What to eat if you have gluten intolerance?

Gluten is a substance present in cereals such as wheat and its derivatives. It helps food maintain its shape and acts like a glue that holds food together. This is why it is used as a texturing agent in the food industry. It is composed of numerous proteins classified into 2 families: prolamins and the glutenins. In the context of celiac disease, it is certain prolamins which trigger the symptoms of intolerance, and in particular:

• the secalins of rye (triticale, which is a hybrid of wheat and rye).
• the avenin of oats : 8% of celiac patients are intolerant to oats.
• gliadin wheat including the following wheat varieties: wheat, kamut, spelled.
• hordenine of barley.

Many misnomers revolve around gluten intolerance. It is therefore important to restore order to the terms used.

• Celiac disease, gluten intolerance : intolerance is a difficulty of the digestive tract in assimilating a food, in this case gluten. The latter does not directly involve the immune system, unlike allergies. There is then no vital prognosis involved. The diagnosis is based on the detection of specific serum antibodies (Immunoglobulin A, otherwise called IgA) and the confirmation by intestinal biopsy during endoscopy which shows villous atrophy. The latter is characteristic of celiac disease and carries serious risks of deficiencies. Indeed, villous atrophy is a reduction in the volume of the villi of the intestinal mucosa, allowing the absorption of certain nutrients. As a result, their atrophy leads to absorption difficulties and consequently malabsorption diarrhea. Patients are genetically predisposed and the prevalence varies from 0.5 to 1% of the population (of which 10 to 20% would be diagnosed).

• Gluten/wheat allergy : the immune system is involved. It is a immediate hypersensitivity reaction with allergic manifestations (skin rashes, angioedema, anaphylactic shock). The vital prognosis can therefore be engaged. The immune reaction is mediated by Immunoglobulin E (IgE). There is no villous atrophy. In addition, the pathology is less common than celiac disease (0.1 to 0.3% of the population).

• Non-celiac gluten hypersensitivity : symptoms suggestive of irritable bowel syndrome (abdominal pain, diarrhea-constipation, bloating) without villous atrophy, in subjects diagnosed as non-celiac and non-allergic. These people see their health improve through the gluten-free diet. To date, there is no scientific rationale. The attributability of gluten therefore remains to be demonstrated. Indeed, the latest research tends towards other components of wheat such as FODMAPs to identify the causes of hypersensitivity to non-celiac gluten, instead of gluten or in addition to gluten. The prevalence is 3% of the population.

Celiac disease is caused by the combination of a genetic predisposition and a triggering event after the ingestion of gluten.

• Genetic predisposition : in 95% of cases, it is the HLA DQ2 gene which is the main genetic predisposition. The remaining 5% is triggered by the DQ8 gene. These genes encode the histocompatibility molecule complex (MHC). The CMH is used to recognition of self and therefore to self-tolerance. They recognize foreign antigens and present them to the immune system. Lymphocytes (immune cells) help differentiate the body's antigens (self) from foreign antigens (non-self). In the context of gluten intolerance, gluten proteins are considered to be foreign bodies and thus involve an immune response in order to destroy them. This genetic predisposition is present in 30 to 40% of the general population.

• Trigger event : it promotes the immune process of the disease. There are several triggering events. First of all, this may be due to significant amount of gluten ingested or to lack of breastfeeding. Indeed, the introduction of gluten must be done in small quantities between 4 and 6 months while breastfeeding continues, but often gluten is incorrectly introduced or introduced at the wrong time in dietary diversification (before 3 months or after 7 months). Intestinal infections can also be a trigger. Adenovirus and rotavirus infection impairs the intestinal barrier and increases intestinal permeability, promoting HLA DQ2 gene expression and consequently disease. Finally, the multiplication and dispersion of modern hybridized wheat, richer in gluten, as well as environmental toxins, are also triggering events.

There are two forms of celiac disease, each characterized by specific symptoms:

• Typical form (20% of cases): the diagnosis is quite easy and allows appropriate early treatment. THE symptoms are very characteristic with chronic malabsorption diarrhea, abdominal pain and a break in the growth curve (or weight loss in adults).

