease are recommended to undergo necessary screenings against the risk of developing celiac disease. Especially in childhood, the right growth and development curve can be caught with early diagnosis. Therefore, screening first-degree relatives for celiac disease is important for early diagnosis.
With a gluten-free diet, protein intake decreases due to the decrease in grain protein and the inability to consume various foods. For this reason, there should be protein sources such as meat, chicken, fish, eggs in the diet. Those who do not consume animal products may prefer to get protein from legumes. Vegans should be especially sensitive. Because while not consuming animal protein sources, it will also remove many grain sources from their diet with gluten-free diet. For this reason, vitamin deficiencies can be observed. With a gluten-free diet, grain consumption decreases and fiber intake decreases. While fresh fruits and vegetables are included in the diet to increase fiber intake during the day, the diet can be enriched in terms of fiber by adding boiled quinoa to salads and teff seeds to yogurt. Care should also be taken when consuming soup on a gluten-free diet. In particular, the majority of instant soups may contain wheat flour or its derivatives. From time to time, ready-made soup mortars can be used in restaurants, so it should be asked before consuming. You can try to prepare tomato soup at home using gluten-free flour or using no flour at all, and you can choose ready-made soups that we have come across recently.
How can we provide elastic structure in dough?
Gluten provides elastic and spongy structure in dough. For this reason, it will be difficult to catch this structure when we want to make gluten-free recipes. It may be possible to provide this structure by using gluten-free xantham gum, guar gum, psyllium husk, chia seeds. Care should be taken when using the amount and content. Even if they do not naturally contain gluten, they may contain due to cross contamination, so it must be obtained from a reliable source.
Care should be taken during preparation and cooking
Cross-contamination is the contamination of an undesirable product from a contaminated product to a non-contaminated product. Cross-contamination may occur if care is not taken in the use of products in the kitchen in mass nutrition institutions. If you share your own kitchen, there are rules that you should pay attention to to prevent cross contamination. First of all, make sure that the kitchen utensils are washed well after each gluten-containing food is prepared. It will be safer to prepare gluten-free meals before the meal is prepared against a more possible risk of contamination. Always keep the containers you use to store gluten-free products separate from other containers. Using non-stick pans in the communal kitchen will reduce the risk of contamination. When storing your products, you can label them using attractive colors so that they are not close to other products and not mixed, and you can store them on a separate refrigerator shelf.
Dietitian Dilara Tuygan
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Alas, Celiac! What will happen now?
The only cure for celiac disease is a gluten-free diet. Patients need to maintain strict gluten-free meals for life. People diagnosed with celiac disease as a result of clinical symptoms, serological tests, and small bowel histology should immediately start a gluten-free diet. He should stay away from the consumption of wheat, barley, rye and oat foods and beverages that should eliminate gluten from his life. Gluten-containing and iced tea such as white bread, whole wheat bread, bran bread and pasta, bulgur are not consumed in the gluten-free diet. It should be used with gluten-containing foods, which we call cross contamination, which do not contain gluten, but in this utility, attention should be paid to gluten contaminated contents.
Serological, hematological and biochemical tests (complete blood count, iron profiles, thyroid tests, calcium, magnesium, zinc, B12, folic acid and vitamin D) density and dietary compliance should be monitored. It is also important in follow-up in children.
Transglutaminase needs to be measured in a certain way to observe the effect of gluten-free treatment. If there are serological findings that do not improve at the end of a year, it should be considered that there is contamination in the diet. Serological tests are considered as a symptom of reaching normal levels, and it is known that the fastest serological tests in celiac disease reach their normal values in the 6th month and the slowest at the end of the 1st year.
A gluten-free diet should be followed very strictly. Very low amounts of gluten can cause clinical symptoms to persist. Celiac patients and their relatives should be well aware of the free, unfavorable foods that are included in the gluten-free diet and which should be controlled.
Dietician Armoni Yılmaz
Guide to Diagnosis, Treatment and Follow-up for Family Physicians in Celiac Disease, 2019
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Öztürk, Y. E., Uyar, G. Ö., Serin, Y., & Gürkan, Ö. E. (2018). Gluten-Free Diet Treatment in Celiac Disease: A Case Report. Journal of Nutrition and Diet, 46 (3), 320-324