• Frustrated or atypical form (80% of cases): their non-specific presentation makes the very complex diagnosis. In fact, the symptoms are uncharacteristic and very varied, leading patients to benefit from a late diagnosis. This results in serious clinical manifestations such as lymphomas (tumors of the lymphatic system), anemia, diabetes, diseases thyroid and autoimmune liver diseases or even irritable bowel syndrome (what to eat in case of irritable bowel syndrome?).

Generally speaking, a excessive gluten consumption is the source of the triggering event and therefore the activation of inflammatory reactions causing chronic diarrhea.

These starchy foods are naturally gluten-free. They are therefore perfect as alternatives to gluten. They can also be used in flour to make any gluten-free culinary preparation (pastries, bread, etc.) as is the case with chickpea flour in India and the Mediterranean basin.

We recommend you :

• to direct you towards the naturally gluten-free starchy foods following: rice, soy, buckwheat, tapioca (cassava), millet, sesame, quinoa, chestnuts, sorghum, yam, potato, corn, polenta, panisses, socca, legumes (peas, lentils), sweet potato, jerusalem artichoke.

• to direct you towards the types of naturally gluten-free bread can be made with the following cereals: buckwheat, rice, quinoa, millet, amaranth, corn and tapioca.

The agri-food industry, with the help of numerous associations such as AFDIAG (Aassociation Ffrench Dare Iintolerant Au Gluten), have allowed celiac patients to regain a semblance of normal life thanks to “gluten-free” dietary products. They are recognizable by a logo “ barred ear of wheat » which is a property of AFDIAG in France. This statement corresponds to a maximum level of residual gluten in the finished product at 20mg/kg, or 2 mg / 100 g of finished product. Foods that carry this label are therefore very well tolerated by celiac patients.

We recommend you :

• to favor foods marked “ gluten free », rather than those with the following information: “May contain…”, “Traces of…”, “Manufactured in a workshop containing…”. These latter are, in fact, to be avoided.

These dairy products are very well tolerated by celiac patients because they are gluten-free.

We recommend you :

• to direct you towards the gluten-free dairy products following: cheeses (cooked, fermented, soft or pressed), cottage cheese, fresh milk, pasteurized, sterilized, UHT, concentrated, powder (whole, skimmed or semi-skimmed), natural Petit Suisse and natural yogurt.

Almost all meats and fish are authorized for those with gluten intolerance. In addition, these foods are rich in protein and help strengthen the immune system. Concerning eggs, they are all authorized for celiac patients.

We recommend you :

• to choose the following meats: natural or candied offal, natural foie gras, pure beef mince, as well as fresh, natural, frozen and canned meats.

• to favor the following fish and seafood products: crustaceans and molluscs (fresh, frozen, natural), fish eggs, as well as fresh, salted, smoked, frozen, raw or canned fish (natural, raw). oil or white wine).

Fruits and vegetables are main source gluten-free foods (except figs dried in flour). Thus, they are to be favored in the daily diet and at each meal. This is also the case for oilseed fruits which are naturally gluten-free.

We recommend you :

• to move towards snacks based on fruits and oilseeds to avoid gluten.

• to bring vegetables to your lunch and dinner meals because they do not contain any trace of gluten.

The term "HOOF" is a mnemonic device for memorizing forbidden cereals (Seagle Avoice Bthe Orge Triticale). Gluten is very present in modern food. Indeed, wheat has undergone numerous changes in recent decades, including hybridizations, as is the case with triticale (rye + wheat). It has also been increasingly enriched with gluten for its interesting properties. The multiplication and dispersion of modern hybridized wheat, richer in gluten, means that the latter is present almost everywhere in our diet, with an average consumption of 15 g per day in France.

We recommend you :

• to completely eliminate these cereals, as well as their derivatives : spelled and einkorn, flour, beer (which contains barley), pastry dough, bread, pasta, ice cream cones, biscuits, wheat germ oil.

These foods contain hidden gluten. In fact, the latter is used as a binder in 70% of industrial products and can be used under the term “ anti-caking agent ».

We recommend you :

• to pay attention to industrial product labels, which contain hidden gluten: cereal margarine, ready meals, beer, yeast, breading, canned "stewed" vegetables, almost all sweets and cakes, cooking broths (in the form of wheat starch, modified starch or traces of gluten).

These cheeses are likely to contain gluten, as are beer-washed cheeses and washed-rind cheeses. Indeed, the presence of beer indicates the presence of gluten in these cheeses. In addition, some yogurts contain gluten, especially those made with cereals. It is also possible that some fruit yogurts contain gluten, in which case you should look at the labels.

We recommend you :

• to look at the labels of all spreadable cheeses : Saint-Môret, Tartare, Boursin, Philadelphia, Kiri. It is possible to consume them if gluten does not appear on the label.

• to look at the labels of all grated cheeses which may contain gluten under the term anti-caking agent.

• to look at the labels of all moldy cheeses such as Bleu d'Auvergne and Roquefort.

• to look at the labels of all beer-washed cheeses or with washed rind: Pavé à la Leffe, Cheddar à la Guinness, Corsica with chestnut beer, Tomme brushed with Savoie beer.

• to look at the labels of all yogurts, and especially those with cereals and fruits.

Some cold meats and some meats (especially marinated) have received an addition of wheat starch in their preparations.

We recommend you :

• of check labels cold cuts and meats in store, and to direct you to butchers if necessary.

• Don’t hesitate to ask your butcher if their products contain gluten. Additionally, ask them to change their gloves in order to avoid any crossing likely to bring gluten to your products.

Some preparations of spices and table salts contain gluten under the term anti-caking agent on their label.

We recommend you :

• of check labels preparations of spices and table salts. If the words “ anti-caking agent » appears in the ingredients, it is best to avoid consuming them.

No, that's not relevant. It must be adapted only to those who need it and therefore those who are gluten intolerant. Indeed, the results of a collaborative study highlighted differences in the nutritional composition between gluten-free products and equivalent foods containing gluten (e.g. gluten-free bread and bread). Indeed, the calorie, macronutrient, salt and cholesterol contents of gluten-free products, saw themselves increased compared to foods that contain gluten.

Therefore, following a gluten-free diet can lead to nutritional imbalance for non-celiac people, and more specifically in fibers. The latter are very present in whole grains containing gluten and are essential for protection against cardiovascular disease and type II diabetes. Indeed, fibers have effects hypocholesterolemic and hypoglycemic and are too little present on the French plate (19 g/day on average instead of the 30 g recommended by ANSES). Removing foods that are sources of fiber such as whole grains is therefore not recommended if you are not gluten intolerant. In addition, the fiber contents of gluten-free products are quite low.

Other studies have shown the impact of the absence of gluten-free foods in the development of pathologies, and in particular type II diabetes. Unlike its counterpart (type I diabetes), type II diabetes is diet-related. Therefore, gluten-free foods tend to have a higher glycemic index (GI) than standard grain products. It is established that a diet rich in high GI is a significant risk factor for developing type II diabetes through hyperinsulinism (increased insulin secretion), then through insulinopenia (deficiency in insulin secretion due to chronic fatigue of the body). pancreas to secrete too much). This hormone plays a key role in bringing carbohydrates into cells.

To conclude, it is much more judicious to move towards a balance of essential nutrients on his plate. Indeed, for example, ensuring a good balance of the omega-3/omega-6 ratio is preferred for cardiovascular health than excluding gluten.

Breakfast :

• Coffee or tea or bowl of UHT milk
• Buttered buckwheat bread toast
• An Apple

Lunch :

• Tomato salad with rapeseed oil
• Smoked salmon fillet
• Basmati rice
• Spinach
• Natural yogurt

Snack :

• A few almonds
• A banana

Dinner :

• Homemade pumpkin soup
• “gluten-free” pasta with fine herbs
• Homemade grated Emmental

• It is possible that a lactose-free diet be carried out in the first phases of the gluten-free diet. Indeed, lactose is a laxative which accelerates intestinal transit, which is not wanted in the context of celiac diarrhea. It will be reintroduced gradually in the “healing” phases, until the diarrhea goes away.

• It's important to take care of your microbiota intestinal to limit dysbiosis (bacterial imbalance) and intestinal permeability favoring intolerance to gluten and other proteins. For this, it is recommended to move towards foods that are sources of prebiotics and probiotics such as natural yogurts, towards foods rich in omega-3 such as rapeseed and hemp oils, but also to manage your stress. Indeed, stress management is essential for a healthy microbiota.